ECT

Question 1

What are indications for ECT

Answer 1

Most conditions except anxiety/ dementia - MDD, BPAD, Schizophrenia – catatonia, positive symptoms, affective
symptoms, OCD, Delirium

• High risk where quick relief needed (suicidal, not eating or
  drinking)
• Where medications have not worked
• Previous good response to ECT

Question 2

What is the moa of ECT

Answer 2

Increase chemicals that are low in depression (dopamine, noradrenaline, serotonin) + increase in global cerebral blood flow and cerebral metabolic rate

Question 3

What are the investigations must be done before ECT

Answer 3

o Assess – dentition, fundoscopy
o Neuro, cardio and resp exams
o MMSE and ACE-R
o Bloods – FBC, U&Es
o ECG, CXR, CT/MRI head
o Anaesthetic review and consent
o Review meds (effect on seizure threshold and possible prolongation of
seizures)

Question 4

How many sessions of ECT, what are they like

Answer 4

o 6-12 session
o Can be spaced as near or far as needed
o 2 more sessions once patient reaches plateau
o Patient under general anaesthetic - Muscle relaxants
(suxamethonium) and short acting anaesthetic (propofol)
o Monitored for 4 hours post-op (MMSE, orientation, obs)

On the day:
o NBM + IV line + Airway + mouth guard
o Induce seizures (15-25s) + Monitoring EEG (20-30s waves)

Question 5

What are the side effects of ECT

Answer 5

o Drowsiness
o Headache
o Muscle ache
o Nausea
o Memory impairment (anterograde or retrograde) – will
return after 6-7 months
o Manic switch
o Arrhythmias and HTN
o Orthopaedic injuries
o Prolonged seizures (>3 mins)
o Prolonged apnoea (>5 mins)
o Risks associated with anaesthesia

Question 6

What are contraindications for ECT

Answer 6

Phaeochromocytoma, Raised ICP,
Recent stroke (<4 weeks),
Cerebral tumour,
CVD and arrhythmias, Severe acute glaucoma