Electroconvulsive therapy (ECT) has been shown to be effective in improving depressive symptoms in the majority of patients and more effective than antidepressant medications in treating the psychotic subtype of depression. Primary indications for ECT among patients with depression are lack of a response to or intolerance of antidepressant medications, previous response to ECT, and the need for a rapid and definitive response (e.g., because of psychosis or a risk of suicide). ECT can be used in both unipolar and bipolar disorders as well as in the elderly and pregnant populations. The following questions will need to be answered in order to properly understand ECT and its role in treatment.

References

Where does ECT play a role in treatment mental illness?

  1. Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med. 2007;357(19):1939-45. DOI: 10.1056/NEJMct075234. PubMed PMID: 17989386.
  2. Goodman WK. Electroconvulsive therapy in the spotlight. N Engl J Med. 2011;364(19):1785-7. DOI: 10.1056/NEJMp1101096. PubMed PMID: 21561344.
  3. Zolezzi, M. Medication management during electroconvulsant therapy. Neuropsychiatr Dis Treat. 2016;12:931-9. [PubMed]
  4. Tess AV, Smetana GW. Medical evaluation of patients undergoing electroconvulsive therapy. N Engl J Med. 2009;360(14):1437-44. DOI: 10.1056/NEJMra0707755. PubMed PMID: 19339723.

What do current psychiatric guidelines recommend?

  1. American Psychiatric Association committee on electroconvulsive therapy.  The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging. 2nd ed. Washington, DC: American Psychiatric Association; 2001.[Weblink]

What recommendations are available for ECT use in pregnancy?

  1. Ward HB, Fromson JA, Cooper JJ, De Oliveira G, Almeida M. Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol. Arch Womens Ment Health. 2018;[Epub ahead of print]. [PubMed]

What role does anesthesia play in ECT?

  1. Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analgesia. 2002;94(5):1351-64. DOI: 10.1097/00000539-200205000-00057. PubMed PMID: 11973219.
  2. Folk JW, Kellner CH, Beale MD, Conroy JM, Duc TA. Anesthesia for electroconvulsive therapy: a review. J Ect. 2000;16(2):157-70. DOI: 10.1097/00124509-200006000-00007. PubMed PMID: 10868325.

How should anesthetics be chosen?

  1. Wagner KJ, Möllenberg O, Rentrop M, Werner C, Kochs EF. Guide to anaesthetic selection for electroconvulsive therapy. CNS Drugs. 2005;19(9):745-58. DOI: 10.2165/00023210-200519090-00002. PubMed PMID: 16142990.

What are significant drug-drug interactions with ECT and how should they be managed?

  1. Mehta V, Mueller PS, Gonzalez-Arriaza HL, Pankratz VS, Rummans TA. Safety of electroconvulsive therapy in patients receiving long-term warfarin therapy. Mayo Clin Proc. 2004;79(11):1396-401. DOI: 10.4065/79.11.1396. PubMed PMID: 15544018.
  2. Naguib M, Koorn R. Interactions between psychotropics, anaesthetics and electroconvulsive therapy: implications for drug choice and patient management. CNS Drugs. 2002;16(4):229-47. DOI: 10.2165/00023210-200216040-00003. PubMed PMID: 11945107.
  3. Small JG, Milstein V. Lithium interactions: Lithium and electroconvulsive therapy. J Clin Psychopharmacol 1990;10(5):346-50. [PubMed]
  4. Zolezzi, M. Medication management during electroconvulsant therapy. Neuropsychiatr Dis Treat. 2016;12:931-9. [PubMed]

How do psychotropic medications effect seizure threshold and how will it affect ECT?

  1. Pisani F, Oteri G, Costa C, Di Raimondo G, Di Perri R. Effects of Psychotropic Drugs on Seizure Threshold. Drug Saf. 2002;25(2):91- 110. DOI: 10.2165/00002018-200225020-00004.
  2. Tang VM, Pasricha AN, Blumberger DM, Voineskos D, Pasricha S, Mulsant BH, et al. Should Benzodiazepines and Anticonvulsants Be Used During Electroconvulsive Therapy?: A Case Study and Literature Review. J Ect. 2017;33(4):237-242. DOI: 10.1097/YCT.0000000000000441. PubMed PMID: 28767528.

What are suggested augmentation strategies with ECT?

  1. Loo C, Simpson B, MacPherson R. Augmentation strategies in electroconvulsive therapy. J Ect. 2010;26(3):202-7. DOI: 10.1097/YCT.0b013e3181e48143. PubMed PMID: 20562640.
  2. Datto C, Rai AK, Ilivicky HJ, Caroff SN. Augmentation of seizure induction in electroconvulsive therapy: a clinical reappraisal. J Ect. 2002;18(3):118-25. DOI: 10.1097/00124509-200209000-00002. PubMed PMID: 12394529.

What are recommended textbooks that may serve as good references regarding ECT?

  1. Mankad MV and Weiner RD (2010).  Anesthetics and Other Medications.  In Mankad MV, Beyer JL, Weiner JL, Krystal AD. Clinical Manual of Electroconvulsive Therapy (pp. 81-93).ISBN: 1585622699, 978-1585622696
  2. Kellner C, Li D, and Maron L (2009). “Anesthesia for electroconvulsive therapy.” In C. Swartz (Ed.) Electroconvulsive Therapy and Neuromodulation Therapies (pp. 412-429).ISBN: 0521883881, 9780521883887