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. 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 (Kirov et al. 2021; Sumia et al. 2021; Nordanskog et al. 2015).

Evidence-based indications for ECT in Finland and Sweden

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. Consequently, the most notable differences between the two countries are not found in the clinical rationale for ECT use, but in the organization, monitoring, quality assurance, and development of ECT.

The use of ECT in Finland and Sweden

Sumia et al. (2021) conducted a survey that studied the use of ECT in Finland in 2013. The survey contains responses from 25 ECT units out of the total of 29 units in Finland representing an 86% response rate. The study shows that in 2013 ECT was available in 20 hospital districts, although the geographical variation was significant and the patients didn’t necessarily have identical access to treatment. A total of 1023 patients received ECT during the year of 2013 in Finland and the number of treatments were approximately 9.7 per patient. The study concludes that the rate of ECT use in Finland (23 per 100 000 inhabitants) was less than in Sweden, where the corresponding level was almost twice as much, 41 per 100 000 inhabitants. (Sumia et al. 2021; Nordanskog et al. 2015.)

One important finding was that 75% of ECT units in Finland reported that they could provide ECT to all the patients that required it. According to the survey, ECT was mainly used to treat severe depression (38,4%), psychotic depression (30,9%) and bipolar disorder with depressive episodes (14,2%). (Sumia et al. 2021.) These findings indicate, that ECT was relatively well recognized in Finland despite the lower national treatment rate compared to Sweden.

National quality registers and monitoring of ECT in Finland and Sweden

One of the biggest differences between Finland and Sweden is the systematic collection of data about ECT. Sweden established a national quality register for ECT, which enables detailed information to be collected on patients, treatment indications, clinical outcomes and adverse effects. The register was expanded from a regional register into a national quality register in 2011. (Nordanskog et al. 2015.)

The national quality register provides Sweden with a robust infrastructure for the systematic monitoring, evaluation, and development of ECT services. In Finland, the absence of a comparable nationwide register makes it more challenging to assess treatment quality, equity of access, and regional variation at a national level. While the clinical indications for ECT are broadly similar in both countries, the systems used to monitor, assure quality, and support service development differ considerably.

From historical comparison to current development

A resent Finnish study about ECT usage (2026) conducted in the Oulu University Hospital by Matias Leppäaho and colleagues shows a significant increase in treatment volumes between 2012 and 2022. The study was published on June 2026, and it shows a steady increase in the demand for ECT in Northern Finland. In 2013 there were 1373 ECT sessions performed on 96 patients, when in 2022 there were a total of 3000 sessions performed on 189 patients. These numbers indicate that the usage rate of ECT in Northern Finland is among the highest in Europe. (Leppäaho et al. 2026.) Therefore, it would be misleading to conclude that Finland generally uses ECT less than Sweden today solely on the basis of the 2013 national comparison.

Another resent European study suggests that ECT use in the Nordic countries remains relatively high compared with Western European countries. Braithwaite et al. (2026) found that all Nordic countries had annual treated patient rates per million population over 200, when in Italy for example the corresponding rate was only 2.7, and other Western countries varied between 30 and 100. These findings suggest that ECT remains underused in some high-income countries. Improved national data collection could help identify regional differences in ECT use and support equitable access to treatment. (Braithwaite et al. 2026.)

Conclusions

Electroconvulsive therapy (ECT) remains an important evidence-based treatment for severe psychiatric disorders in both Finland and Sweden. Although differences have been reported in the volume of ECT use between the two countries, the clinical indications for treatment are largely similar and are based on national guidelines and scientific evidence. The most notable differences appear to be related to the monitoring, quality assurance, and development of ECT services. Sweden’s national quality register provides a strong foundation for the systematic evaluation of ECT treatment, whereas Finland currently lacks a comparable nationwide system. The considerable variation in ECT practices across Europe further highlights the importance of high-quality monitoring, research, and equitable access to evidence-based treatment in the future.

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Authors

Outi Päiveröinen, Master’s Degree Student, Master’s Degree Programme in Development of Mental Health and Substance Abuse Service, Master School, Savonia UAS

Teija Korhonen, Principal lecturer, Master School, Savonia UAS

This article was prepared with the help of AI.

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References

Braithwaite, R., Amad, A., Cattaneo, C. I., Di Pauli, J., Finnegan, M., Frias, P., Gonçalves-Pinho, M., Grözinger, M., Järventausta, K., Jørgensen, A., Karttunen, S., Kessler, U., Nordanskog, P., Obbels, J., Oliveira-Maia, A. J., Rhebergen, D., Sienaert, P., Tas, F. Q., Wilhelmy, S., & Kirov, G. (2026). Use of electroconvulsive therapy in Nordic and western European countries. European Psychiatry, 1–50. Luettavissa: https://doi.org/10.1192/j.eurpsy.2026.12238 Viitattu 10.9.2026.

Depressio: Käypä hoito -suositus. Suomalaisen lääkäriseuran Duodecimin ja Suomen psykiatriyhdistys ry:n asettama työryhmä. Helsinki: Suomalainen lääkäriseura Duodecim. 2026. (Viitattu 4.9.2026.)

Kirov G, Jauhar S, Sienaert P, Kellner CH, McLoughlin DM. Electroconvulsive therapy for depression: 80 years of progress. The British Journal of Psychiatry. 2021;219(5):594-597. doi:10.1192/bjp.2021.37

Kritzer MD, Peterchev AV, Camprodon JA. Electroconvulsive Therapy: Mechanisms of Action, Clinical Considerations, and Future Directions. Harv Rev Psychiatry. 2023 May-Jun 01;31(3):101-113. doi: 10.1097/HRP.0000000000000365. PMID: 37171471; PMCID: PMC10198476.

Leppäaho M, Karttunen S, Haapea M, Myllynen AS, Hakko H, Jääskeläinen E. Change in the Use of Electroconvulsive Therapy Between 2012 and 2022 in Northern Finland. J ECT. 2026 Jun 3. doi: 10.1097/YCT.0000000000001275. Epub ahead of print. PMID: 42240533.

Nationella vård- och insatsprogram: Elektrokonvulsiv behandling vid svår depression hos vuxna. 21.7.2025. Luettavissa: https://www.vardochinsats.se/depression-och-aangestsyndrom/behandling-och-stoed/elektrokonvulsiv-behandling-vid-svaar-depression-hos-vuxna/ Viitattu 4.9.2026.)

Nordanskog P, Hultén M, Landén M, Lundberg J, von Knorring L, Nordenskjöld A. Electroconvulsive Therapy in Sweden 2013: Data From the National Quality Register for ECT. J ECT. 2015 Dec;31(4):263-7. doi: 10.1097/YCT.0000000000000243. PMID: 25973769; PMCID: PMC4652632.

Parent A. Giovanni Aldini: from animal electricity to human brain stimulation. Can J Neurol Sci. 2004 Nov;31(4):576-84. doi: 10.1017/s0317167100003851. PMID: 15595271.

Suleman, R. 2020. A brief history of electroconvulsive therapy. American Journal of Psychiatry Resident`s Journal. Vol 16, number 1. Luettavissa https://psychiatryonline.org/doi/10.1176/appi.ajp-rj.2020.160103 Viitattu 4.9.2026.

Sumia P, Seppälä N, Ritschkoff J, Tammentie-Sarèn T, Leinonen E, Järventausta K. A Survey of Electroconvulsive Therapy in Finland. J ECT. 2021 Mar 1;37(1):36-39. doi: 10.1097/YCT.0000000000000709. PMID: 32658056.