On The Angie there is the description of treatment number 6 with ECT. Trouble with waking due to the laryngeal mask which is exceptional since in the last 16 years we used it only once for a patient with a large beard. It was difficult to ventilate him due to the beard. Don’t forget to read the comments.
ECT electroconvulsive therapy electroshock
The new Journal of ECT is out. This number is all about side-effetc of ECT. An important issue to my opinion. One important article of this issue is Pharmacological Attenuation of Electroconvulsive Therapy-Induced Cognitive Deficits
The most important psychopharmacological agents in the attenuation of ECT-induced cognitive deficits studied up until now are:
- Ketamine anesthesia in ECT might be neuroprotective according to a retrospective study. In this study it was reported that a significantly quicker recovery of orientation in 36 patients who were switched from methohexital to ketamine anesthesia appeared midway through the ECT course because of insufficient seizure duration with the barbiturate anesthetic drug. In another trial etomidate was compared to ketamine anesthesia across 6 ECT sessions in 10 patients. Anterograde memory function (tested simply as short-term memory for 4 words) was significantly better in the ketamine group. There is some fear that ketamine might attenuate the convulsion as well adn thus hamper therapeutic efficacy. Ketamine also has some troublesome side-effects such as hallucinations.
- There are no clinical trials that have assessed the inflammatory hypotheses in the context of ECT. However, across a 6-month period, indomethacin (100-150 mg/d) was found to protect against cognitive decline in patients with Alzheimer disease as compared with placebo-treated patients. In animal studies there is some attenuation of cognitive side effects of ECT by cox-2 inhibitors.
- Calcium channel blockers (antihypertensive drugs) with the exception of nifedipine,seem to consistently preserve task recall after ECS in rats. The preclinical findings of the memory-preserving effects of these drugs have not been replicated in human subjects in the context of ECT. Two placebo controlled trials were negative.
- Three clinical trials have assessed the antiamnestic effects of cholinesterase inhibitors (ChEIs) in the context of ECT. The results of these trials suggest that the coadministration of ChEI with ECT may compensate for or correct the ECT-induced cholinergic changes, which putatively, at least, partly explain cognitive impairment with ECT.
- Mifepristone (40 mg/kg), a glucocorticoid receptor antagonist, administered 1 hour before ECS prevented the development of retrograde amnesia (for passive avoidance learning) induced by 5 once-daily ECS. This result supports the hypothesis for the involvement of glucocorticoid mechanisms in ECT-induced amnestic deficits. There are no published data with patients treated with ECT. One placebo-controlled clinical trial is currently being conducted using a 600-mg/d dose of mifepristone during the course of ECT; no data are available as yet
- Thyrotropin-releasing hormone (0.5 mg)showed disappointing results in 2 trials.
- Naloxone showed in 2 trials essentially negative results. These could be due to the relatively low dose of naloxone administered and the crossover design of the two trials. It has been suggested the dose of naloxone should be between 1 to 4 mg/kg to produce demonstrable effects. However, considering the possible risk of increased retrograde amnesia with naloxone 1.6 mg/kg as shown in one of these trials, higher doses should be used with caution.
Allthough the explaining mechaniosm of action of the mentioned drugs the results on the side effects of ECT of these drugs are disappointing. It is questionable whether better research would deliver better results. Drugs or group of drugs that may reward further investigation include ketamine or other NMDA receptor antagonists, Cox-II inhibitors, mifepristone and calcium channel blockers.
Pigot, M., Andrade, C., FRANZCP, C.L. (2008). Pharmacological Attenuation of Electroconvulsive Therapy-Induced Cognitive Deficits. The Journal of ECT, 24(1), 57-67. DOI: 10.1097/YCT.0b013e3181616c14
Today I had treatment number four. I’m assuming I’ll have around 8, so it’s kind of nice to know we’re halfway there.
Nothing too terribly exciting about today’s experience, but I do have a bit of a headache, which I’d not gotten to this point. But it’s not unexpected-it’s one of the common side effects.
A report of udergoing ECT by a patient on the Angie
A short description and a correction in this second post on The Angie by someone undergoing ECT treatment.
During ECT you are normally not intubated, this procedure only applies to pregnant women in their third trimester. They need to be intubated due to risks of regurgitation of gastric content.
The misunderstanding results from the mouth guard to protect your teeth during stimulation. Due to direct stimulation of the masseter your teeth are clenched. Like in the picture accompanying this post. The stimulation duration is only 4-8 seconds. After that the mout guard can be removed.
I recently made the decision to try and battle a lifelong struggle with depression with ECT, or electroconvulsive therapy. Because it’s such a hot-button issue in the field of psychiatry and there are many conflicting reports out there on the internet, I thought I would write, from the patient’s point of view, what getting an ECT treatment is all about.
In the interest of full disclosure, I would like to mention that I’ve only received one treatment so far. I’m hoping to use this blog to talk about my experiences as I go through them in the next few weeks while I’m getting the remainder of the treatments.
This is description of ECT by someone undergoing this treatment, I hope she or he will keep us informed about the ECT course on: The Angie, What electroconvulsive therapy is like.
A written account on Vicarious Therapy about her experiences during an ECT course.
I did not create a video when I went through my ECT treatments, but I did the next best thing; I wrote about my experiences with ECT on a Bipolar/Depression Discussion Board as I was going through the 8 treatments I received.
A compelling story about the ECT and how she experienced the treatment.
My 1st treatment was Friday. As my brain is super important to me I had all sort of concerns about the procedure and its effect on my intellectual abilities. I read tons. The document on this website: http://www.mheccu.ubc.ca/ has lots of info. The Drs told me that I may have some short term memory loss for around the time of the treatments, but that most of those would come back within a few weeks of the treatments ending. The literature and studies I have read say the same thing.
A very short but accurate list of 5 questions to ask yourself when faced by this decision. From Johns Hopkins Health Alert.
Answers to other three important questions on the site of The Royal College of Psychiatrists
1. How is ECT given
2. The Pros and Cons of ECT
3. Controversies in ECT
Thanks to There are black dogs and black dogs
Take special notice of the Further Information Section on this site
Objective: The Mental Health Act in New South Wales (NSW) has recently been revised, resulting in the Mental Health Bill 2007, which has been submitted to the NSW Parliament to be passed as law. The new Bill includes some changes to the sections dealing with electroconvulsive therapy (ECT), particularly for involuntary patients. The implications of these changes for the provision of ECT in these patients are examined in this paper. Conclusions: New limits introduced in the Mental Health Bill 2007 may have potentially detrimental consequences for ECT therapy in involuntary patients and may inadvertently result in the provision of suboptimal ECT to these patients.
The worst ill patients will have difficulty receiving the right treatment with ECT. These involuntary patients are usually the ones that needs ECT the most.
Australas Psychiatry. 2007 Dec;15(6):457-60.
The NSW Mental Health Bill 2007: Implications for the provision of