Question | Answer |
ECT is | electroconvulsive therapy |
ECT does this | elicits a grand mal seizure |
usual course of ECT | 6-12 treatments |
ECT is considered | as a late option for resistant illness - per Dr. Nickell, good option none the less. Many insurances will not pay until failure of a medication from each class occurs. |
3 theories on the mechanism of action of ECT | NT Theory
Neuroendocrine Theory
Anticonvulsant Theory |
NT Theory states | ECT acts like TCA, increasing DA, 5HT and adrenergic NT |
Neuroendorcrine Theory states | ECT releases hypothalamic and pituitary hormones, prolactin, TSH, ACTH and endorphins |
ACTH is | adrenocorticotropic hormone |
Anticonvulsant Theory states | ECT exerts anticonvulsant effect on brain leading to an antidepressant effect |
situations where ECT may be used | need for rapid response due to severe psychiatric or medical conditions
risks of other tx outweigh risks of ECT
hx of poor med response
hx of good ECT response
pt preference |
Insurance wants this | ECT as last resort |
Contraindications to ECT | pre-existing cardiac illness - must be assessed
compromised pulmonary status - must be assessed
hx of CNS problems
medical complications after anesthesia |
Adverse effects of ECT | CV effects
Systemic Effects
Cognitive Effects |
Systemic Effects include | HA, anorexia, muscle aches, drowsiness, nausea |
Cognitive Effects include | memory disturbance, confusion |
Placement of ECT electrodes (3 areas) | Right Unilateral
Bifrontal
Bitemporal |
When not to use Right Unilateral Initially | When patient is Left Handed (85% of people are right brain dominant). Treatment over the dominant side can make pts delirius. |
Right unilateral and bifrontal provide patients with: | Good Response and Low Side Effects |