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Depression is a common disease, a reason for a suffer for more and more people in every age. Every case can have another reason, can require an another course of treatment. Depending on the severity of depression is ordered neither only psychotherapy or combined psychotherapy with the neuro-pharmacotherapy. In a lot of countries is admitted a controversial type of treatment, based on electric controlled trigger off seizure, used by therapy-resistant depression, bipolar disorder, psychosis, schizophrenias, mania. (1)
Electroconvulsive therapy (ECT) is one of the most successful somatic intervention used in psychiatry. During the procedure by the patients under an anesthesia is triggered a seizure attack with short electric impulses. The therapy enable a reducing of frequency of recidivisms, reduces or removes psychotic and catatonic episodes, in some cases can come to total relinquish of pharmacotherapy. In a lot of cases can come to recovery, in those situations the therapy should be stopped. The side effects of the procedure may stay for a days ,maximal few weeks after the treatment. However the symptoms of the disease can appear again after cycle of ECT, then the ECT has only anti-recidivism efficacy. (2,3)
With the time more and more doctors become convinced to electroconvulsive therapy, there is much fewer counterarguments against ECT. The all of controversies, about that way of treatment, come from false thinking, that the ECT can lead to the personality changes. That fear is completely groundless, what can be proved by 75-years-old therapy usage history. (1)
,br/>The patient, before starting the treatment must be investigated under a lot of aspects, from routine labour diagnostic, through EEG, until to dental status diagnostic or another tests required by corresponding disorders. By therapy-resistant depression should be described the severity of disease (egg. according to Hamilton scale). A cognitive status is based on Mini Mental Test result. (1)
The patient stay with an empty stomach, short before ECT electrodes putting on, is done EEG test, the patient is controlled by ECG and pulse-saturation registration. After dose of anesthetic the patient fall asleep, his muscle become relaxed, between the lips must be put a security trochlea to prevent collapsing of the airways.
The most common anesthetics is Propofol, rarer one of the barbiturates – Methohexital. They are used, despite of the effects such as elevating seizure threshold and reducing of convulsion duration. The period of anesthesia effectiveness by dose 0,75-1 mg/kg is 2-8 minutes. After the procedure the patient is monitored in a special area for a 35-45 minutes. (1)
The electrodes are put on a special places bitemporal (that way may lead to reducing of cognitive functions, in a case of one-site electrodes it comes to improve of cognitive functions by the patients with severe depression), in some of centers there are used bifrontal electrodes. The most common way is to use of one-site electrodes, there is the fewest side effects of treatment (one electrode is in the place of parietal lobe, the second – temporal lobe). The electric impulses last 0,5-1,5 ms.
The side effects of therapy come once to 50 000 cases, what makes the ECT the most safe procedure under an anesthesia. The most dangerous risk are aspiration of chyme, by the patients, who did not stay with an empty stomach, there also comes to cardiologic disturbances. Generally the therapy is very good accepted by the patients, that is also true by the elderly patients with the systemic disorders. The most common side effects are headache, especially with a pressure character, sometimes comes to nausea, emesis, muscle ache, dizziness.
After the ECT therapy comes to reducing of frequency, severity of disease episodes, the suicide rate falls about 80 % by the patients. In the cases of depression is the lower dose of anti-depressives needed, in the cases of psychosis – the lower dose of narcoleptics. Sometimes can come to resign of pharmacologic therapy or to recovery. However, despite of so good effects, the procedure is not so common by depression treatment, it is a pity, because it could perhaps improve the life of a lot of patients without a long therapy, associated with side effects of psychoactive drugs.
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Written by: Magdalena Chorążka
Source:
1. Elektrokrampftherapie – Indikation, Durchführung und Behandlungsergebnisse. H.W. Folkers, Nervenarzt 2011.82:93-103
2. Intensivkurs Psychatrie Und Psychotherapie, Brunnhuber S. et all, Elsevier Urban&Partner 2004,
3.http://de.wikipedia.org/wiki/Depression
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