Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-g7b4s Total loading time: 0 Render date: 2025-04-29T20:25:12.390Z Has data issue: false hasContentIssue false

Chapter 22 - Practical Aspects of ECT

Published online by Cambridge University Press:  27 June 2019

By
Ross A Dunne ,
Alex O’Neill-Kerr ,
Declan M McLoughlin  and
Jonathan Waite
Edited by
I. Nicol Ferrier  and
Jonathan Waite
I. Nicol Ferrier
Affiliation:
University of Newcastle upon Tyne
Jonathan Waite
Affiliation:
University of Nottingham
Get access

Summary

The Royal College of Psychiatrists recommends that a specially designated space for ECT treatment should be available (ECTAS, 2018). As the number of patients being referred for ECT continues to decline (Buley et al., 2017) the availability of ECT for patients who require it may be compromised. The College ECT Committee is supportive in helping clinics to find alternative treatments for depression which may be delivered in the ECT centre. A number of centres already provide additional services to ECT, for example clozapine and depot clinics. ECT clinics are also used for the delivery of rTMS (Chapter 15) and ketamine infusions (Chapter 17).

Type
Chapter
Information
The ECT Handbook , pp. 183 - 201
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

AAGBI (2015) Recommendations for standards of monitoring during anaesthesia and recovery 2015. Association of Anaesthetists of Great Britain & Ireland.Google Scholar
Benbow, S. M., Benbow, J. & Tomenson, B. (2003) Electroconvulsive therapy clinics in the United Kingdom should routinely monitor electroencephalographic seizures. Journal of ECT, 19, 217–20.Google Scholar
Bickerton, D., Worrall, A. & Chaplin, R. (2009) Trends in the administration of electroconvulsive therapy in England. B J Psych Bull, 33, 61–3.Google Scholar
Brown, E. D., Lee, H., Scott, D. & Cummings, G. G. (2014) Efficacy of continuation/maintenance electroconvulsive therapy for the prevention of recurrence of a major depressive episode in adults with unipolar depression: a systematic review. Journal of ECT, 30, 195–202.CrossRefGoogle Scholar
Buley, N., Copland, E., Hodge, S., et al. (2017) A further decrease in the rates of administration of electroconvulsive therapy in England. Journal of ECT, 33, 198–202.Google Scholar
Chung, K. F. (2002) Relationships between seizure duration and seizure threshold and stimulus dosage at electroconvulsive therapy: implications for electroconvulsive therapy practice. Psychiatry and Clinical Neuroscience, 56, 521–6.Google Scholar
Cronholm, B. & Ottoson, J. O. (1996) Experimental studies of the therapeutic action of electroconvulsive therapy in endogenous depression. The role of the electrical stimulation and of the seizure studied by variation of stimulus intensity and modification by lidocaine of seizure discharge. Convuls Ther, 12, 172–94.Google Scholar
d’Elia, G. (1970) Unilateral electroconvulsive therapy. Acta Psychiatrica Scandinavica Suppl, 215, 1–98.Google ScholarPubMed
Dunne, R. A. & McLoughlin, D. M. (2012) Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression. World Journal of Biological Psychiatry, 13, 248–58.Google Scholar
ECTAS (2018) Standards for the administration of ECT, 14th edition. London, Royal College of Psychiatrists.Google Scholar
ECTAS 6th National Report (2016) London, Royal College of Psychiatrists.Google Scholar
Enns, M., Peeling, J. & Sutherland, G. R. (1996) Hippocampal neurons are damaged by caffeine-augmented electroshock seizures. Biol Psychiatry, 40, 642–7.Google Scholar
Fink, M., Petrides, G., Kellner, C., et al. (2008) Change in seizure threshold during electroconvulsive therapy. Journal of ECT, 24, 114–16.Google Scholar
Freeman, C. P. (ed.) (1995) The ECT Handbook: The Second Report of the Royal College of Psychiatrists’ Special Committee on ECT (Council Report CR39). Royal College of Psychiatrists.Google Scholar
Geschwind, N. & Levitsky, W. (1968) Human brain: left–right asymmetries in temporal speech region. Science, 161, 186–7.Google Scholar
Guy, W. & Bonato, R. R. (1976) ‘CGI: Clinical Global Impressions’. In, ECDEU Assessment Manual for Psychopharmacology. National Institute for Mental Health.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23, 56–62.Google Scholar
Hardy, S., Cornish, J., Leyden, J., et al. (2015). Should nurses administer ECT? Journal of ECT, 31, 207–8.Google Scholar
Husain, M. M., Rush, A. J., Fink, M., et al. (2004) Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. Journal of Clinical Psychiatry, 65, 485–91.Google Scholar
Janakiramaiah, N., Motreja, S., Gangadhar, B. N., et al. (1998) Once vs. three times weekly ECT in melancholia: a randomized controlled trial. Acta Psychiatrica Scandanavica, 98, 316–20.Google Scholar
Jelovac, A., Kolshus, E. & McLoughlin, D. M. (2013) Relapse following successful ECT for major depression: a meta-analysis. Neuropsychopharmacology, 38, 2467–74.CrossRefGoogle ScholarPubMed
Kales, H., Raz, J., Tandon, R., et al. (1997) Relationship of seizure duration to antidepressant efficacy in electroconvulsive therapy. Psychological Medicine, 27, 1373–80.CrossRefGoogle ScholarPubMed
Kellner, C. H., Knapp, R., Husain, M. M., et al. (2010) Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. British Journal of Psychiatry, 196, 226–34.Google Scholar
Kellner, C. H., Husain, M. M., Knapp, R. G., et al. (2016a) Right unilateral ultrabrief ECT in geriatric depression: Phase 1 of the PRIDE Study. Am J Psychiatry 2016, 1101–09.Google Scholar
Kellner, C. H., Husain, M. M., Knapp, R. G., et al. (2016b) A novel strategy for continuation ECT in geriatric depression: Phase 2 of the PRIDE Study. Am J Psychiatry, 2016, 1110–18.Google Scholar
Kellner, C. H. & Farber, K. G. (2016) The role of bilateral ECT when right unilateral ECT is inferior. American Journal of Psychiatry, 173, 731.Google Scholar
Kellner, C. H., Farber, K. G., Chen, X. R., et al. (2017) A systematic review of left unilateral ECT. Acta Psychiatr Scand, 136, 166–76.Google Scholar
Knecht, S., Drager, B., Deppe, M., et al. (2000) Handedness and hemispheric language dominance in healthy humans. Brain, 123, 2512–18.CrossRefGoogle ScholarPubMed
Kolshus, E., Jelovac, A. & McLoughlin, D. (2017) Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials. Psychological Medicine, 47, 518–30.CrossRefGoogle ScholarPubMed
Krystal, A. D., Coffey, C. E. & Weiner, R. D. (1998) Changes in seizure threshold over the course of ECT affect therapeutic response and are detected by ictal EEG recordings. J Neuropsychiatry & Clin Neurosci, 10, 178–86.Google Scholar
Kurinji, S. & Andrade, C. (2003) ECS seizure threshold: normal variations, and kindling effects of subconvulsive stimuli. Journal of ECT, 19, 31–7.CrossRefGoogle ScholarPubMed
Lambourn, J. & Gill, D. (1978) A controlled comparison of simulated and real ECT. British Journal of Psychiatry, 133, 514–19.Google Scholar
Letemendia, F. J., Delva, N. J., Rodenburg, M., et al. (1993) Therapeutic advantage of bifrontal electrode placement in ECT. Psychological Medicine, 23, 349–60.CrossRefGoogle ScholarPubMed
Lin, C. H., Chen, M. C., Yang, W. C. & Lane, H. Y. (2016) Early improvement predicts outcome of major depressive patients treated with electroconvulsive therapy. Eur Neuropsychopharmacol, 26, 225–33.Google Scholar
Lisanby, S. H., Sampson, S., Husain, M. M., et al. (2008) Towards individualised post-electroconvulsive therapy care: piloting the Symptom-Titrated, Algorithm-Based Longitudinal ECT (STABLE) intervention. Journal of ECT, 24, 179–82.Google Scholar
Loo, C. K. Simpson, B. & MacPherson, R. (2010) Augmentation strategies in electroconvulsive therapy. Journal of ECT, 26, 202–7.Google Scholar
McAllister, M., Crabb, J., Brodie, D. & Krishnadas, R. (2011) Effect of closing ECT facilities on electroconvulsive therapy use in Glasgow. Journal of ECT, 27, 131–3.Google Scholar
McCall, W. V., Shelp, F. E., Weiner, R. D., et al. (1993) Convulsive threshold differences in right unilateral and bilateral ECT. Biological Psychiatry, 34, 606–11.Google Scholar
McCall, W. V., Reboussin, D. M., Weiner, R. D., et al. (2000) Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Archives of General Psychiatry, 57, 438–44.Google Scholar
McLoughlin, D. M. (2016) Addressing crossover of high-dose right unilateral ECT to bitemporal ECT. American Journal of Psychiatry, 173, 731–2.Google Scholar
Montgomery, S. A. & Åsberg, M. (1979) A new depression rating scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–9.Google Scholar
National Institute for Health and Care Excellence (NICE) (2016) Depression in adults: recognition and management. London: NICE ISBN: 978-1-4731-2712-8.Google Scholar
Nordenskjöld, A., von Knorring, L., Ljung, T., Carlborg, A., Brus, O. & Engström, I. (2013) Continuation electroconvulsive therapy with pharmacotherapy versus pharmacotherapy alone for prevention of relapse of depression: a randomized controlled trial. J ECT, 29, 86–92.Google Scholar
O’Neill-Kerr, A., Yassin, A., Rogers, S., et al. (2017) Switching from age-based stimulus dosing to dose titration protocols in electroconvulsive therapy: empirical evidence for better patient outcomes with lower peak and cumulative energy doses. Journal of ECT, 33, 181–4.Google Scholar
Royal College of Anaesthetists (2016) Guidelines for the provision of anaesthetic services (GPAS). Royal College of Anaesthetists.Google Scholar
Royal College of Physicians (2015) List of equipment needed by an MDT for inpatient obesity patients. In, Action on obesity: Comprehensive care for all; p 20. London: Royal College of Physicians.Google Scholar
Sackeim, H. A., Decina, P., Kanzler, M., et al. (1987a) Effects of electrode placement on the efficacy of titrated, low-dose ECT. American Journal of Psychiatry, 144, 1449–55.Google Scholar
Sackeim, H. A., Decina, P., Portnoy, S., et al. (1987b) Studies of dosage, seizure threshold, and seizure duration in ECT. Biological Psychiatry, 22, 249–68.Google Scholar
Sackeim, H. A., Decina, P, Prohovnik, I., et al. (1987c) Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments. Arch Gen Psychiatry, 44, 355–60.Google Scholar
Sackeim, H. A., Devanand, D. P. & Prudic, J. (1991) Stimulus intensity, seizure threshold, and seizure duration: impact on the efficacy and safety of electroconvulsive therapy. Psychiatric Clinics of North America, 14, 803–43.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Prudic, J., Devanand, D. P., et al. (1993) Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New England Journal of Medicine, 328, 839–46.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Prudic, J., Devanand, D. P., et al. (2000) A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry, 57, 425–34.Google Scholar
Sackeim, H. A., Prudic, J., Fuller, R., et al. (2007) The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244–54.Google Scholar
SEAN (Scottish ECT Accreditation Network) (2016) Annual Report 2016. NHS National Services Scotland.Google Scholar
Semkovska, M., Keane, D., Babalola, O., et al. (2011) Unilateral brief-pulse electroconvulsive therapy and cognition: effects of electrode placement, stimulus dosage and time. Journal of Psychiatric Research, 45, 770–80.Google Scholar
Tor, P.-C., Bautovich, A., Wang, M.-J., et al. (2015). A systematic review and meta-analysis of brief versus ultrabrief right unilateral electroconvulsive therapy for depression. Journal of Clinical Psychiatry, 76, 1092–8.Google Scholar
UK ECT Review Group (2003) Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet, 361, 799–808.Google Scholar
Whittaker, R., Scott, A. & Gardner, M. (2007) The prevalence of prolonged cerebral seizures at the first treatment in a course of electroconvulsive therapy. Journal of ECT, 23, 11–13.CrossRefGoogle Scholar
Woodcock, H. M., Cornish, J., Vaughan, J. J. et al. (2015) The development and use of a modified WHO checklist for use in ECT. Journal of ECT, 31, 83–6.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×