Posted by Elizabeth on March 23, 2002, at 13:00:10
In reply to Re: Anyone had success with ECT?ISO M Shelli R, posted by OldSchool on March 18, 2002, at 20:26:15
Hi everyone. I was just looking through this thread concerning indications for ECT.
It's true that ECT is mainly reserved for situations when medications don't work. ECT is very effective for major depression *in general*. However, it's more effective for some types of depression than others.
The main types of depression for which ECT is known to be especially effective are severe depressions with melancholic and/or psychotic features. These types of depression usually (not always) respond well to medications, though (in the case of psychotic depression, an antipsychotic drug is almost always necessary in addition to an antidepressant). ECT is sometimes used when the risk of suicide and/or starvation (or serious malnutrition) is immediate enough that it would be too dangerous to wait for an antidepressant to start working. (There are also some rapid-acting medications, such as antipsychotics, benzodiazepines, stimulants, and opioids, that may be used temporarily to keep the depression under control while waiting for an antidepressant to work.) In the past ECT has been used when medications were contraindicated for safety reasons; because of the discovery of safer ADs, I don't think that this situation comes up much anymore. (In the past, MAOIs were sometimes used as an alternative when TCAs were contraindicated, since MAOIs do not cause the potentially dangerous cardiovascular side effects that are seen with TCAs. If antidepressant medication in general was contraindicated -- for example, in pregnancy -- or if MAOIs didn't work, ECT was often used.)
Atypical depressions and depressions associated with personality disorders are frequently resistant to usual medication treatments; such depressions can be very severe, as well. But ECT is generally *not* an effective treatment for these types of depression. ECT is similarly ineffective for dysthymia (which, although not severe, can cause quite a bit of impairment and is sometimes refractory to medication treatments).
Many depressions don't meet the criteria for "melancholic" or for "atypical" features. It's not clear how well ECT works in these cases; because they are so heterogeneous, it's probably impossible to make any prediction. My guess is that it would be worth trying ECT in severe refractory cases of "undifferentiated" depression [not a technical term, just my word for it], particularly if the depression has features that somewhat resemble melancholia (e.g., melancholic-like neurovegetative signs with reactive mood).
In addition to depression, ECT is used to treat bipolar disorder (including mania) and schizophrenia. In bipolar disorders, ECT can be used to quiet down an acute manic or mixed episode (something that often can't wait; mixed states, in particular, are associated with a high degree of suicidality), as well as relieving depression (although, interestingly, ECT can trigger mania or hypomania when used to treat bipolar depression -- I think it's less likely to than antidepressants are, tho'). We don't have much information on the use of ECT for rapid-cycling bipolar disorder. Using ECT to treat episodes in bipolar disorder can be awkward since you can't take anticonvulsants while having ECTs!
ECT is effective for catatonic states, which occur in both mood disorders and schizophrenia and which aren't always treatable with medications.
In schizophrenia, ECT works best if the illness has been of brief duration, rather than chronic. ECT is used sometimes as an adjunct to antipsychotic medication in partial responders; by itself, it's less effective than antipsychotic drugs.
It's not clear when, if ever, bilateral ECT should be tried before unilateral.
poster:Elizabeth
thread:97068
URL: http://www.dr-bob.org/babble/20020322/msgs/99643.html