National overviews of ECT data published by regulatory bodies or governmental agencies on the internet are not so easily accessed, despite such internet sites being hand searched. National government overviews do not usually appear in the databases where systematic literature search of published journal articles and studies is undertaken. Conclusion Today utilization rates, practice, and ECT parameters vary greatly

throughout continents and countries. Unmodified ECT is still in use (Asia, Africa, Latin America, and even in Europe). In spite of existing guidelines, there is no uniform worldwide Inhibitors,research,lifescience,medical practice. Large global variation in ECT utilization, administration, and practice advocates a need for worldwide sharing of Inhibitors,research,lifescience,medical knowledge about ECT, reflection, and learning from

each other’s experiences. Acknowledgments This study has been possible because of research commissioning on the topic “ECT for depression” from the Norwegian Directorate of Health to the Norwegian Knowledge Centre. We thank the Norwegian Knowledge Centre’s research librarian K. T. Hammerstrøm (KTH) for Inhibitors,research,lifescience,medical designing and undertaking the literature search in collaboration with the authors. We also extend our gratitude to M. J. Cooke, Bergen Inhibitors,research,lifescience,medical University Psychiatric Hospital Psychosis Unit, for all her helpful English language correction. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Appendices Appendix A Search strategy Ovid MEDLINE(R) 1950 to November 2010 Week 2 EMBASE 1980 to 2010 Week 45 PsycINFO 1806 to November 2010 Week 3 SveMed+ EBSCO; Cinahl 1 Electroconvulsive Therapy/ Electroconvulsive Therapy/ Electroconvulsive exp Shock/ Explodesökning på Electroconvulsive-Therapy

S7 or S14 2 (electroconvulsive$ or electr$ convulsive$).tw. Inhibitors,research,lifescience,medical (electroconvulsive$ or electr$ convulsive$).tw. (electroconvulsive$ or electr$ convulsive$).tw. (electroconvulsive$ or electr$ convulsive$) S8 or S9 or S10 or S11 or S12 or S13 3 (Selleckchem ABT888 electroshock$ or electr$ shock$).tw. (electroshock$ Cediranib (AZD2171) or electr$ shock$).tw. (electroshock$ or electr$ shock$).tw. (electroshock$ or electr$ shock$) TI ((practice of electroconvulsive*) or (practice of electr* convulsive*) or (practice of electroshock*) or (practice of electr* shock*) or (practice of ect)) or AB ((practice of electroconvulsive*) or (practice of electr* convulsive*) or (practice of electroshock*) or (practice of electr* shock*) or (practice of ect)) 4 ect.tw. ect.tw. ect.tw.