II. History
- First ECT performed in 1938 by Cerletti and Bini
III. Indications
- Medication resistant Major Depression
- Severe Major Depression with Suicidal Ideation
- Delusional Depression
- Acute Mania
- Severe psychiatric illness with food and fluid refusal
- Severe adverse medication affects
- Comorbid Condition
- Pregnancy with severe refractory depression
IV. Contraindications
- Brain Tumor or other space occupying lesion
- Cerebrovascular Accident within the last month
V. Indications: Symptoms most responsive to ECT
VI. Examination: Pre-procedure evaluation
- Complete History and Physical Examination
- Focused areas of attention
- Cardiopulmonary examination
- Neurologic Examination
- Musculoskeletal Examination
VII. Labs: Pre-procedure evaluation
- Hemoglobin
- Hematocrit
- Serum Electrolytes
VIII. Diagnostics: Pre-procedure evaluation
IX. Technique
- Monitoring
- Blood Pressure
- Oxygen Saturation
- Telemetry monitoring of Heart Rate and rhythm
- Electroencephalogram
- Respiratory support
- Airway management
- Bag Valve Mask Ventilation
- Anesthesia
- Electrical Stimulus
- Brief unilateral or bilateral stimulus
- Results in 50 second Generalized Seizure
- Course
- ECT administered 3 times per week
- Total course may last 6-12 treatments
X. Cost
- Each treatment: $1500
- Total Course (6-12 treatments): $9,000 to $18,000
XI. Adverse Effects
- Hypertension
- Cardiac Arrhythmia
- Post-ECT Confusion
-
Memory Loss
- Memory Loss is short-term and reversible
XII. Safety
- Pregnancy
- Considered safe without increased risk of congenital abnormalities or childhood neurocognitive deficits
XIII. Efficacy
- High response rate in refractory Major Depression
- Relapse rate after ECT: 50% within one year
XIV. Management following ECT (relapse prevention)
- Example protocol: Nortriptyline and Lithium