A controversial but sometimes rapidly eﬀective treatment for cases of severe DEPRESSION, particularly where psychotic features are present (see PSYCHOSIS), or in high-risk patients such as suicidal or post-partum patients. ECT is only indicated after antidepressants have been tried and shown to be ineﬀective; the full procedure of treatment should be explained to the patient, whose consent must be obtained.
Before treatment, the patient will have been fasted for at least eight hours. After checking for any potential drug ALLERGY or interactions, the patient is given a general anaesthetic and muscle relaxants. Depending on the side of the patient’s dominance, either unilateral (on the side of the non-dominant hemisphere of the BRAIN) or bilateral (if dominance is uncertain,
e.g. in left-handed people) positioning of electrodes is used. Unilateral ECT has the advantage of being associated with less anterograde AMNESIA. When the current passes, the muscles will contract for approximately 10 seconds, with further tonic spasms lasting up to a minute. The patient should then be put in the COMA or recovery position and observed until fully conscious. Up to 12 treatments may be given over a month, improvement usually showing after the third session. Widely used at one time, the treatment is now given only rarely. It can be extremely frightening for patients and relatives and is not recommended for children.