Medical consultation for electroconvulsive therapy
- Anjala Tess, MD
Anjala Tess, MD
- Assistant Professor in Medicine
- Harvard Medical School
- Gerald W Smetana, MD
Gerald W Smetana, MD
- Professor of Medicine
- Harvard Medical School
Electroconvulsive therapy (ECT) is a commonly performed procedure in the United States. Use of ECT is rising, and psychiatrists often request medical evaluation before ECT since many eligible patients are elderly with multiple medical comorbidities. This topic review will discuss the use, indications, anesthetic technique, procedure, and morbidity of ECT, as well as risk assessment and strategies to reduce the risk of the procedure.
INDICATIONS FOR ECT
The primary indication for electroconvulsive therapy (ECT) is for the treatment of major depression that is refractory to antidepressant medications . Indications listed in the American Psychiatric Association guidelines for the treatment of patients with major depressive disorder include depression with psychotic features, catatonia, persistent suicidal intent, food refusal leading to nutritional compromise or dehydration, and pregnancy and other situations where a rapid antidepressant response is required (table 1). The report also recommends ECT for patients who have previously shown a positive response to it and for those who have medical conditions that prevent the use of antidepressant medications. The Canadian Psychiatric Association clinical guidelines for the treatment of depressive disorders suggest similar indications . (See "Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT)" and "Unipolar depression in adults: Treatment of resistant depression".)
Other psychiatric conditions for which ECT is effective include bipolar depression and mania .
TECHNIQUE AND ANESTHESIA
The technique for administering electroconvulsive therapy, including anesthesia, is discussed separately. (See "Technique for performing electroconvulsive therapy (ECT) in adults".)
MORBIDITY AND MORTALITY
Clinicians should be aware of certain potential side effects or complications of electroconvulsive therapy (ECT). (See "Overview of electroconvulsive therapy (ECT) for adults", section on 'Adverse effects'.)
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- INDICATIONS FOR ECT
- TECHNIQUE AND ANESTHESIA
- MORBIDITY AND MORTALITY
- Cardiovascular effects
- Central nervous system and other effects
- ROLE OF THE MEDICAL CONSULTANT
- Preprocedure evaluation
- Strategies to reduce the risk of cardiac complications
- - Postprocedure hemodynamic changes
- - Prophylactic beta blockers
- - Other prophylactic medications
- Coexisting cardiac disease
- - Hypertension
- - Coronary heart disease
- - Heart failure and valvular disease
- - Pacemakers and implantable defibrillators
- Coexisting pulmonary disease
- Coexisting neurologic and neurosurgical disease
- - Brain tumors
- - Stroke
- - Dementia
- - Neuromuscular disease
- - Epilepsy
- - Cranial metallic objects
- INFORMATION FOR PATIENTS