Electroconvulsive therapy and treatment of depression

Electroconvulsive therapy has a proven mechanism of action. When using it, the level of norepinephrine and other catecholamines in the hippocampus, frontal cortex, and basal ganglia increases. Dopamine secretion is increased in the striatum.

The indications for the appointment of electroconvulsive therapy (ECT) are:

  • depression in the context of bipolar disorder and paroxysmal schizophrenia; 
  • resistant depressive states.

There are emergency and routine indications for ECT. Emergency indications include:

  • depression with strong motor response and physical exhaustion;
  •  depression with thoughts of sinfulness and suicidal intentions;
  • stuporous depression with longing and refusal to eat;
  • depression with motor retardation, self-blame;
  • depression with Kotard’s delusions (nihilistic statements).

Emergency indications for ECT include:

  • depression with hypochondriacal delirium;
  • depression with paranoid elements.

Before ECT, it is necessary to determine the somatic and neurological status. The patient is examined for a general analysis of blood, urine, EGC, blood biochemical parameters. Consultations are carried out: therapist, ophthalmologist, neuropathologist, gynecologist. X-rays of the spine are taken. 

Contraindications for ECT are: 

  • fevers of an inflammatory nature;
  • heart defects;
  • arrhythmias;
  • aortic aneurysm;
  • tuberculosis;
  • bronchial asthma;
  • osteoporosis;
  • osteomyelitis;
  • ulcerative bleeding;
  • organic lesions of the brain;
  • glaucoma.

Electroconvulsive treatment of depression is carried out using anesthesia, muscle relaxants, atropine, which reduces the risk of complications. And it is a necessary procedure in the treatment of drug-resistant depression. 

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