|Year : 2017 | Volume
| Issue : 2 | Page : 71-73
Electroconvulsive therapy: 80 NOT OUT
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||29-Dec-2017|
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Grover S. Electroconvulsive therapy: 80 NOT OUT. J Geriatr Ment Health 2017;4:71-3
Although convulsive therapy was used for the management of psychiatric disorders since the 16th century, electrical current was used for the first time to induce seizures in 1938 by Cerletti and Bini. Initial use of electroconvulsive therapy (ECT) among patients with various psychiatric disorders showed its beneficial effect, and it became a popular treatment. Psychopharmacological agents entered into the armamentarium of psychiatrists in the 1950s, and over the years, efforts have been made to improve the safety of various psychopharmacological agents without compromising the efficacy. With the emergence of psychopharmacological agents, over the years, ECT has lost its position in the psychiatry armamentarium and it is no more used as a first-line treatment for any of the psychiatric disorders. However, ECT is possibly the only somatic treatment which has survived for the last 8 decades, despite advancement in the pharmacotherapy and development of various schools of psychotherapies. One of the major reasons for reduction in the use of ECT is stigma attached to it. Media portrayal of it being used as a punishment and belief among general public that once ECT is given to a patient, then no other treatment works, etc., have contributed to the negative image of this very useful treatment. It can be said that till today, for a subgroup of patients, it is the only treatment which provides relief in their symptoms.
To counteract the negative image and the side effects of ECT, in its journey of 8 decades, ECT has also seen multitude of modifications such as use of unilateral ECT, use of modified ECT, use of brief and ultra-brief pulse current, and use of bifrontal electrode placement. All these technical modifications have made ECT safe, without compromising its efficacy. In contemporary clinical practice, modified ECT is a well-accepted treatment and is recommended as an important treatment modality for the management of various psychiatric disorders by clinical practice guidelines of various professional bodies.,
Since the beginning, ECT has been used among elderly patients. Available reports suggest that ECT has been used among elderly as old as 97 years of age. Some of the available data from the western countries suggest that although the use of ECT has reduced, but when the use is compared among various age groups, proportionate reduction is lower among elderly. In fact, as per some of the reports, elderly form the largest group of patients receiving ECT.,,
Elderly often have comorbid physical illnesses which at times preclude the use of various psychotropic medications. In such a situation, ECT is often the only treatment option, which is considered as safer than other available options. ECT is primarily used among elderly for management of severe depression. Besides this, ECT has also been used among elderly for the management of psychosis, dementia, catatonia, and motoric symptoms of Parkinson's disease. In terms of efficacy, elderly have been shown to respond to ECT better than individuals of other age groups.
Compared to Western countries, ECT is still more commonly used in Indian setting. In contrast to the Western countries, elderly form a small proportion of patients receiving ECT in a country like India. A survey of various teaching institutes and studies from India reveal that elderly constitute about 15% of all the patients who receive in teaching institute setting.,,
Data from India on the use of ECT among elderly are limited. There is only one published retrospective study, and there are few case reports which have reported the outcomes of elderly patients undergoing ECT. Accordingly, there is a need to expand the data on use of ECT from this country.
To commemorate the completion of 80 years of use of ECT in the clinical practice, the Executive Committee of Indian Association for Geriatric Mental Health decided to bring out a special issue on the use of ECT and brain stimulation among elderly. An effort was made to contact various researchers from India and few of the researchers from developed countries. It is hoped that this special issue will help in expanding the knowledge base about the efficacy of ECT among elderly in Indian setting. In addition, an effort has also been made to include some of the preliminary experience about various brain stimulation techniques among the elderly.
This issue includes four review articles. First review provides information about the available literature on the use of ECT among elderly in terms of efficacy/effectiveness. The second review deals with the anesthetic considerations and interaction with the psychotropic medications., The first review article shows that ECT is effective in elderly, especially in patients with depression, and is associated with side effects as seen among patients of other age groups. As modified ECT is becoming a norm in India, it is important for the practicing psychiatrists to have understanding about the anesthetic procedure and the medications. Little is known about interaction of psychotropic medications with the anesthetic medications. The second review article provides information about the anesthetic considerations while using ECT and also provides information about the interaction between psychotropic medications and the anesthetic medications. Newer brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are becoming popular, and it is important to understand the role of these treatment modalities among the elderly. The third review deals with the effectiveness of rTMS, mainly among elderly patients with depressive disorders. The fourth review focuses on the role of rTMS among patients with mild cognitive impairment. It is expected that these reviews will provide updated knowledge on the various topics, especially to the practicing clinicians and, for the researchers, will provide ideas for continuing with their research endeavors.
An article from the United States of America provides details of the ECT practices in this country and brings out the differences in the clinical practice.
As pointed out earlier, there is lack of effectiveness data and information about real-life practice of ECT among elderly patients with various mental disorders. A retrospective analysis of effectiveness of ECT from various centers provides a glimpse of the current clinical practice in different institutes.,,, Data from a center from Mumbai show that schizophrenia is the most common indication, whereas data from Bengaluru and Lucknow show that depression is the most common indication for the use of ECT among elderly patients.,, Data from Chandigarh center provide information about trends in use of ECT among elderly patients, and this article shows that over the years, there is increase in the proportion of elderly patients considered for ECT.
The issue also includes a case series on preliminary experience of use of rTMS among elderly patients. This case series suggests that elderly patients usually do not respond well to rTMS. A case report highlights the usefulness of tDCS among elderly patients with auditory hallucinations. Three case reports provide useful information on the use of ECT among elderly patients with dementia.,, One of these case reports shows that ECT has been rarely used for the management of catatonia among elderly patients with dementia. Another case report highlights the beneficial effect of ECT in the management of agitation in a patient with dementia.
The information compiled in this issue shows that ECT has an important role in the management of various psychiatric disorders among the elderly patients. However, still, there are many lacunae in the literature, and there is a need to further research on ECT and newer brain stimulation techniques.
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