Pharmacological and ECT - ECT

• - predominantly used for depression, and can be particularly effective in older adults.
• - Although antidepressants are usually tried first
• + Life-threatening poor fluid intake
• + Strong suicidal intent
• + Psychotic features or stupor
• + Antidepressants are ineffective or not tolerated.

- Effective for established mania (though may precipitate a manic episode in bipolar)

- Effective for certain types of schiz, esp. catatonic states, positive psychotic symptoms, and schizoaffective disorder.

• - Also used for puerperal psychosis
• (with prominent mood symptoms or severe postnatal depression where a rapid improvement is nec. to reunite mother with her baby)

• - administered 2-3 times/ week. most need 4-12 treatments
• + general anaesthetics (short-acting induction agent) and muscle relaxant
• + 2 electrodes to scalps, bilateral or unilateral
• + deliver sufficient electric current to have a generalized seizure of at least 15 secs

• - MoA: not clear.
• ^{causes a release of neurotransmitters as well as hypothalamic and pituitary hormones; it also affects neurotransmitter receptors and second messenger systems, and results in a transient increase in blood–brain barrier permeability}

• - mortality is same as minor surgical procedure under GA (1 in 100 000)
• - common: loss of memory, part events surrounding ECT (can be reduced by unilateral electrode placement)
• - Minor complaints: confusion, headache, nausea, muscle pains reported in 80% of pt
• - Anaes complications e.g. arrhythmias, aspiration can be reduced by goof preop assessment.
• - Prolonged seizure (^{in pt on drugs that lower seizure threshold e.g. antidepressant and antipsychotics)}
• - More difficult to induce seizure - ^{benzodiazepines}