ECT

Question 1

indications for ECT

Answer 1

catatonia
severe mania
severe depressio

Question 2

what do you give before ECT

Answer 2

GA

muscle relaxant

Question 3

what tests preop before ECT

Answer 3

physical exam

Bloods, CXR, ECG

Question 4

How do you review meds before ECT

Answer 4

lower SSRI, not SNRI

lower other meds that change seizure threshold

Question 5

what are direct side effects of ECT (not anaesthetic)

Answer 5

Retrograde / anterograde amnesia
muscle pain, headache, nausea, confusion

most recover fully within 6 months

Question 6

outline. 2 types of ECT

Answer 6

bilat - lower threshold, more effective, but more side effects
unilat- higher threshold, less effective, fewer. cognitive side effects

Question 7

what is an absolute contraind for ECT

Answer 7

raised intracranial pressure

Question 8

how should you approach refractory depression

Answer 8

1. check med adherence
2. Switch antidepressant (initially to alternative SSRI, then other classes)
3. Refractory depression:
   
   • add mirtazapine to SSRI, lithium, antipsychotic
   • ECT