Depression electroconvulsive therapy

For very severe cases of depression, electroconvulsive therapy (ECT) can be tried. However, you must remember that demented patients are especially sensitive to the adverse memory effects of ECT. 

Black DW, Winokur G, NasraUah A The treatment of depression electroconvulsive therapy versus antidepressants—a naturahstic evaluation of 1,495 patients. 

The adverse effects of lithium in elderly patients include cognitive status worsening, tremor, and hypothyroidism. The authors suggested that divalproex is also useful in elderly patients with mania and that concentrations of divalproex in the elderly are similar to those useful for the treatment of mania in younger patients. They noted that carbamazepine should be considered a second-line treatment for mania in the elderly. A partial response would warrant the addition of an atypical antipsychotic drug. For bipolar depression, they recommended lithium in combination with an antidepressant, such as an SSRI. They also noted that lamotrigine may be useful for bipolar depression. Electroconvulsive therapy (ECT) may also be useful, but there have been no comparisons of ECT and pharmacotherapy in elderly patients with bipolar depression. 

There is, however, a unique risk in the bipolar form that antidepressant treatment may trigger a switch into mania. This may occur either as the natural outcome of recovery from depression or as a pharmacological effect of the drug. Particular antidepressants (the selective serotonin reuptake inhibitors) seem less liable to induce the switch into mania than other antidepressants or electroconvulsive therapy. Treatment for mania consists initially of antipsychotic medication, for instance the widely used haloperidol, often combined with other less specific sedative medication such as the benzodiazepines (lorazepam intramuscularly or diazepam orally). The manic state will usually begin to subside within hours and this improvement develops further over the next 2 weeks. If the patient remains disturbed with manic symptoms, additional treatment with a mood stabilizer may help. 

Electroconvulsive therapy (ECT) is the application of prescribed electrical impulses to the brain for the treatment of severe depression, mixed states, psychotic depression, and treatment-refractory mania in patients who are at high risk of suicide. It also may be used in pregnant women who cannot take carbamazepine, lithium, or divalproex. 

Electroconvulsive therapy (ECT) is used for severe mania or depression during pregnancy and for mixed episodes prior to treatment, anticonvulsants, lithium, and benzodiazepines should be tapered off to maximize therapy and minimize adverse effects. 

Treatment-resistant depression Depression characterized by multiple failed trials of antidepressants and/or electroconvulsive therapy. 

Electroconvulsive therapy A physical therapy used in the treatment of a major depressive disorder that does not respond to pharmacotherapy. 

Exercise (regular aerobic and weight training at least three times a week) / The use of electroconvulsive therapy for severe mania or mixed episodes, psychotic depression, or rapid cycling is still considered the best... 

Shock Therapy. The early 20th century saw the development of the first effective biological treatments for depression, the shock therapies. The first shock treatments used injection of horse serum or insulin. A major advance in treatment occurred with the advent of electroconvulsive therapy (ECT) in 1934. Although initially used to treat schizophrenia, ECT was soon found to be highly effective for other psychiatric disorders including depression and mania. ECT remained the primary biological psychiatric treatment until the widespread release of psychiatric medications in the 1950s. 

Electroconvulsive Therapy (ECT). Introduced in the mid-1930s, ECT was initially used to treat schizophrenia (for which it is not effective) but was later found to be very effective in the treatment of major depression and mania. It gained widespread use and was the primary biological psychiatric treatment until the introduction of newer psychiatric medications in the 1950s. 

Finally, when depressive symptoms persist after treatment with both a mood stabilizer and an antidepressant has been maximized, other treatment alternatives remain. These include the use of electroconvulsive therapy (ECT) or the addition... 

Carney S, Cowen P, Geddes G, et al. Efficacy and safety of electroconvulsive therapy in depressive disorders a systematic review and meta-analysis. Lancet 2003 361(9360) 799-808. 

Shock Therapy. Insulin coma treatments were used in the early 1900s but offered no tangible improvement. Electroconvulsive therapy (ECT) arose in the 1930s and 1940s and was the hrst treatment to provide some relief from psychosis. However, its effects are only temporary and it proved too costly for continuous use. ECT continues to have some use for life-threatening catatonia, but it is mainly used to treat refractory depression or bipolar disorder. 

Repetitive TMS, unlike electroconvulsive therapy (ECT), uses sub-convulsive stimuli to treat depression. Compared to ECT, TMS has a potential to target specific brain regions and to stimulate brain areas thought to be primarily involved in depression while sparing areas like the hippocampus, thereby reducing the probability of cognitive side effects. However, the therapeutic efficacy of TMS as a treatment for depression is, unlike ECT, modest. Most TMS studies use high-frequency, fast stimulation (> 10 Hz) over the left dorsolateral prefrontal cortex, an area which has been... 

Depression refractory to other antidepressants or electroconvulsive therapy PO Initially, 10 mg 3 times/day. May increase to 60 mg/day. 

Contraindications Hypersensitivity, mental depression or history of mental depression (especially with suicidal tendencies), active peptic ulcer, ulcerative colitis, patients receiving electroconvulsive therapy. 

Nemeroff, C.B., Bissette, G., Akil, H., and Fink, M. (1991) Neuropeptide concentrations in the cerebrospinal fluid of depressed patients treated with electroconvulsive therapy. Corticotrophin-releasing factor, beta-endorphin and somatostatin. Br J Psychiatry 158 59-63. 

Electroconvulsive therapy is one of the most efficacious treatments for adults with nonresistant (70% response) and resistant MDD (50% response) (APA, 2000). Because of the invasiveness of this treatment, however, it remains the treatment of choice only for the most severe, incapacitating forms of resistant depression. No studies have been carried out among adolescents, but anecdotal reports have suggested that adolescents with refractory depression may respond to ECT without significant side effects (Rey and Walter, 1997). Approximately 60% of adult patients treated successfully with ECT tend to relapse after 6 months (APA, 2000). Therefore, they must also receive maintenance treatment with antidepressants and sometimes maintenance ECT. There are no reports of use of maintenance ECT in adolescents. 

Grunhaus, L., Dannon, P.N., and Schreiber, S. (2000) Repetitive trans-craneal magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder an open study. Biol Psychiatry 47 314-324. 

Electroconvulsive therapy, an effective treatment for depression during pregnancy (Eorssman, 1955 Impastato et ah, 1964), should be considered when other... 

Electroconvulsive therapy [ECT] is mostly used for severe depression. Elowever, a balanced, extensive review of the literature by Sackeim s group (see Nobler et ah, Chapter 10, in this volume] reveals not only the remarkable potency and safety of this politically controversial mode of treatment, but also the multiplicity of its biological influence and impact on a diversified gamut of brain functions. ECT is probably also effective in acute manic states and might be viewed as a mood stabilizer. Whether or not maintenance ECT acts as a mood stabilizer is still unknown. It might be viewed as an antidepressant with a broad stabilizing effect. 

Electroconvulsive therapy (ECT) is an established and effective treatment of depression and some forms of schizophrenia. ECT is the treatment of choice in several types of depression (W. Z. Potter and Rudorfer 1993), especially severe depression (American Psychiatric Association Task Force on Electroconvulsive Therapy 1990 W. Z. Potter et al. 1991). The mechanism by which ECT exerts its antidepressant effect is still unknown. Studies of pharmacologically as well as of electrically induced convulsions suggest that the convulsion is a necessary condition for ECT s therapeutic effects (Cerletti and Bird 1938 Lerer 1987 Lerer et al. 1984). However, there is no satisfactory explanation for the clinical efficacy of convulsions. 

Evidence on the potential antidepressant efficacy of L-dopa is more voluminous, but also discouraging [Kapur and Mann 1992 Oren et al. 1994). Despite the definite effects of L-dopa on mood, its antidepressant efficacy, given with or without a peripheral decarboxylase inhibitor, is not established even in the subset of patients with psychomotor retardation and low pretreatment CSF HVA who are supposed to be particularly sensitive to its effects. Standard antidepressants or electroconvulsive therapy are the methods of choice in treating depression in patients with Parkinson s disease, in whom L-dopa appears to have limited or no antidepressant efficacy and has been suspected of producing depression [Cummings 1992). Furthermore, pro-... 

Anderson DN, Wilkinson AM, Abou-Saleh MT, et al Recovery from depression after electroconvulsive therapy is accompanied by evidence of increased tetra-hydrobiopterin-dependent hydroxylation. Acta Psychiatr Scand 90 10-13, 1994 Anderson IM, Cowen PJ Effect of pindolol on endocrine and temperature responses to buspirone in healthy volunteers. Psychopharmacology 106 428-432, 1992 Anderson IM, Tomenson BM Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants a meta-analysis. BMJ 310 1433-1438, 1995... 

Anderson SMP, Godfrey PP, Grahame-Smith DG The effects of phorbol esters and lithium on 5-HT release in rat hippocampal slices. Br J Pharmacol 93 96P, 1988 Andrade C, Gangadhar BN, Swaminath G, et al Predicting the outcome of endogenous depression following electroconvulsive therapy. Convulsive Therapy 4 169-174, 1988... 

Clark CP, Alexopoulos GS, Kaplan J Prolactin and clinical response to electroconvulsive therapy in depressed geriatric inpatients a preliminary report. Convulsive Therapy 11 24-31, 1995... 

Kellner CH, Beale MD, Pritchett JT, et al Electroconvulsive therapy and Parkinson s disease the case for further study. Psychopharmacol Bull 30 495-500, 1994 Kellner M, Wiedemann K, Kiieg J-C, et al Effects of the dopamine autoreceptor agonist roxindole in patients with depression and panic disorder (abstract). Neuropsychopharmacology 10 1018, 1994... 

Kim SW, Dysken MW, Pandey GN, et al Platelet 3H-imipramine binding sites in OC behavior. Biol Psychiatry 30 467-474, 1991 Kindler S, Shapira B, Hadjez J, et al Factors influencing response to bilateral electroconvulsive therapy in major depression. Convulsive Therapy 7 245-254, 1991... 

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