Electroconvulsive therapy (ECT)

Learning objectives

Electroconvulsive therapy (ECT) is a procedure in which small electric currents are passed through the brain to intentionally trigger a brief tonic-clonic epileptic seizure
Is a safe and effective treatment for severe medication-resistant depression
Can also be beneficial in:
- Severe mania
- Catatonia
- Agitation and aggression in people with dementia
- Schizophrenia
Performed under general anesthesia
Modern ECT devices deliver brief electrical stimuli via two electrodes and are equipped with controls to adjust the duration and frequency of the stimulus
The electrodes can either be attached on both sides of the head, typically bitemporal, for bilateral ECT or on the dominant hemisphere for unilateral ECT

Cardiovascular effects	Bradycardia Hypotension Possibly asystole Systolic arterial pressure may increase by 30-40% Heart rate may increase by 20% or peak at 3-5 min Myocardial oxygen consumption increases while myocardial oxygen supply may be reduced due to Myocardial ischemia and infarction may occur Left ventricular systolic and diastolic function can remain decreased up to 6 h after ECT
Cerebral effects	Increase in: Cerebral oxygen consumption Blood flow Intracranial pressure Reports of: Transient ischemic deficits Intracranial hemorrhage Cortical blindness Prolonged Seizures Status epilepticus Postictal: Disorientation Impaired attention Memory problems Short-term memory impairment lasting several weeks Permanent memory loss Retrograde and aterograde amnesia
Other physiological effects	Increased intraocular pressure Increased intragastric pressure
General physical effects	Headaches Myalgia Drowsiness Weakness Nausea Anorexia Increased salivation Dental damage Oral cavity lacerations