Electroconvulsive therapy adverse effects

DNLM 1. United States. Food and Drug Administration. 2. Mental Disorders—therapy—United States. 3. Brain Damage, Chronic—etiology— United States. 4. Drug Industry—United States. 5. Electroconvulsive Therapy—adverse effects—United States. 6. Psychotropic Drugs—adverse effects—United States. WM 400 B833b 2008]... 

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. 

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. 

Somatic therapies have had a long and at times dubious history in the treatment of mental disorders. Clearly, electroconvulsive therapy (ECT) has stood the test of time but has also been plagued by problems in terms of misuse, underuse, a complicated administration process, cognitive adverse effects, and a negative public image. Even so, ECT remains the most effective treatment for some of the most severely ill, medication-refractory, or medication-intolerant patients, often proving to be lifesaving (1). 

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. 

Catatonic schizophrenia is a controversial syndrome, and there is debate about its etiology and treatment. There has been a report of two cases of catatonic schizophrenia successfully treated with clozapine a 49-year-old woman and a 19-year-old man (18). Both responded to clozapine despite being resistant to several conventional and atypical antipsychotic drugs and, in the second case, a course of electroconvulsive therapy. These two cases are intriguing, because the dose of clozapine required to improve catatonia was about double the dose required to improve psychosis significantly (600 mg/day and 750 mg/day). The two patients had common adverse effects of clozapine the first had mild nocturnal hypersalivation and mild/moderate constipation, and the second had moderate nocturnal hypersalivation. 

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