| The difficult-to-treat electroconvulsive therapy patient - Strategies for augmenting outcomes. | |
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MedLine Citation:
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PMID: 19647325 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Several treatment strategies for augmenting outcomes with ECT (concurrent antidepressant treatment, frequency of ECT treatments, hyperventilation and use of remifentanil) are discussed in the context of a difficult clinical case, accompanied by a review of the relevant existing literature. METHODS: Literature on the above aspects of ECT technique was identified via a PubMed search and was critically reviewed. RESULTS: There is preliminary evidence that concurrent administration of some antidepressant medications may be useful in the highly treatment resistant patient, though due attention should be given to potential risks in combining these with ECT; reduction of the treatment frequency to twice a week; hyperventilation prior to each treatment; and the use of remifentanil to minimise the dosage of induction anaesthetics with anticonvulsant properties, may be useful strategies to enhance seizure production in cases where a high or rapidly rising seizure threshold is a major impediment to ECT treatment. LIMITATIONS: It should be noted that empirical evidence for the effectiveness of each of the above strategies in producing better outcomes with ECT is not definitive, pointing to the need for further research in these areas. CONCLUSIONS: The above strategies may be useful in clinical ECT practice, particularly in patients who are apparently treatment resistant, but the practitioner should be aware that the level of evidence underpinning these approaches is at present, preliminary. |
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Authors:
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Colleen K Loo; Andrew Kaill; Pauline Paton; Brett Simpson |
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Publication Detail:
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Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Review Date: 2009-07-31 |
Journal Detail:
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Title: Journal of affective disorders Volume: 124 ISSN: 1573-2517 ISO Abbreviation: J Affect Disord Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-12 Completed Date: 2010-10-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7906073 Medline TA: J Affect Disord Country: Netherlands |
Other Details:
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Languages: eng Pagination: 219-27 Citation Subset: IM |
Copyright Information:
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Crown Copyright 2009. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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School of Psychiatry, University of N.S.W., Sydney, Australia. colleen.loo@unsw.edu.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anesthesia, General / contraindications*, methods* Anesthetics, Intravenous / administration & dosage* Anticonvulsants / adverse effects*, therapeutic use Antidepressive Agents / administration & dosage, adverse effects* Depressive Disorder, Major / physiopathology, therapy* Dominance, Cerebral / physiology Dose-Response Relationship, Drug Drug Interactions Drug Therapy, Combination Electroconvulsive Therapy / contraindications*, methods* Electroencephalography / drug effects Female Frontal Lobe / drug effects, physiopathology Humans Hyperventilation / physiopathology* Mental Status Schedule Piperidines / administration & dosage* Recurrence Retreatment / methods Suicide, Attempted / prevention & control, psychology Temporal Lobe / drug effects, physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 0/Anticonvulsants; 0/Antidepressive Agents; 0/Piperidines; 132875-61-7/remifentanil |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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