ECT

Question 1

What are the indications for ECT?

Answer 1

Treatment-resistant depression
Life-threatening severe depression
Treatment-resistant mania
Catatonia
4-12 sessions, twice a week

Question 2

How does ECT work?

Answer 2

Modulation of neurotransmitter functioning
Changes in regional blood/activity
Modulation of neuronal connectivity
Alterations of neuronal structures, including hippocampal neurogenesis

Question 3

What are contraindications for ECT?

Answer 3

Absolute:
Cochlear implant
Relative:
Raised intracranial pressure
Intracranial aneurysm
History of cerebral haemorrhage
Recent myocardial infarction (less than 3 months)
Aortic aneurysm
Uncontrolled cardiac arrhythmias
Decompensated cardiac failure (ECHO may be helpful)
Acute respiratory infection
Deep vein thrombosis

Question 4

What are the side effects of ECT?

Answer 4

Headache
Confusion
Nausea
Impaired cognitive function
Temporary retrograde and anterograde amnesia
Long term:
Component of retrograde memories before ECT, esp autobiographical memories

Question 5

What are the options for electrode placement?

Answer 5

Bilateral and unilateral
Bilateral placement is probably more effective but may give rise to more cognitive side-effects
Unilateral placement does give less cognitive side-effects but is also probably less effective.

Question 6

What is the process of ECT?

Answer 6

Carried out under GA- short acting with a muscle relaxant
Electrodes are placed either bilaterally or unilaterally
Electrode placed 4cm above the midpoint of the lateral angle of the eye and the external auditory meatus
First session a dose titration is carried out to establish seizure threshold (generalised of at least 15 seconds)
Doses are increased until a full response is seen