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Electroconvulsive Therapy
Aka: Electroconvulsive Therapy
- History
- First ECT performed in 1938 by Cerletti and Bini
- Indications
- Medication resistant Major Depression
- Severe Major Depression with Suicidal Ideation
- Delusional Depression
- Acute Mania
- Severe psychiatric illness with food and fluid refusal
- Severe adverse medication affects
- Neuroleptic Malignant Syndrome
- Comorbid Condition
- Parkinson's Disease
- Pregnancy
- 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
- Delusions
- Nihilism
- Impoverishment
- Sin or guilt
- Examination: Pre-procedure evaluation
- Complete History and Physical Examination
- Focused areas of attention
- Cardiopulmonary examination
- Neurologic Examination
- Musculoskeletal Examination
- Labs: Pre-procedure evaluation
- Hemoglobin
- Hematocrit
- Serum Electrolytes
- 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
- 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]