When should ECT be used?

1977 ◽  
Vol 15 (1) ◽  
pp. 2-4
Keyword(s):  
Electroconvulsive Therapy ◽  
Mode Of Action ◽  
Depressive Illness ◽  
Muscle Relaxants ◽  
House Of Commons ◽  
Mode Of Administration ◽  
Lay People ◽  
Harmful Effects

Though electroconvulsive therapy (ECT) has been widely used in depressive illness for over 30 years, its use is empirical, its mode of action remains unknown, and some medical and lay people have asserted that its dangers outweigh its usefulness. Over the years the mode of administration has gradually changed with the introduction of anaesthetics and muscle relaxants. The number of shocks in a course of ECT has tended to lessen and unilateral ECT has some advantages.1 Nevertheless, recently the long-standing controversy on its use has increased. In some states in America legislation has been introduced to restrict it2 and questions on its possible harmful effects have been asked in the House of Commons.3

Which Depressed Patients will Respond to Electroconvulsive Therapy?

1989 ◽  
Vol 154 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Allan I. F. Scott
Keyword(s):  
Effective Treatment ◽  
Clinical Features ◽  
Electroconvulsive Therapy ◽  
Physiological Responses ◽  
Depressive Illness ◽  
Seizure Threshold ◽  
Posterior Pituitary ◽  
Clinical Predictors ◽  
Depressed Patients ◽  
Wide Range

A small yet significant minority of contemporary patients with endogenous depressive illness who are treated with electroconvulsive therapy (ECT) gain little or no benefit. It is argued that the use of clinical features alone may not improve the ability to predict outcome after ECT. Many biological measures have been used to attempt to identify depressed patients for whom ECT would be an effective treatment, but none has yet been shown to be superior to clinical predictors. Depressed patients show a wide range of physiological responses to the first treatment of a course of ECT. Of these physiological responses, estimations of seizure threshold and of the release of posterior pituitary peptides merit further investigation as putative predictors of recovery.

The Therapeutic Efficacy of Electroconvulsive Therapy (Ect) a Double Blind Controlled Trial of Ect and Simulated Ect

1978 ◽  
Vol 23 (1) ◽  
pp. 71-75 ◽  
Author(s):  
C. P. Freeman
Keyword(s):  
Electroconvulsive Therapy ◽  
Therapeutic Efficacy ◽  
Controlled Trial ◽  
Depressive Illness ◽  
Double Blind

A double-blind controlled trial of ECT versus simulated ECT is described. The results show that real ECT is significantly superior to simulated ECT in the treatment of depressive illness.

The Onset and Rate of the Antidepressant Effect of Electroconvulsive Therapy

1993 ◽  
Vol 162 (6) ◽  
pp. 725-732 ◽  
Author(s):  
Allan I. F. Scott ◽  
Lawrence J. Whalley
Keyword(s):  
Electroconvulsive Therapy ◽  
Royal College ◽  
Mode Of Action ◽  
Depressive Disorders ◽  
Practical Interest ◽  
Antidepressant Effect ◽  
Rapid Improvement ◽  
Research Committee ◽  
Biological Studies ◽  
Antidepressant Effects

This annotation is concerned with how soon and at what rate antidepressant effects become apparent over a course of electroconvulsive therapy (ECT). The first question is of importance in the design and interpretation of biological studies of the mode of action of ECT. The second question is of practical interest to the treating psychiatrist when we ask how the speed of recovery is influenced by what the psychiatrist prescribes, that is, the number and frequency of treatments. These questions are little better answered now than 20 years ago. This may come as a surprise to many readers, who have been advised to use ECT when “seeking rapid improvement” in depressive disorders (ECT Sub-Committee of the Research Committee of the Royal College of Psychiatrists, 1989). This lack of progress is attributable to a dearth of appropriately designed ECT studies.

Effect of Electroconvulsive Therapy on Erythrocyte Adenosine Triphosphatase Activity in Depressive Illness

1980 ◽  
Vol 137 (4) ◽  
pp. 343-345 ◽  
Author(s):  
L. J. Whalley ◽  
M. Scott ◽  
H. W. Reading ◽  
J. E. Christie
Keyword(s):  
Atpase Activity ◽  
Erythrocyte Membrane ◽  
Electroconvulsive Therapy ◽  
Healthy Subjects ◽  
Adenosine Triphosphatase ◽  
Depressive Illness ◽  
Slight Reduction ◽  
Acute Effects ◽  
Adenosine Triphosphatase Activity ◽  
Depressed Patients

SummaryErythrocyte membrane adenosine triphosphatase activities were examined in twelve unipolar depressed patients receiving ECT. Eleven patients undergoing diagnostic cystoscopy served as controls for the acute effects of anaesthesia, and sixteen healthy subjects served as non-depressed controls. The unipolar depressed patients had a slight reduction in their (Na++K+)-ATPase activity but effective ECT treatment was not associated with any increase in this activity. This approach is unlikely to cast further light on the membrane phenomenology of depressive illness.

Plasma noradrenaline response to electroconvulsive therapy in depressive illness

1997 ◽  
Vol 171 (2) ◽  
pp. 182-186 ◽  
Author(s):  
C. B. Kelly ◽  
S. J. Cooper
Keyword(s):  
Major Depressive Disorder ◽  
Electroconvulsive Therapy ◽  
Depressive Illness ◽  
Plasma Noradrenaline ◽  
Clinical State ◽  
Major Depressive ◽  
Blood Samples ◽  
Strong Trend ◽  
Before And After ◽  
Depression Ratings

BackgroundAbnormalities of catecholaminergic function have been hypothesised to cause depressive illness. Plasma noradrenaline can be used as a marker of central noradrenergic activity. It is of interest to examine the change in resting plasma noradrenaline in patients with depressive illness over a course of electroconvulsive therapy (ECT) and relate this to their clinical state.MethodPatients referred for ECT who suffered from DSM – III – R major depressive disorder or dysthymia were recruited. Blood samples were taken before and after each treatment, during a course of ECT, to measure plasma noradrenaline and Cortisol. Clinical ratings were carried out weekly during the course of ECT.ResultsPlasma noradrenaline fell significantly in those patients with melancholic/psychotic depressions but increased in those with non-melancholic depressive illness. There was a strong trend indicating that a fall in plasma noradrenaline was associated with improvement in depression ratings in the melancholic/psychotic patients only.ConclusionsElectroconvlusive therapy decreases plasma noradrenaline in melancholic/psychotic depressive illness and this shows a trend associated with clinical improvement.

The Role of Electroconvulsive Therapy in the Treatment of Depressive Illness in Old Age

1989 ◽  
Vol 155 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Susan M. Benbow
Keyword(s):  
Old Age ◽  
Electroconvulsive Therapy ◽  
Age Groups ◽  
The Elderly ◽  
Depressive Illness ◽  
Electrode Placement ◽  
Physical Problems ◽  
Younger Age ◽  
Old Age Psychiatry ◽  
Temporary Memory

Electroconvulsive therapy is an important treatment in the depressive states of late life, and there is general agreement about the indications for its use in old age psychiatry. Indeed, old age may be associated with a better response to ECT than that in younger age groups. The additional risk involved through physical problems in the elderly is not great when compared with that of continuing depression and of the side-effects of alternative treatments. Temporary memory disorders and confusion may occur, but are minimised if unilateral electrode placement is used. Some patients treated with unilateral ECT do not respond, but will respond to bilateral treatment. Anxiety over unwanted treatment effects, which can lead to ineffective treatment of depressive illness, must be outweighed by knowledge of the dangers of leaving depression untreated in old age.

A Comparison of Techniques in Electro-Convulsive Therapy

1968 ◽  
Vol 114 (513) ◽  
pp. 989-996 ◽  
Author(s):  
Max Valentine ◽  
K. M. G. Keddie ◽  
David Dunne
Keyword(s):  
Electroconvulsive Therapy ◽  
Muscle Relaxants ◽  
Present Form ◽  
Convulsive Therapy ◽  
Intravenous Anaesthesia ◽  
Comparison Of Techniques ◽  
Electro Convulsive Therapy

Electroconvulsive therapy, modified by intravenous anaesthesia and muscle relaxants, has long been accepted as a satisfactory form of treatment. Relatively simple and safe, and effective in selected cases, the technique has undergone little change in recent years and seems almost in danger of becoming fixed indefinitely in its present form.

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