title: Decreasing adverse outcomes of unmodified electroconvulsive therapy: suggestions and possibilities.
abstract: Electroconvulsive therapy (ECT) is far and away the most effective treatment for depression and quite effective for a range of other psychiatric conditions that are unresponsive to medication. Electroconvulsive therapy in the developed world has been administered with anesthesia, muscle relaxants, and ventilation since the mid-1950s following 20 years of unmodified treatment. However, in much of the developing world, ECT continues to be administered unmodified because of lack of resources. We review the efficacy of unmodified compared with modified treatment. We also review the potential drawbacks of unmodified treatment including fear and anxiety, worse postictal confusion, fracture risk, and the negative effects of unmodified treatment on how ECT is perceived in the general community. Finally, we consider potential solutions in developing countries to minimize adverse outcomes of unmodified treatment by pretreating patients either with low-dose benzodiazepines or sedating, but not anesthetizing, dosages of anesthetic agents. Randomized controlled trials are necessary before either of these options could be considered an acceptable alternative to completely unmodified treatment when modified treatment is unavailable.
authors.affiliation: Department of Pschiatry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Jesus
authors.initials: J
authors.lastname: Gallegos
authors.forename: Punit
authors.initials: P
authors.lastname: Vaidya
authors.forename: Douglas
authors.initials: D
authors.lastname: D'Agati
authors.forename: Geetha
authors.initials: G
authors.lastname: Jayaram
authors.forename: Thai
authors.initials: T
authors.lastname: Nguyen
authors.forename: Adarsh
authors.initials: A
authors.lastname: Tripathi
authors.forename: Jitendra K
authors.initials: JK
authors.lastname: Trivedi
authors.forename: Irving M
authors.initials: IM
authors.lastname: Reti
mesh_terms: D000758:Anesthesia; D018686:Anesthetics, Intravenous; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D001569:Benzodiazepines; D003221:Confusion / Q000209:etiology; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D003906:Developing Countries; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods*; D005239:Fear; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives; D008723:Methohexital; D009125:Muscle Relaxants, Central; D015742:Propofol; D011595:Psychomotor Agitation / Q000209:etiology; D012306:Risk
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central; D001569:Benzodiazepines; D008723:Methohexital; D015742:Propofol