- Clinical science
Electroconvulsive therapy (ECT) involves unilateral (sometimes bilateral) electrode placement over the nondominant hemisphere to induce tonic-clonic seizures under sedation. Although not fully understood, ECT likely causes anticonvulsant effects, brain remodeling, and improves brain perfusion. ECT is indicated for refractory cases, life-threatening symptoms (e.g., suicide risk), or special patient groups (e.g., pregnant patients) with certain mental disorders; including depression, schizoaffective disorder, and bipolar mood disorder. Complications include reversible memory loss, tension headaches, and transient muscle pain.
Usually indicated in the following conditions for refractory cases, life-threatening symptoms, or if medication is contraindicated (e.g., pregnancy):
- Depression (most common)
- Schizoaffective disorder
- Schizophrenia with catatonia
- Bipolar mood disorder (e.g., manic episodes)
- Highly suicidal or pregnant depressed patients (not usually first-line)
ECT is the most effective treatment for severe major depressive disorder!
- No absolute contraindications.  Relative contraindications include:
Pregnancy and pacemakers are not a contraindication for ECT!
We list the most important contraindications. The selection is not exhaustive.
- General preparation and procedure
- Unilateral electrode placement over the nondominant hemisphere
- EEG as well as constriction of the contralateral arm via blood pressure cuff for monitoring the seizure
- Administration of oxygen via face mask + preparation for emergency intubation if necessary
- ECG and pulse oximetry allow for monitoring further vital signs.
- Administration of premedications:
- Short-term general anesthesia, including a muscle relaxant (e.g., succinylcholine) to avoid risk of fractures
- An electric current is passed from one side of the cerebral cortex to the other.
- 6–12 sessions in total consisting of generalized tonic-clonic convulsions lasting 25–30 seconds, usually 2–3 times per week
- Treatment sessions can be discontinued once symptoms improve.
- Maintenance may be implemented once every 1–8 weeks.
- ECT itself is generally considered a safe procedure; the risk of mortality (due to cardiac or pulmonary compromise) is associated with anesthesia.
- If properly conducted, ECT is one of the safest procedures involving sedation.
- To date, no brain damage has been reported with the current method!
- Improvement is directly proportional to increased delta wave activity in the prefrontal cortex.