ECT (electroconvulsive therapy)

Mechanism is unknown, but it does not damage the brain, and there is evidence of brain growth after procedure.

Dosing

1 hour sessions 3 days a week for 3-4 weeks. Cannot drive on day of treatment.

Usually covered by insurance.

Management

Ideal for severe psychotic depression (remission rates > 90% there). Surprisingly, ECT is better tolerated and more effective in very old patients (> age 85).

In TRD, ECT is more effective than TMS, but not as well tolerated, and some patients may respond better to one or the other.

TOLERABILITY: Headache, muscle aches, and brief confusion after treatment as anesthesia wears off.

MEMORY: Patients won’t remember the weeks during which they had the ECT in the future, and in rare cases may have memory problems for past events. However, on the whole cognition improves after ECT (due to treatment of depression). They do not forget improtant things like how to do their job or relative’s names. Consider ginkgo to prevent cognitive side effects.

RISKS: cardiovascular, can raise blood pressure and cause arrhythmias. The anesthesia carries similar risks to a dental anesthesia.

PREVENTION: After successful the best prevention is lithium (either alone in bipolar or with nortriptyline or venlafaxine in unipolar). Or can use monthly maintenance ECT.

EMR Text