Technique for performing electroconvulsive therapy (ECT) in adults
- Charles Kellner, MD
Charles Kellner, MD
- Professor of Psychiatry
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Peter P Roy-Byrne, MD
Peter P Roy-Byrne, MD
- Editor-in-Chief — Psychiatry
- Section Editor — Depressive Disorders
- Professor of Psychiatry and Behavioral Sciences
- University of Washington School of Medicine
- Stephanie B Jones, MD
Stephanie B Jones, MD
- Editor-in-Chief — Anesthesiology
- Section Editor — Anesthesia with Comorbid Non-Cardiopulmonary Conditions
- Associate Professor of Anesthesia
- Harvard Medical School
Electroconvulsive therapy (ECT) is practiced widely in the United States and the rest of the world . It is used mainly to treat severe depression, but is also indicated for patients with other conditions, including bipolar disorder, schizophrenia, schizoaffective disorder, catatonia, and neuroleptic malignant syndrome.
There is no question about the efficacy and safety of ECT. Nevertheless, it remains controversial and stigmatized because of misinformation and outdated perceptions about how the treatment is performed.
The goal of ECT is to produce a generalized cerebral seizure under general anesthesia. The technique affects the rate of remission with ECT, which varies from 20 to 80 percent in research studies using different procedures . However, response and remission rates in clinical practice, using standard techniques, are at the higher end of that range.
The technique for performing ECT is reviewed here. An overview of ECT, the indications for treating unipolar major depression with ECT, the efficacy of ECT for treating unipolar depression, and medical consultation for ECT are discussed separately.
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- PRE-ECT ORDERS
- TREATMENT PROTOCOL
- PHYSIOLOGIC MONITORING
- ELECTRODE PLACEMENT
- Standard choice
- Side effects
- Stimulus type
- Stimulus dose
- ANESTHESIA TECHNIQUE
- Anticholinergic medication
- Anesthetic medication
- Muscle relaxation medication
- Cardiovascular medication
- SEIZURE DURATION
- Managing missed or short seizures
- INFORMATION FOR PATIENTS
- OUTSIDE SOURCES OF PATIENT EDUCATION