Somatic therapies: Electroconvulsive therapy

Abstract

Electroconvulsive therapy (ECT) is a somatic treatment procedure which involves the electrical induction of seizures as a treatment for psychiatric disorders. It remains one of the safest and most effective treatments for major depressive disorder. Late-life depressive disorder responds preferentially to ECT, and its efficacy is not hampered by the presence of vascular changes in the aging brain. It is highly effective in treating major depressive disorder with psychotic features, a common presentation in older adults. ECT acts quickly to achieve remission, an attribute which makes it very useful for an older adult whose life is in danger because of refusal of food or fluids or active suicidal ideation in the context of depressive disorders, psychotic disorders, catatonia, or other psychiatric illnesses. Although ECT, with its repeated episodes of brief anesthesia, seems like a particularly assertive form of treatment, it can be safer and easier to tolerate than pharmacotherapy for a frail elder. For these reasons, ECT is an essential tool of the geriatric psychiatrist. This chapter covers the history of ECT, its mechanism of action, risks associated with use of ECT, evaluation of patients for ECT, and ECT administration technique. It also reviews relevant literature related to efficacy for various indications of use, including geriatric depressive disorders and neurological disorders such as Parkinson disease. Management of older patients following completion of a course of ECT, including the use of maintenance ECT to prevent relapse, is also reviewed. Risks and side effects of ECT, including the risk of cognitive impairment, are also discussed. Cases and multiple choice questions have been included to help the reader integrate some of the theoretical concepts into clinical strategies for patient care.