Electroconvulsive therapy

Extent of clinical use of ECT varies cross-nationally. Many psychiatrists, including ourselves, use it as a first choice treatment in severe depression with psychomotor retardation or mood-congruent depressive delusions. Alternatively an antidepressant may be tried, with a change to ECT if there is poor response or worsening. ECT is also appropriate for moderately severe depressions which have not responded to one or two courses of antidepressant.

An alternative to ECT for the treatment of psychotic (delusional) depression with mood-congruent delusions is combination of neuroleptic and antidepressant. Spiker et al. (89> report that only 35 per cent of psychotic depressions responded to tricyclics alone, but 80 per cent responded to tricyclics plus antipsychotic medications. Neuroleptic-antidepressant combinations are also indicated where there are non-mood-congruent delusions or schizoaffective symptoms.

In the United Kingdom, the Royal College of Psychiatrists(90) has made detailed recommendations on administration of ECT, including equipment, anaesthesia, and the use of stimulus dose titration to achieve a moderately suprathreshold dose.

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