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.
Don’t Forget to Solve all the previous Year Question asked on ELECTROCONVULSIVE THERAPY (ECT)