Recognizing and Treating Depression in the Elderly

Mark D. Miller, MD

Medscape Psychiatry & Mental Health eJournal. 1997;2(2) 

In This Article

Treatment -- ECT

Electroconvulsive therapy (ECT) is a very effective treatment for depression; it is usually undertaken after several medication trials have failed or when a patient is severely suicidal. In 1938, the question of inducing a seizure as a treatment for depression was explored after it was noted that epileptic patients who were depressed showed a marked improvement in mood after a seizure. Treatment with ECT for depression was found to be successful.[61]

Typically, 6 to 12 ECT treatments are required for an antidepressant response. Maintenance antidepressant medication is begun upon completion. Unilateral ECT causes less memory loss and confusion compared with bilateral ECT and is attempted first. Patients with coexisting dementia are prone to post-ECT confusion and may require a longer time interval between treatments. Some centers offer outpatient maintenance ECT for patients who cannot be stabilized on antidepressant medication.

A common myth is that ECT causes permanent memory damage. The seizure induced by ECT certainly causes temporary interference with the laying down of new memory, such that patients often have impaired recall of events experienced immediately prior to their ECT treatment. However, long-term follow-up studies have not demonstrated any difference in memory at 6 months after a completed course of ECT, compared with baseline.[62,63]

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