ECT

Question 1

What is ECT?

Answer 1

The passage of a small electrical current through the brain with a view to inducing a generalised fit which is therapeutic

Question 2

What are the indications for ECT?

Answer 2

Depression- severe, suicidal, life threatening or moderate/ severe resistant
Uncontrolled mania
Catatonia

Question 3

Is bilateral or unilateral ECT more effective?

Answer 3

Bilateral

Question 4

Are cognitive side effects more severe with bilateral or unilateral ECT?

Answer 4

Bilateral

Question 5

What is the dose for bilateral ECT?

Answer 5

ST*1.5

Question 6

What is the dose for unilateral ECT?

Answer 6

ST*6

Question 7

What physiological changes are seen during ECT?

Answer 7

First pulse slows then rises sharply : 130-190/min
Falls to resting rate around end of seizure then less marked tachycardia for a few minutes
BP rises up to 200mmHg systolic
Cerebral blood flow increases by up to 200%

Question 8

What are the possible side effects of ECT?

Answer 8

Nausea and vomiting 
Headache
Muscle aches 
Cognitive effects - immediate confusion, retrograde and anterograde amnesia 
Prolonged seizures
Anaesthesia risks

Question 9

What are some relative contraindications for ECT?

Answer 9

Raised intracranial pressure 
Aneurysms 
MI in last 3 months 
Risk of embolism - recent stroke, DVT 
Uncontrolled BP/HR
Acute glaucoma

Question 10

Is ECT contraindicated in pregnancy?

Answer 10

No

Question 11

What monitoring is done during ECT?

Answer 11

EEG
O2 saturations
BP
HR

Question 12

Should antidepressants be stopped when commencing ECT?

Answer 12

No but safely reduce them to minimum dose