Electroconvulsive therapy

Question 1

What are the NICE guidelines indications for ECT?

Answer 1

It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with:

Catatonia

Prolonged or severe manic episode - not used in bipolar if not in manic episode as can precipitate one.

Severe depression that is life-threatening

Also used in pregnancy when drugs are potentially dangerous to foetus.

Question 2

How is long is a course of ECT?

Answer 2

Administered 2-3 times per week. Most patients need between 4 and 12 treatments.

Question 3

How is ECT administered?

Answer 3

Administer short acting induction anaesthetic and muscle relaxant which ensures about 5 minutes of general anaesthesia.
Psychiatrist applies two electrodes to patient’s scalp in bilateral or unilateral placement, and delivers electric current of sufficient charge to effect a generalised seizure of at least 15 seconds in duration.

Patients will usually also be on anti-depressants and must stay on these for an extended period post treatment in order to avoid discontinuation symptoms.

Question 4

What are the possible side effects of ECT?

Answer 4

Loss of memory (retrograde amnesia) is a common complaint.

Post-ictal headache, confusion, nausea and muscle pain.

Cardiac arrhythmia

Question 5

What is the difference between unilateral and bilateral ECT?

Answer 5

Unilateral ECT only involves the non-dominant hemisphere. It is far less effective but can reduce the retrograde amnesia associated with ECT.

Question 6

What are the proposed mechanisms of action of ECT?

Answer 6

Increase levels of neurotransmitter
Increase levels of blood flow to the brain
Increase in neurogenesis

Question 7

What psychiatric drugs increase seizure threshold meaning that a dose of ECT may need to be higher?

Answer 7

Benzodiazepines

Question 8

What psychiatric drugs decrease seizure threshold meaning that a dose of ECT may need to be lower?

Answer 8

Antidepressants and antipsychotics

Question 9

What are the contraindications to ECT?

Answer 9

There are no absolute contraindications to ECT. Relative contraindications include:

Heart disease
Raised intracranial pressure
Risk of cerebral bleeding (hypertension, recent stroke)
Poor anaesthetic risk

Question 10

What are the NICE guidelines indications for ECT?

Answer 10

It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with:

Catatonia

Prolonged or severe manic episode

Severe depression that is life-threatening

Question 11

Which one of the following is least recognised as a potential adverse effect of electroconvulsive therapy?

Nausea

Epilepsy

Cardiac arrhythmias

Short term memory impairment

Headache

Answer 11

Epilepsy

Although electroconvulsive therapy, by definition, causes a controlled seizure there is no increased risk of epilepsy in the long-term.