- First ECT performed in 1938 by Cerletti and Bini
- Medication resistant Major Depression
- Severe Major Depression with Suicidal Ideation
- Delusional Depression
- Acute Mania
- Catatonia
- Severe psychiatric illness with food and fluid refusal
- Severe adverse medication affects
- Comorbid Condition
- Pregnancy with severe refractory depression
- Brain Tumor or other space occupying lesion
- Cerebrovascular Accident within the last month
- Age <13 years old (approved in U.S. for age >=13 years old)
- Symptoms most responsive to ECT
- Pre-procedure evaluation
- Consider cardiology clearance in known cardiovascular disease
- Complete History and Physical Examination
- Focused areas of attention
- Cardiopulmonary examination
- Neurologic Examination
- Musculoskeletal Examination
- Pre-procedure evaluation
- Hemoglobin
- Hematocrit
- Serum Electrolytes
- Pre-procedure evaluation
- Monitoring
- Blood Pressure
- Oxygen Saturation
- Telemetry monitoring of Heart Rate and rhythm
- Electroencephalogram
- Respiratory support
- Airway management
- Bag Valve Mask Ventilation
- Anesthesia
- Electrical Stimulus
- Brief unilateral or bilateral stimulus
- Results in 50 second Generalized Seizure
- Course
- ECT administered 2 to 3 times per week for 3 to 6 weeks
- Total course may last 6-12 treatments
- Each treatment: $1500
- Total Course (6-12 treatments): $9,000 to $18,000
- Headache
- Fatigue
- Cognitive Impairment (mild, and resolve within 2 to 4 weeks)
- Jaw pain
- Hypertension
- Cardiac Arrhythmia (rare)
- Post-ECT Confusion
-
Memory Loss
- Memory Loss is short-term and reversible
- Pregnancy
- Considered safe without increased risk of congenital abnormalities or childhood neurocognitive deficits
- High response rate (80%) and remission rate (60%) in refractory Major Depression
- Decreases Suicide rates and psychiatric hospitalization rates
- Relapse rate after ECT: 50% within one year
- Example protocol: Nortriptyline and Lithium