ECT

In 1938, Lucio Cereletti and Ugo Bini conducted the first electrical induction of a series of seizures in a catatonic patient and produced a successful treatment response. ECT has been indicated in management of several psychiatric illness.

1. ECT is considered as a first line treatment for (1) emergency treatment of depression where a rapid definitive response is needed (2) treatment resistant depression and who has responded to ECT in a previous episode of illness.
2. ECT may be the treatment of choice when the depressive illness is associated with;
   • Life threatening situation because of refusal of food and fluids
   • High suicide risk
   • Stupor
   • Marked psychomotor retardation
   • Depressive delusions and hallucinations (Psychotic depression)
   • Patients who are pregnant, if there is concern about the teratogenic effects of antidepressants and antipsychotics.
3. It May be considered for the treatment of mania when associated with
   • Life threatening physical exhaustion
   • Prolonged and severe mania with lack of response to all other appropriate drug treatments
4. May be considered as a fourth line option for treatment resistant schizophrenia after treatment with 2 antipsychotic drugs and then clozapine has proved ineffective, though it is rarely used for this purpose in current practice.
5. May be indicated in patients with catatonia where treatment with a benzodiazepine (usually lorazepam) has proved ineffective.
6. As an adjunctive treatment for motor, psychotic and affective symptoms in Parkinson’s disease with severe disability despite medical treatment.
7. Neuroleptic malignant syndrome And Intractable seizure disorders

NOTE: There are no absolute contraindications.

There are few relative contraindications. Few of them are

• Acute respiratory infection
• A history of recent myocardial infarction (within 3 months and depending on severity)
• Uncontrolled cardiac failure