• Commonly called shock treatment, electroconvulsive therapy (ECT) has received bad press since it was introduced in the 1930s.
  • Over the years it has been refined, however, and may now even be safer than lithium
  • In a review of studies, about 80% of ECT-treated patients experienced improvement, and for some, it is the only treatment that works.
It may be particularly beneficial for the following patients:
  • Patients who need immediate stabilization of their condition and who cannot wait for medications to be become effective.
  • Most patients with mania. (It may be particularly important for elderly patients with severe mania.)
  • Patients who suffer suicidal thoughts and guilt during the depressive phase.
  • Patients who simply prefer ECT.
  • Pregnant patients.
  • Patients who cannot tolerate drug treatments.
  • Patients with certain types of heart problems.
  • Young patients.
The Procedure:
  • Hospitalization is not necessary for the treatment. In general, ECT proceeds as follows:
  • A muscle relaxant and short-acting anesthetic are administered.
  • A small amount of electric current is sent to the brain, causing a generalized seizure that lasts for about 40 seconds.
  • The response to ECT is usually very fast, and the patient often needs less medication afterward.
  • ECT operates a modulation of serum Brain derived neurotrophic factor levels in drug resistant depressed patients. 
Side effects of ECT may include :
  • Temporary confusion, 
  • Memory lapses, 
  • Headache, 
  • Nausea, 
  • Muscle soreness, and heart disturbances. 
  • Administration of the drug naloxone immediately before ECT may help reduce its effects on concentration and some (but not all) forms of memory impairment. 
  • Concerns about permanent memory loss appear to be unfounded. 
CONTRAINDICATIONS:There are no absolute contraindications to the use of electroconvulsive therapy (ECT), but some conditions are relative contraindications, they are:
  • Space-occupying intracerebral lesions (except for small, slow growing tumors without edema or other mass effect)
  • Conditions with increased intracranial pressure
  • Unstable vascular aneurysms or malformations
  • Intracerebral hemorrhage
  • Pheochromocytoma
  • Recent myocardial infarction
Exam Question
  • ECT operates a modulation of serum Brain derived neurotrophic factor levels in drug resistant depressed patients.
  • There is no absolute contraindication for ECT
  • Mainly used for the treatment of major depressive disorder
  • Pheochromocytoma is a relative contraindication

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