ELECTROCONVULSIVE THERAPY (ECT)

ELECTROCONVULSIVE THERAPY (ECT)


ELECTROCONVULSIVE THERAPY (ECT)

Introduction:

  • A type of convulsive therapies used for psychiatric disorders treatment.
  • Usage of electricity as an agent inducing convulsions – Referred as “electroconvulsive therapy.”
Types:
A. Direct ECT:

  • Anesthetic agents & muscle relaxants not used.
  • Generalized convulsions produced result in fractures or teeth dislocations.
  • Higher incidence of side effects – Rarely used now.

B. Modified ECT (Indirect ECT):

  • Anesthetic agents & muscle relaxants are administered before ECT.
  • Muscles relaxed —> risk of bone fractures &other injures from motor activity during seizures minimized.

Technique:

  • Based on electrode placement – Bilateral ECT & Unilteral ECT.
  • Bilateral ECT: 
    • Most commonly used.
    • Involves electrodes placed on both sides of skull (bifronto-temporal electrode placement).
  • MOA:
    • Induction of bilateral generalized seizure via ECTs.
    • By down regulation of postslnaptic beta-adrenergic receptors.
    • Changes in growth factors & molecular mechanisms (increased brain derived neurotrophic factor, BDNF)
    • Neurogenesis (hippocampus).

Indications:

  • Depression (Major depressiue disorder): 
    • Both major depressive disorder & bipolar disorder.
    • Mainly for depression with suicide risk (Acute suicidal patients).
    • Depression with stupor.
    • Depression with psychotic symptoms (psychotic depression or delusional depression).
  • Manic episode:
    • Acute mania – Not 1st line treatment.
    • Only for intolerant/unresponsive to pharmacotherapy.
    • Severe maniac patients with suicide risk.
  • Schizophrenia:
    • Catatonic schizophrenia – 1st line treatment.
    • Note: Not effective in chronic schizophrenia.
  • Other indications:
    • Intractable seizures.
    • Neuroleptic malignant syndrome.
    • Delirium.
    • On-off phenomenon of Parkinson’s disease

Adverse effects:

  • Memory disturbances:
    • Most common side effect.
    • Retrograde amnesia more common.
    • Mild & recovery within 1-6 months after treatment.
  • Other side effects:
    • Delirium
    • Headache
    • Muscle aches
    • Fractures (very rare with modified ECT)
    • Nausea
    • Vomiting.
Contraindications:
  • No absolute contraindications.
  • Relative contraindication:
    • Raised intracranial tension (space occupying lesion in CNS).
    • Recent myocardial infarction
    • Severe hypertension
    • Cerebrovascular disease
    • Severe pulmonary disease
    • Retinal detachment
Note: Pregnancy not a contraindication.

Exam Important

  • Generalized convulsions produced during direct ECT result in fractures or teeth dislocations.
  • ECT is used for major depressiue disorder, catatonic schizophrenia, intractable seizures, neuroleptic malignant syndrome, delirium & on-off phenomenon of Parkinson’s disease.
  • ECT not effective in chronic schizophrenia.
  • Memory disturbances most commonly retrograde amnesia occur as side effect to ECT.
  • There are no absolute contraindications to ECT.
  • Raised intracranial tension (space occupying lesion in CNS) is a relative contraindication to ECT.
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