Electroconvulsive Therapy

Aka: Electroconvulsive Therapy

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II. History

  1. First ECT performed in 1938 by Cerletti and Bini

III. Indications

  1. Medication resistant Major Depression
  2. Severe Major Depression with Suicidal Ideation
  3. Delusional Depression
  4. Acute Mania
  5. Catatonia
  6. Severe psychiatric illness with food and fluid refusal
  7. Severe adverse medication affects
    1. Neuroleptic Malignant Syndrome
  8. Comorbid Condition
    1. Parkinson's Disease
  9. Pregnancy with severe refractory depression
    1. See Psychiatric Medications in Pregnancy

IV. Contraindications

  1. Brain Tumor or other space occupying lesion
  2. Cerebrovascular Accident within the last month
  3. Age <13 years old (approved in U.S. for age >=13 years old)

V. Indications: Symptoms most responsive to ECT

  1. Guilt
  2. Loss of interest
  3. Agitation
  4. Anxiety
  5. Dysphoria
  6. Helplessness
  7. Worthlessness
  8. Delusions
    1. Nihilism
    2. Impoverishment
    3. Sin or guilt

VI. Examination: Pre-procedure evaluation

  1. Consider cardiology clearance in known cardiovascular disease
  2. Complete History and Physical Examination
  3. Focused areas of attention
    1. Cardiopulmonary examination
    2. Neurologic Examination
    3. Musculoskeletal Examination

VII. Labs: Pre-procedure evaluation

  1. Hemoglobin
  2. Hematocrit
  3. Serum Electrolytes

VIII. Diagnostics: Pre-procedure evaluation

  1. Electrocardiogram

IX. Technique

  1. Monitoring
    1. Blood Pressure
    2. Oxygen Saturation
    3. Telemetry monitoring of Heart Rate and rhythm
    4. Electroencephalogram
  2. Respiratory support
    1. Airway management
    2. Bag Valve Mask Ventilation
  3. Anesthesia
    1. Sedative-Hypnotic agent: Methohexital (Brevital)
    2. Paralytic Agent: Succinylcholine
  4. Electrical Stimulus
    1. Brief unilateral or bilateral stimulus
    2. Results in 50 second Generalized Seizure
  5. Course
    1. ECT administered 2 to 3 times per week for 3 to 6 weeks
    2. Total course may last 6-12 treatments

X. Cost

  1. Each treatment: $1500
  2. Total Course (6-12 treatments): $9,000 to $18,000

XI. Adverse Effects

  1. Headache
  2. Fatigue
  3. Cognitive Impairment (mild, and resolve within 2 to 4 weeks)
  4. Jaw pain
  5. Hypertension
  6. Cardiac Arrhythmia (rare)
  7. Post-ECT Confusion
  8. Memory Loss
    1. Memory Loss is short-term and reversible

XII. Safety

  1. Pregnancy
    1. Considered safe without increased risk of congenital abnormalities or childhood neurocognitive deficits

XIII. Efficacy

  1. High response rate (80%) and remission rate (60%) in refractory Major Depression
  2. Decreases Suicide rates and psychiatric hospitalization rates
  3. Relapse rate after ECT: 50% within one year

XIV. Management following ECT (relapse prevention)

  1. Example protocol: Nortriptyline and Lithium

XV. References

  1. Banazak (1996) Am Fam Physician 53(1):273-8 [PubMed]
  2. Espinoza (2022) N Engl J Med 386(7): 667-72 [PubMed]
  3. Gaddey (2024) Am Fam Physician 109(5): 410-6 [PubMed]
  4. Sackeim (2001) JAMA 285:1299-307 [PubMed]

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Related Studies

Ontology: Electroconvulsive Therapy (C0013806)

Definition (NCI_NCI-GLOSS) A treatment for severe depression and certain mental disorders. A brief seizure is induced by giving electrical stimulation to the brain through electrodes placed on the scalp.
Definition (CSP) used for severe depression resistant to drug treatment; patients are anesthetized and given a muscle relaxant, and a brief pulse of current is passed through the brain, triggering a short seizure, 6-12 times over a 2-4 week period.
Definition (MSH) Electrically induced CONVULSIONS primarily used in the treatment of severe AFFECTIVE DISORDERS and SCHIZOPHRENIA.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D004565
ICD10 1907
SnomedCT 182674004, 171932003, 150913001, 150914007, 23835007
English Convulsive Therapies, Electric, Convulsive Therapy, Electric, ECT (Psychotherapy), Electric Convulsive Therapies, Electric Convulsive Therapy, Electric Shock Therapies, Electroconvulsive Therapies, Electroconvulsive Therapy, Electroshock Therapies, Electroshock Therapy, Shock Therapies, Electric, Shock Therapy, Electric, Therapies, Electric Convulsive, Therapies, Electric Shock, Therapies, Electroconvulsive, Therapies, Electroshock, Therapy, Electric Convulsive, Therapy, Electric Shock, ECT, Electric Shock Therapy, Therapy, Electroconvulsive, Therapy, Electroshock, ECT - Electroconvulsve therapy, Electroconvulsive therapy NOS, ELECTROSHOCK THER, CONVULSIVE THER ELECTRIC, SHOCK THER ELECTRIC, ELECTROCONVULSIVE THER, ECT PSYCHOTHER, ECS, electroplexy shock therapy, ECT (electro-convulsive therapy), electroconvulsive therapy (treatment), electroconvulsive therapy, electroconvulsive shock therapy, ecs, ect, electric shock treatments, ect therapy, electroconvulsive therapy (ECT), est, shock treatment, shocking treatment, Therapy;electroconvulsive, electric shock therapy, electroconvulsive treatments, electroshock treatment, shock treatments, electric convulsive therapy, electric shock treatment, electroconvulsive treatment, Electroconvulsive therapy NOS (procedure), Electroconvulsive ther., Electroconvulsive therapy (regime/therapy), electroshock therapy, ECT therapy, EST therapy, Electroconvulsive therapy, Electroshock therapy, ECT - Electroconvulsive therapy, EST - Electroshock treatment, Electroconvulsive treatment, Electroplexy, Electroshock treatment, Electroconvulsive therapy (procedure), Electroconvulsive therapy, NOS, Electroshock therapy, NOS, ECT (Therapy), Electroconvulsive Shock Therapy, ECS Therapy, EST
Dutch ECT, ECT (elektroconvulsieve therapie), elektroshocktherapie, Convulsieve therapie, elektro-, ECT (psychotherapie), Elektro-convulsieve therapie, Elektroshocktherapie, Shocktherapie, elektro-
French TE, ECT (traitement électro-convulsif), Sismothérapie, Sismothérapie électrique, Électrochocs, ECT (ÉlectroConvulsivoThérapie), Séismothérapie, Électro-convulsivothérapie, Électroconvulsivothérapie
German ECT, ECT (Elektrokonvulsionstherapie), ECT (Psychotherapie), Elektrokrampftherapie, Elektroschocktherapie, Krampftherapie, Elektro-, Schocktherapie, Elektro-
Portuguese TEC (terapia electroconvulsivante), Terapia Eletroconvulsiva, Terapia por Eletrochoque, Terapia electroconvulsivante, ECT (Psicoterapia), Eletrochoqueterapia, Eletroconvulsoterapia, Terapia por Choque Elétrico
Spanish TEC (tratamiento electroconvulsivo), ECT, Terapia de Choque Eléctrico, terapia electroconvulsiva, SAI (procedimiento), terapia electroconvulsiva, SAI, ECT (Psicoterapia), Terapia de Shock Eléctrico, Terapia por Electrochoque, TEC, electrochoque, terapia de choque eléctrico, terapia de electroshock, terapia electroconvulsiva (procedimiento), terapia electroconvulsiva, Terapia electroconvulsiva, TEC (Psicoterapia), Terapia Electroconvulsiva, Terapia por Electroshock
Japanese ＥＣＴ（電撃療法）, ﾃﾞﾝｹﾞｷﾘｮｳﾎｳ, ECTﾃﾞﾝｹﾞｷﾘｮｳﾎｳ, 電気けいれん療法, けいれん療法-電気, 電撃療法, 電気ショック療法, 電気痙攣療法, 電気衝撃療法, ショック療法-電気
Swedish Elbehandling
Czech elektrokonvulzívní terapie, Elektrokonvulzivní terapie, ECT (elektrokonvulzivní terapie), ECT, elektrokonvulzivní terapie
Finnish Sähkösokkihoito
Italian Elettroshock terapia, Terapia di shock elettrico, ECT (Psicoterapia), Terapia elettroconvulsivante
Russian ELEKTROSHOKOVAIA TERAPIIA, EKT (PSIKHOTERAPIIA), SHOKOVAIA TERAPIIA ELEKTRICHESKAIA, ELEKTROSUDOROZHNAIA TERAPIIA, SUDOROZHNAIA TERAPIIA ELEKTRICHESKAIA, ELEKTROKONVUL'SIVNAIA TERAPIIA, СУДОРОЖНАЯ ТЕРАПИЯ ЭЛЕКТРИЧЕСКАЯ, ШОКОВАЯ ТЕРАПИЯ ЭЛЕКТРИЧЕСКАЯ, ЭКТ (ПСИХОТЕРАПИЯ), ЭЛЕКТРОКОНВУЛЬСИВНАЯ ТЕРАПИЯ, ЭЛЕКТРОСУДОРОЖНАЯ ТЕРАПИЯ, ЭЛЕКТРОШОКОВАЯ ТЕРАПИЯ
Croatian ELEKTROKONVULZIVNA TERAPIJA, ELEKTROŠOK TERAPIJA
Polish Terapia elektrowstrząsowa, Elektroterapia drgawkowa, Leczenie elektrowstrząsami
Hungarian Elektrokonvulzív terápia
Norwegian Elektrosjokkterapi, ECT, Elektrosjokkbehandling
Derived from the NIH UMLS (Unified Medical Language System)

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