Antonio,Aileen Beatrice

Junior Intern
Electroconvulsive Therapy
Historical Background
Hippocrates 400 B.C. Melancholic black bile
Paracelsus 1520 Psychiatric illness not demonic
but natural diseases
Kraeplin Illnesses divided into two major groups

Etiologies of Depression
Bioamine Hypothesis Neurotransmitters
Freud Loss of the love object
Genetic Factors
Lifes Stressors
Learned Helplessness
Cognitive Theories
Organic Cause drugs, medications, illnesses,
sleep abnormalities

Epidemiology
20% lifetime expectancy
2:1 female to male ratio
50% have onset by age 30
More common in single/divorced
No correlation between social classes or race
10% complete suicide 66% contemplate
Treatment Options
Medications
ECT
Transcranial Magnetic Therapy
Vagal Nerve Stimulator
Various Psychotherapies
Psychoanalysis
ECT History
Can a seizure be protective?
Meduva 1930s camphor
Cerletti and Bini electrical charge
75,000 treatments per year
Twice as effective as medication
Mortality .01% per course same as any
anesthesia induction
ECT INDICATIONS
Major Depression 90% effective
Mania 80% effective
Acute Schizophrenic Psychosis 50% effective
Neuroleptic Malignant Syndrome
Advanced Parkinsons
Intractable Epilepsy
Catatonia
Contraindications
No absolute contraindications
High risk with:
Space occupying lesion
Recent myocardial infarction
Brain aneurysm
ECT Procedure
Confirm Diagnosis
Medical and Psychiatric Exam
EKG
Lab tests
Head CT/Spine films if indicated
Consent forms
Anesthesia evaluation
Risks, benefits, alternatives
Primary Choice
Urgent need for rapid response
Patient history
Patient preference
Elderly
Psychotic Depressions
Catatonic States
Adverse Effects
General Anesthesia
Complicated seizure
Medication Interactions
Cognitive Changes
Cardiovascular Problems
Risk Reduction
Oxygenation
Reduce medications
Pre treatment with Robinul
Use of Beta Blockers
Check electrolytes
BP and EEG monitoring
NPO after midnight, clean scalp, usual BP
meds with sip of water
Atropine if necessary

Anesthetic Agents

Diprovan Non barbituate short acting
Brevital barbituate yet less effect on seizure
Succinylcholine
Beta Blockers
Versed
Amnesia
Retrograde and Anterograde
Few weeks to month in duration
Less with non dominant unilateral treatment
Discontinue Lithium
Occurs in patients with severe Depression
who do not have ECT
BDNF theory
ECT does not injure the brain
Complications
Headache, muscle soreness
Jaw pain, oral injury
Spinal problems
Nausea
Confusion
Cardiovascular Problems
Death 1:10,000