Additional Treatment Options for Depression

Question 1

Indications for ECPT

Answer 1

• unipolar depression (not associated with mania).
• PPP (post partum psychosis),
• catatonia but treat not effective,
• depression, severse regressed behavs in depression,
• severe suicidal.

ECT can relieve unbearable depression. ”It really shakes things uo”

Question 2

Contraindications for ECT

Answer 2

no abolute contrasidications
* Intercranial pressure are at greater risk.
* Recent myocardial infarction
* Retinal detachment
* High risk ansetetic complications are things to assess for and monitor.

ECT should not be used without the pateitns consent., Ex. If theyre on form 9 they shouldn’t use it.

Best used treatment for depression in pregnanacy since so many meds are sketchy with the placeta

Question 3

ECT Adverse Reactions

Answer 3

achy, fatigue ,nausea, right after session. memory loss right before a session. Rare: can’t remember weeks and months

Question 4

ECT Bilateral or Unilateral Placement

Answer 4

unilateral chosen initially cause it has less memory loss and confusion. Blilateral is more effective but more side effects. Usally 6-12 treatmetns. Start the voltage low and go slow.

Question 5

Prior to ECT

Answer 5

• Informed consent & education
• Pre-ECT medical work up related to anesthesia administration and health conditions
• Often complete a Montreal Cognitive Assessment (MoCA) as a baseline measure to monitor for potential memory loss
• NPO after midnight before treatment
• No benzo’s evening prior to ECT (Benzo’s raise the seizure threshold and the whole point of ECT is to get a seizure)
• MAOIs should be stopped 2 weeks prior to ETC, theyre contraindicared
  anticonvulsants are also stopped
• Indicares what the alternatives are or what were tried
• Talk about the side effects

Question 6

Morning of ECT

Answer 6

• Void
• Vital signs
• Remove dentures, nail polish, & jewelry
• Dress in hospital gown
• Administer anticholinergics 30-60 minutes prior to ECT treatment (arropine, to decrease the oral secretions)

Question 7

ECT Procedure

Answer 7

• Generally in an OR suite or recovery room
• Individual monitored for vital signs, ECG, & EEG
• IV succinylcholine (muscle relaxant) then anesthetic
  – administered by anesthesiologist
• Gel & electrodes
• Mouth guard & 02 mask
  We wait for the muscke relexant to reach the l,imbs, * Looks like a slight “waving” of the wings
• Propoal, ketamine, thyokental is the most common ansestesia
• Seizures were aiming for is 25seconds. Under 25 seconds is semi-therapeutic.
• We want to go through the whole ohase of tonic to clonic

Question 8

ECT Recovery

Answer 8

• Placed in recovery position
• Vitals sign monitored
• 1-1 stand-by observation by recovery nurse
• Oxygen removed once sign of gagging noted
• Nurse checks for any injury to mouth
• Orient individual several times as they wake up
• Tylenol PRN for headache
• Common is mem loss around procedure. Can’t remember before the procedure or firectly after it.

Question 9

Vagus Nerve Stimulation

Answer 9

• Low frequency electric stimulation of the vagus nerve
• A device is implanted surgically
• Thin wires wrap around the vagus nerve
• Pulses are delivered for 30 sec q 5 min – 24 hours a day
• Orignally used for epilepsy but now its being used for people with severe depression,.
• Parasympathetic effect
• Changes in levels of 5ht, EPN, glutamate,
• Indivation: severe depression where multiple other things have been tried

Question 10

Repetitive transcranial magnetic stimulation (rTMS)

Answer 10

• Used to treat mild to moderate depression
• Completed as an outpatient
• Short magnetic impulses to stimulate nerve cells
• No medication or anesthesia
• No cognitive side effects.

Question 11

A client is scheduled for ECT in the morning. Which of the following HS medication should be held the evening prior to ECT?
Olanzapine
Temazepam
Amitriptyline
Sertraline

Answer 11

Temazepam since it’s a benzo