Procedure
Electroconvulsive Therapy
search
Electroconvulsive Therapy
History
First ECT performed in 1938 by Cerletti and Bini
Indications
Medication resistant
Major Depression
Severe
Major Depression
with
Suicidal Ideation
Delusion
al Depression
Acute
Mania
Severe psychiatric illness with food and fluid refusal
Severe adverse medication affects
Neuroleptic Malignant Syndrome
Comorbid Condition
Parkinson's Disease
Pregnancy with severe refractory depression
See
Psychiatric Medications in Pregnancy
Contraindications
Brain Tumor
or other space occupying lesion
Cerebrovascular Accident
within the last month
Indications
Symptoms most responsive to ECT
Guilt
Loss of interest
Agitation
Anxiety
Dysphoria
Helplessness
Worthlessness
Delusion
s
Nihilism
Impoverishment
Sin or guilt
Examination
Pre-procedure evaluation
Complete History and Physical Examination
Focused areas of attention
Cardiopulmonary examination
Neurologic Exam
ination
Musculoskeletal Exam
ination
Labs
Pre-procedure evaluation
Hemoglobin
Hematocrit
Serum
Electrolyte
s
Diagnostics
Pre-procedure evaluation
Electrocardiogram
Technique
Monitoring
Blood Pressure
Oxygen Saturation
Telemetry monitoring of
Heart Rate
and rhythm
Electroencephalogram
Respiratory support
Airway management
Bag Valve Mask Ventilation
Anesthesia
Sedative-Hypnotic
agent:
Methohexital
(
Brevital
)
Paralytic Agent
:
Succinylcholine
Electrical Stimulus
Brief unilateral or bilateral stimulus
Results in 50 second
Generalized Seizure
Course
ECT administered 3 times per week
Total course may last 6-12 treatments
Cost
Each treatment: $1500
Total Course (6-12 treatments): $9,000 to $18,000
Adverse Effects
Hypertension
Cardiac Arrhythmia
Post-ECT Confusion
Memory Loss
Memory Loss
is short-term and reversible
Safety
Pregnancy
Considered safe without increased risk of congenital abnormalities or childhood neurocognitive deficits
Efficacy
High response rate in refractory
Major Depression
Relapse rate after ECT: 50% within one year
Management following ECT (relapse prevention)
Example protocol:
Nortriptyline
and
Lithium
References
Banazak (1996) Am Fam Physician 53(1):273-8 [PubMed]
Sackeim (2001) JAMA 285:1299-307 [PubMed]
Type your search phrase here