Should I be concerned about Electroconvulsive Therapy (ECT) in the context of an intracranial mass or lesion?

Many Electroconvulsive Therapy (ECT) clinicians would think long and hard about this situation, as this as a relative contraindication. There is an increase in intracranial pressure that accompanies the seizure of ECT that could be exacerbated by the presence of an intracranial space-occupying lesion. With regard to other treatments, the prevailing sense at present is that Transcranial Magnetic Stimulation (TMS) does not usually affect intracranial pressure.

See the APA 2001 Task Force on ECT:
https://www.appi.org/Practice_of_Electroconvulsive_Therapy_Second_Edition
The Practice of Electroconvulsive Therapy. Recommendations for Treatment, Training, and Privileging (A Task Force Report of the American Psychiatric Association), Second Edition
ISBN 978-1-58562-787-5

And the ECT Policy for New South Wales:
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2011_003.pdf
High Risk Situations
Intracranial space occupying lesions: Intracranial pressure that has been increased by a space-occupying lesion may be increased further by ECT, possibly leading to coning.

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