What is the role of electroconvulsive therapy (ECT) in the treatment of the elderly?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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Answer

Geriatric patients can be particularly sensitive to adverse effects from daily medications, including psychotropic medications. The use of ECT in the elderly population may reduce risks associated with polypharmacy if the number of psychotropic medications can be reduced. A high proportion of patients who receive ECT are in the geriatric age group. [1] In elderly patients, ECT has been used to treat catatonia, [78] bipolar mania, [79] and psychotic disorders. [78]

Generally, geriatric patients with depression have better outcomes with ECT than do younger patients. [1] ECT is especially indicated for patients with depression who are at risk for harm because of psychosis, suicidal ideation, or severe malnutrition, [80, 81, 82] but it is also helpful for treatment-resistant nonpsychotic major depression. [83, 84]

Seizure threshold may rise with increasing age, and effective seizures may be hard to induce. [1] Geriatric patients may be at a higher risk for persistent confusion and greater memory deficits during and after ECT. [1]


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