# Electroconvulsive therapy in Finland and Sweden: similar clinical practice, different approaches to monitoring and development

> ECT remains an important evidence-based treatment for severe psychiatric disorders in both Finland and Sweden.

## Overview
Finland and Sweden provide a unique opportunity to compare electroconvulsive therapy (ECT) practices in two neighboring countries with highly similar healthcare systems and extensive use of ECT for severe psychiatric disorders. While clinical indications and treatment practices are largely comparable, the countries differ in how ECT services are organized, monitored, and developed. These differences offer valuable insights into alternative approaches to quality assurance and service development in ECT.

## Clinical Indications and Practice
In both Finland and Sweden, the use of ECT is guided by scientific evidence and national clinical recommendations. The indications for treatment are broadly comparable, particularly regarding severe and psychotic depression and situations requiring rapid symptom relief. ECT remains one of the oldest biological treatments in modern psychiatry and continues to play an important role in the treatment of severe and psychotic depression.

## ECT Usage in Finland
A 2013 survey by Sumia et al. (2021) analyzed ECT use across 25 of Finland's 29 ECT units. Key findings included:
* ECT was available in 20 hospital districts, though geographical variation was significant.
* A total of 1,023 patients received ECT in 2013, with an average of 9.7 treatments per patient.
* The national rate of ECT use was 23 per 100,000 inhabitants.
* 75% of units reported they could provide ECT to all patients requiring it.
* Primary indications were severe depression (38.4%), psychotic depression (30.9%), and bipolar disorder with depressive episodes (14.2%).

## Monitoring and Quality Assurance
One of the biggest differences between Finland and Sweden is the systematic collection of data. Sweden established a national quality register for ECT in 2011, which enables detailed tracking of patients, treatment indications, clinical outcomes, and adverse effects. This provides a robust infrastructure for monitoring and service development. In contrast, the absence of a comparable nationwide register in Finland makes it more challenging to assess treatment quality, equity of access, and regional variation at a national level.

## Recent Trends and European Context
A 2026 study by Leppäaho et al. conducted at Oulu University Hospital indicates a significant increase in treatment volumes in Northern Finland between 2012 and 2022:
* **2013:** 1,373 sessions performed on 96 patients.
* **2022:** 3,000 sessions performed on 189 patients.

These figures suggest that the usage rate in Northern Finland is among the highest in Europe, indicating that earlier national comparisons may not reflect current usage levels. Furthermore, a 2026 study by Braithwaite et al. found that all Nordic countries maintain relatively high annual treated patient rates (over 200 per million population) compared to other Western European countries, where rates vary between 30 and 100.

## Conclusion
While clinical indications for ECT are similar in Finland and Sweden, the primary divergence lies in the organization and monitoring of services. Sweden’s national quality register serves as a model for systematic evaluation, whereas Finland lacks a similar nationwide system. Improved data collection across Europe could help identify regional disparities and support more equitable access to evidence-based psychiatric care.

## References
* Braithwaite, R., et al. (2026). Use of electroconvulsive therapy in Nordic and western European countries. *European Psychiatry*.
* Depressio: Käypä hoito -suositus. (2026). Suomalaisen lääkäriseuran Duodecim.
* Kirov G, et al. (2021). Electroconvulsive therapy for depression: 80 years of progress. *The British Journal of Psychiatry*.
* Kritzer MD, et al. (2023). Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions. *Harv Rev Psychiatry*.
* Leppäaho M, et al. (2026). Change in the Use of Electroconvulsive Therapy Between 2012 and 2022 in Northern Finland. *J ECT*.
* Nationella vård- och insatsprogram: Elektrokonvulsiv behandling vid svår depression hos vuxna. (2025).
* Nordanskog P, et al. (2015). Electroconvulsive Therapy in Sweden 2013: Data From the National Quality Register for ECT. *J ECT*.
* Parent A. (2004). Giovanni Aldini: from animal electricity to human brain stimulation. *Can J Neurol Sci*.
* Suleman, R. (2020). A brief history of electroconvulsive therapy. *American Journal of Psychiatry Resident`s Journal*.
* Sumia P, et al. (2021). A Survey of Electroconvulsive Therapy in Finland. *J ECT*.