Other Treatments

Highlights
Introduction
Causes
Risk Factors
Complications of Depression
Diagnosis
Treatment
Antidepressants and Drug Treatment Guidelines
Psychotherapy
Other Treatments
Lifestyle Changes
Resources
References

Other Treatments

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is commonly called shock treatment. It has received bad press, in part for its potential memory-depleting effect. Since its introduction in the 1930s, ECT has been significantly refined, and is now considered to be the best treatment for severe depression. It is especially effective for patients with severe depression who experience delusions and hallucinations. Maintenance ECT may also help prevent relapse. In a 2000 study, continued use of ECT in responsive patients, along with long-term antidepressant use, prevented relapse in 73% of patients after 5 years compared to 18% in patients on antidepressants alone.

text continues below

Candidates for ECT. About 40,000 Americans receive ECT each year. Many are elderly women who are psychiatric inpatients. Many experts urge that ECT be used earlier in the course of major depression, although most insurers or HMOs will not pay for early treatment. ECT may be beneficial for the following patients with severe depression:

Patients who cannot, for any reason, take antidepressant drugs
Suicidal patients
Elderly patients who are psychotic and depressed
Pregnant women with severe depression
Patients with certain heart problems
Young patients who fit the adult criteria for ECT

The Procedure. In general, hospitalization is not necessary. ECT involves the following steps:

The patient receives a muscle relaxant and short-acting anesthetic.
A small amount of electric current is sent to the brain, causing a generalized seizure that lasts for about 40 seconds.
Most patients receive 6 treatments, spaced every 2 - 5 days. Others receive up to 15 treatments, followed by 6 - 12 additional treatments spaced every other week or longer for another 2 - 4 months.

This procedure is associated with a great deal of anxiety and the patient should be reassured. One form of ECT called right unilateral ECT (RUL ECT) may provide equal therapeutic benefits to more traditional bilaterally applied forms of the therapy, and more importantly, may have a less potentially deleterious effect on memory.