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. If you or a loved one is suffering from drug addiction Recovery Delivered can help them get through it to a heath lifestyle and a great future.
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.
Conclusion 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
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.
The tempting foods aren’t the enemy, but controlling how you respond to those temptations makes all the difference in the battle of the holiday bulge. Many people struggle with keeping a healthy weight even after trying out different diets and exercises, if you are one of them then you should attend this MGB Treatment Webinar for more information on surgical weight loss procedures.
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.
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.
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.