Ect how many

Reports of the response of catatonia to 1 induced seizure are noted by Fink and Taylor. Thomas and Kellner 10 reported remission of severe obsessive-compulsive disorder and depression symptoms after a single unilateral session of low-dose ECT. Although unusual, these cases underscore the potentially special efficacy of the first ECT session.

Unfortunately, patients who have considerable symptom improvement after the first ECT session and who would be expected to do very well, never look as good as they did after that first treatment. The reasons underlying such a trajectory of symptom persistence are not yet understood. What does the speed of response tell us about the mechanisms of action of ECT? Clearly, in certain patients, the neurobiological changes induced by ECT include almost immediate alterations in brain systems that regulate mood and affect.

There is evidence to demonstrate that, overall, bipolar patients require fewer ECT sessions than unipolar patients. Longer-term changes, such as synaptogenesis and neuronal regeneration, may also occur and contribute to the antidepressant and antipsychotic effects of ECT. The discovery of reliable biomarkers for ECT response would be a boon-both in furthering our understanding of mechanisms of action and in our ability to determine when an individual patient has had an adequate course of ECT.

To date, the closest the field has come to such a biomarker is the DST. When a patient is urgently ill eg, suicidal, catatonic, malnourished , this feature of the treatment may be lifesaving. Sometimes the rapid effectiveness of ECT may be used to help a patient and family with an important but nonmedically critical situation. The patient was quickly readied for her first ECT, which was given the day before the wedding.

To that end, it is important to ensure that ECT is not relegated to the bottom of our treatment algorithms-the last resort option-while patients try sequential trials of antidepressant medications that may be less effective and slower- acting than ECT. The efficiency of ECT, I: response rate in depressive episodes. Shapira B, Lerer B. People suffering from bipolar disorder and schizophrenia may also benefit from ECT.

Before ECT, patients are asked not to eat or drink from midnight the night before treatment. During the procedure, the patient receives a short acting anesthetic agent which puts the patient to sleep for approximately minutes. Two of these electrodes are for monitoring the brain waves. The other two are for delivering a short, controlled set of electrical pulses for a few seconds.

The electrical pulses must produce a generalized seizure to be effective. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current. Patients awaken about 5 to 10 minutes after the end of the treatment. Patients are then moved to the recovery room and remain there until their blood pressure, pulse and breathing return to their pre-treatment levels.

Kolar D. Current status of electroconvulsive therapy for mood disorders: A clinical review. Evidence-Based Mental Health. Weiner RD, et al. Key updates in the clinical application of electroconvulsive therapy. International Review of Psychiatry.

Rasmussen KG, et al. An open-label, pilot study of daily right unilateral ultrabrief pulse electroconvulsive therapy. Journal of ECT. Acharya D, et al. Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia. International Journal of Geriatric Psychiatry. Geduldig ET, et al. Electroconvulsive therapy in the elderly: New findings in geriatric depression. Current Psychiatry Reports. Depression basics. Rasmussen KG Jr expert opinion.

Mayo Clinic, Rochester, Minn. After a patient is put to sleep, his or her muscles are paralyzed and oxygen is administered by mask intubation is rarely required. A small amount of electricity is then used to generate a generalized seizure of about seconds duration. The maximum amount of electricity we use is joules, though most patients require much less than this. Defibrillation is around joules.

Most patients require 6 to 12 total treatments. ECT is frequently given on an outpatient basis, though at UNC we often start patients as an inpatient. This is especially true for older patients or patients with complicated medical problems so that they may be monitored for any unusual response to ECT, including the extent of memory impairment if any or other side effects.

See below. Side effects of ECT can be divided into those due to the anesthesia and those due to the treatment itself. Nausea is sometimes seen as a result of sensitivity to the anesthetic agents used.

Muscle aches from the paralytic agents is not uncommon as well. Post treatment sedation is of course not unexpected. Patients often get post-treatment headaches probably due to vasodilatation. All of these side effects can usually be successfully managed by medications as necessary. The biggest concern most people have about ECT is the potential for memory loss. It is normal to have some impairment in memory after a seizure. For example, a person may forget what happened right before the seizure retrograde amnesia and have trouble remembering what happened in the time period right after waking up anterograde amnesia.

This is to be expected in all persons to some degree and is the same phenomenon seen in individuals with epileptic grand-mal seizures.