1. ELECTROCONVULSIVE THERAPY

2. ECT mechanism of action
Decrease of cerebral metabolism markedly in the frontal lobe
Changes in NT receptors
- Down regulation of postsynaptic beta adrenergic receptors
Changes in second messenger systems
- G-proteins
- Adenylyl cyclase
- Phospholipase c
- calcium

3. ECT Indications MDD Severe with melancholic feature
With psychotic symptoms
With suicidal thoughts and plan
Refusion of eating
Manic episodes
Dangerous level of exhaustion
severe
Schizophrenia
With marked positive symptoms
Catatonia
Pregnancy
No tolerance to drugs
Drug contraindications
Geriatric and medically ill patients
delirium

4. ECT Pretreatment Evaluations
Blood and urine chemistries
CXR
ECG
Dental examination
Brain imaging if indicated

5. ECT Premedications Muscarinic anticholinergic drugs Anesthetics
Muscle relaxants

6. ECT Bilateral or unilateral electrode placement
Inducing seizures at least 25 sec.
Number of ECT treatments
Maintenance treatment
Contraindications
Mortality

7. ECT Adverse Effects Headache Delirium Memory impairment Break teeth
Back pain
Nausea, vomiting
Muscle soreness