ECT amp its use in depressive disorders Introduction ECT applies an electrical current to the human brain patient is under general anesthesia ID: 812433
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Slide1
Electoconvulsive Therapy (ECT) & it´s use in depressive disorders
Slide2IntroductionECT applies an electrical current to the
human
brain
(
patient
is
under
general
anesthesia
–
at
least
nowadays
)
A
general
seizure
is
induced
Slide3HistoryPhysicians observed that schizophrenic patient
improved
after a
seizure
At
first
attempted
to
induce
seizure
pharmacologically
In 1938
italian
physians
induced
the
first
seizure
by
electrical
current
Bone
fractures
were
common
before
the
development
of
muscle
relaxants
in
the
1950s
Slide4IndicationsMain Indication: severe depressive episodeOthers: bipolar
disorder
,
schizophrenia
,
schizoaffective
disorder
,
delirium
,
and
neuroleptic
malignant
syndrome
.
Slide5Mechanism of ActionIs in fact UNKNOWNBut biochemical
changes
within
the
brain
have
been
observed
:
Increase
release
of
monoamine
neurotransmitters
(i.e.
dopamine
,
serotonine
,
and
norepinephrine
)
Increase
release
of
hypothalamic
hormones
(
prolactin
, TSH,
endorphins
)
Decreased
metabolic
activity
in frontal
and
cingulate
cortex
Slide6Contraindications (no absolute ones)ECT causes transient increases in
blood
pressure
, pulse,
and
intracranial
pressure
Patient
should
be
evaluated
for
coronary
heart
disease
before
undergoing
ECT
Arterial
hypertension
should
be
well
controlled
As
well
as
heart
failure
and
valvular
heart
disease
Pulmonary
disease
(
with
respect
to
general
anesthesia
)
Neurologic
disease
(
brain
tumors
,
history
of
stroke
,
dementia
)
Slide7Adverse EffectsIt is a very safe
procedure
(
mortaliy
rate
of
0.004 %)
Aspiration
pneumonia
Fracture
–
especially
patients
with
osteoporosis
Dental
and
tongue
injuries
Headache
Nausea
Cognitive
impairments
(
memory
loss
,
thought
process
– transient, after 15
days
cognitive
improvement
!)
Slide8SHORT! RecapitulationUnipolar major depression:At least one
major
depressive
episode
(5 out 9
specified
symptoms
/
signs
)
NO
history
of
mania
(
minor
depression
: 1-3 out
of
9
symptoms
/
signs
)
Bipolar
disorder
At
least
one
major
depressive
episode
PLUS
one
episode
of
mania
or
hypomania
Slide9Slide10ECT in unipolar severe major depressive episodeIf treatment
with
two
or
three
antidepressants
fail
or
patient
cannot
tolerate
antidepressants
Special
considerations
:
pregnant
/
lactating
,
elderly
,
debilitated
,
patient
request
Indications
for
first-
line
therapy
:
Severe
suicidality
Catatonia
Severe
psychosis
Malnutrition
with
food
refusal
Slide11EfficacySuperior to any other treatment in severe
major
depressive
episode
(
remission
is
induced
in 70-90 %)
Citalopram
induces
remission
in 30 %
Imipramine
in 49%
Slide12Other conditions – bipolar disorderSevere major depressive episode (as
in unipolar
disorder
)
Mania
–
usually
responds
to
pharmacotherapy
– but:
manic
delirium
ECT
may
be
life
saving
Efficacy
in bipolar
disorder
: 78 % (
imipramine
59 %)
Slide13References: UPTODATE:Mojtabai R, Olfson M. National patterns in antidepressant treatment by psychiatrists and general medical providers: results from the national comorbidity survey replication. J Clin Psychiatry 2008; 69:1064.Marcus SC, Olfson M. National trends in the treatment for depression from 1998 to 2007. Arch Gen Psychiatry 2010; 67:1265.
Harman
JS, Veazie PJ, Lyness JM. Primary care physician office visits for depression by older Americans. J Gen Intern Med 2006; 21:926.
Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009; 374:609.
Cepoiu M, McCusker J, Cole MG, et al. Recognition of depression by non-psychiatric physicians--a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23:25.
American
Psychiatric
Association
.
Diagnostic
and
Statistical Manual
of
Mental
Disorders
,
Fifth
Edition (DSM-5), American
Psychiatric
Association
, Arlington, VA 2013.
Smith FA,
Levenson
JL, Stern TA.
Psychiatric
assessment
and
consultation
. In: The American
Psychiatric
Publishing
Textbook
of
Psychosomatic
Medicine
:
Psychiatric
Care
of
the
Medically
Ill
, Second Edition,
Levenson
JL. (Ed), American
Psychiatric
Publishing,
Inc
, Washington, DC 2011. p.3.
The ICD-10
Classification
of
Mental
and
Behavioral
Disorders
: Clinical
Descriptions
and
Diagnostic
Guidelines. http://
www.who.int
/
classifications
/
icd
/en/
bluebook.pdf
(
Accessed
on
December
04, 2013).
Regier
DA, Narrow WE, Clarke DE, et al. DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. Am J Psychiatry 2013; 170:59
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Yang
T, Dunner DL. Differential subtyping of depression. Depress Anxiety 2001; 13:11
.
Zimmerman
M, Ruggero CJ, Chelminski I, Young D. Clinical characteristics of depressed outpatients previously overdiagnosed with bipolar disorder. Compr Psychiatry 2010; 51:99.
Slide14References - continuedZimmerman M, Galione JN, Chelminski I, et al. Validity of a simpler definition
of
major
depressive
disorder
.
Depress
Anxiety
2010; 27:977.
Andrews G,
Slade
T, Sunderland M, Anderson T.
Issues
for
DSM-V:
simplifying
DSM-IV
to
enhance
utility
:
the
case
of
major
depressive
disorder
. Am J
Psychiatry
2007; 164:1784.
Zimmerman M, Galione JN, Chelminski I, et al. A simpler definition of major depressive disorder. Psychol Med 2010; 40:451.
Zimmerman M, Chelminski I, McGlinchey JB, Young D. Diagnosing major depressive disorder X: can the utility of the DSM-IV symptom criteria be improved? J Nerv Ment Dis 2006; 194:893.
Uher R, Payne JL, Pavlova B, Perlis RH. Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV. Depress Anxiety 2014; 31:459.
American
Psychiatric
Association
.
Diagnostic
and
Statistical Manual
of
Mental
Disorders
,
Fourth
Edition, Text Revision, American
Psychiatric
Association
, Washington, DC, 2000
.
McCullough
JP Jr, Klein DN, Keller MB, et al. Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): validity of the distinction. J Abnorm Psychol 2000; 109:419.
McCullough JP Jr, Klein DN, Borian FE, et al. Group comparisons of DSM-IV subtypes of chronic depression: validity of the distinctions, part 2. J Abnorm Psychol 2003; 112:614.
Klein DN, Shankman SA, Lewinsohn PM, et al. Family study of chronic depression in a community sample of young adults. Am J Psychiatry 2004; 161:646.