Electroconvulsive Therapy

Electroconvulsive therapy (ECT) involves the passage of a small electric charge across the brain by electrodes applied to the frontotemporal aspects of the scalp with the aim of inducing a tonic-clonic seizure. Reference to it is made here principally to indicate its place in therapy. ECT requires the patient to be receiving a general anaesthetic, carrying the small risks equivalent to those associated with general anaesthesia in minor surgical operations. It may cause memory deficits although this is generally transient. For these reasons as well as the

1 Shelton R C et al 2001 Effectiveness of St. John's Wort in major depression. A randomised control trial. Journal of the American Medical Association 285:1978-1986

relative ease of use of antidepressant drugs, ECT is usually reserved for psychiatric illness where pharmacological treatments have been unsuccessful or where the potential for rapid improvement characteristic of ECT treatment is important. This may arise where patients are in acute danger from their mental state, for instance the severely depressed patient who has stopped eating or drinking. Modern-day ECT is a safe and effective alternative to pharmacological treatment and remains a firstline option in clinical circumstances where rapid response is desired, when it can be life-saving.

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