electroconvulsive therapy (ECT)

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Introduction

A low-voltage alternating current is sent to the brain to induce a convulsion or seizure, which accounts for the therapeutic effect.

Biochemistry

Indications

* improves depression/functioning, interpersonal relationships, psychosis, & emotional lability in adolescent & young adult patients with major depression, bipolar disorder, & primary psychotic disorders [13]

# ECT appears to be no better than other treatments at reducing short-term risk for suicide in high-risk patients[14]

Contraindications

Benefit/risk

Procedure

Complications

Management

More general terms

Additional terms

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 715-716
  3. Kelly & Zisselman, J Am Geriatrics Soc 48:560, 2000
  4. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  5. 5.0 5.1 5.2 5.3 5.4 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010
  6. 6.0 6.1 Mehta V et al, Safety of Electroconvulsive Therapy in Patients Receiving Long-term Warfarin Therapy, Mayo Clin Proc 79(11): 1396, 2004
  7. 7.0 7.1 Kellner CH et al, Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: A multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry 2006, 63:1337 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17146008
  8. van der Wurff FB, Stek ML, Hoogendijk WJ, Beekman AT The efficacy and safety of ECT in depressed older adults: a literature review. Int J Geriatr Psychiatry. 2003 Oct;18(10):894-904. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14533122
  9. 9.0 9.1 9.2 Schoeyen HK et al. Treatment-resistant bipolar depression: A randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment. Am J Psychiatry 2014 Sep 15 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25219389 <Internet> http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.2014.13111517
  10. 10.0 10.1 Yager J NEJM Journal Watch. July 20, 2016 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
    Kellner CH et al. Right unilateral ultrabrief pulse ECT in geriatric depression: Phase 1 of the PRIDE study. Am J Psychiatry 2016 Jul 15; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27418379
    Kellner CH et al. A novel strategy for continuation ECT in geriatric depression: Phase 2 of the PRIDE study. Am J Psychiatry 2016 Jul 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27418381
  11. Obbels J, Verwijk E, Vansteelandt K et al. Long-term neurocognitive functioning after electroconvulsive therapy in patients with late-life depression. Acta Psychiatr Scand 2018 Jul 12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30003550 https://onlinelibrary.wiley.com/doi/abs/10.1111/acps.12942https://onlinelibrary.wiley.com/doi/abs/10.1111/acps.12942
  12. Weiss A, Hussain S, Ng B, Sarma S, Tiller J, Waite S, Loo C. Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy. Aust N Z J Psychiatry 2019 Apr 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30966782 https://journals.sagepub.com/doi/10.1177/0004867419839139
  13. 13.0 13.1 Benson N, Seiner S, Bolton P et al. Acute phase treatment outcomes of electroconvulsive therapy in adolescents and young adults. J ECT 2019 Sep; 35:178-183. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30562200 https://insights.ovid.com/crossref?an=00124509-201909000-00011
  14. 14.0 14.1 Peltzman T, Shiner B, Watts B et al. Effects of electroconvulsive therapy on short-term suicide mortality in a risk-matched patient population. J ECT 2020 Mar 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32205732 https://journals.lww.com/ectjournal/Abstract/publishahead/Effects_of_Electroconvulsive_Therapy_on_Short_Term.99067.aspx
  15. Espinoza RT, Kellner CH Electroconvulsive Therapy. N Engl J Med 2022; 386:667-672. Feb 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35172057 https://www.nejm.org/doi/full/10.1056/NEJMra2034954