Electroconvulsive therapy history

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

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 psychostimulant effects of the glucocorticoids are well known (80), and their dose dependency is recognized (SED-11, 817) they may amount to little more than euphoria or comprise severe mental derangement, for example mania in an adult with no previous psychiatric history (SEDA-17, 446) or catatonic stupor demanding electroconvulsive therapy (81). In their mildest form, and especially in children, the mental changes may be detectable only by specific tests of mental function (82). Mental effects can occur in patients treated with fairly low doses they can also occur after withdrawal or omission of treatment, apparently because of adrenal suppression (83,84). 

Major depressive (endogenous) Precipitating life event not adequate for degree of depression. Autonomous (unresponsive to changes in life). May occur at any age (childhood to old age). Biologically determined (family history). About 25% of all depressions. Core depressive syndrome plus "vital" signs abnormal rhythms of sleep, motor activity, libido, appetite. Usually responds specifically to antidepressants or electroconvulsive therapy. Tends to recur throughout life. 

Woerner et al. (1998) studied a group of neuroleptic-naive patients aged 55 and above, evaluated them at baseline before the start of neuroleptics, and followed up at 3-month intervals. Relatively low doses of conventional neuroleptics were used The rates of TD were 25%, 34%, and 53% after 1, 2, and 3 years of cumulative antipsychotic treatment. Once again, the rates were astronomically high A greater risk of TD was associated with history of [electroconvulsive therapy] treatment, higher mean daily and cumulative antipsychotic doses, and presence of extrapyramidal signs early in treatment. ... 

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