ECT

Renee Snow and Roy Perlis

A. Indications

· major depression +/- psychotic features; mania; refractory psychosis, catatonia

B. Contraindications

· absolute: none

· relative: unrepaired critical AS, ejection fraction <20%

C. Routine pre-ECT workup

· CBC, Electrolytes/BUN/Cr, U/A, CXR, EKG

D. Admitting orders

· consult somatic therapies, begin ECT

· NPO after midnight for ECT (remember IV hydration if needed)

· d/c or reduce benzodiazepines, anticonvulsants,

Lithium (causes confusion)

· for anxiety or insomnia, consider Trilafon, Benadryl, Vistaril

E. Major side effects

· encephalopathy: generally resolves within 24h; delirium workup

· memory loss: anterograde amnesia resolves within one month;

retrograde amnesia generally involves recent weeks.

· post-ECT headache: Tylenol; premedicate with PR Tylenol

F. Maintenance

· Significant relapse risk (>50% at 12 months) without medications

· Consider maintenance ECT

source: Welch CA (1997) ECT in the General Hospital. In: Cassem NH (ed.), MGH Handbook of General Psychiatry (4^th ed.)