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24 - Electroconvulsive therapy

from Section 4 - Specific modalities of treatment

Published online by Cambridge University Press:  05 May 2013

By
Joshua Berman  and
Joan Prudic
Edited by
J. John Mann
Edited in association with
Patrick J. McGrath  and
Steven P. Roose
J. John Mann
Affiliation:
Columbia University, New York
Patrick J. McGrath
Affiliation:
Columbia University, New York
Steven P. Roose
Affiliation:
Columbia University, New York
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Summary

This chapter discusses potential mechanisms of antidepressant action and outlines areas of active research in electroconvulsive therapy. Electroconvulsive treatment (ECT) remains the most effective treatment for major depression. During the seizure itself, and for a period of hours afterward, there is higher sympathetic tone with markedly elevated heart rate and blood pressure during ictus and for several minutes postictally. Pre-existing seizure disorder is generally not a contraindication for ECT; however, in patients with seizures, it should be ascertained that the seizure is not caused by a mass lesion or vascular malformation which could constitute higher risk with ECT. ECT requires the consent of the patient or, in the event that the patient lacks capacity, a ruling from a legal authority regarding procedures for substituted consent if available. The most common adverse effects of ECT are headache and myalgia.

Keywords

selective serotonin reuptake inhibitorslithium carbonatemajor congenital malformationspregnancytricyclic antidepressantsvagal nerve stimulationlamotriginedepressionbipolar disorder
Type
Chapter
Information
Clinical Handbook for the Management of Mood Disorders , pp. 311 - 324
Publisher: Cambridge University Press
Print publication year: 2013

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