Current Psychiatry Reports

, Volume 5, Issue 3, pp 225–230 | Cite as

Electroconvulsive therapy in the medically Ill

  • Eric J. Christopher


The use of electroconvulsive therapy (ECT) in the US continues to expand in the treatment of psychiatric disorders. Electroconvulsive therapy remains the “gold standard” for the treatment of major depression and a variety of other psychiatric and neurologic disorders. Because of the effectiveness and resurgence of ECT, more patients are considered good candidates for this treatment option. Overall, these patients are medication refractory and elderly, and thus more sensitive to polypharmacy. Additionally, these patients tend to have more coexisting medical problems, and often require that a practitioner have solid clinical knowledge of the fields of medicine and psychiatry. This article will review some of the most common comorbid conditions found in patients referred for ECT.


Chronic Obstructive Pulmonary Disease Atrial Fibrillation Status Epilepticus Labetalol Esmolol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Accornero F: An eyewitness account of the discovery of electroshock. Convuls Ther 1988, 4:40–49.PubMedGoogle Scholar
  2. 2.
    Rosenbach ML, Hermann RC, Dorwart RA: Use of electroconvulsive therapy in the Medicare population between 1987 and 1992. Psychiatr Serv 1997, 49:1537–1542.Google Scholar
  3. 3.
    Kelly KG, Zisselman M: Update on electroconvulsive therapy in older adults. J Amer Geriatrics Soc 2000, 48:560–566.Google Scholar
  4. 4.
    A Task Force Report of the American Psychiatric Association: The Practice of Electroconvulsive Therapy Recommendations for Treatment, Training, and Privileging, edn 2. Washington, DC: American Psychiatric Association; 2001. In this updated second edition, the task force provides the most upto-date recommendations in treatment with ECT. The entire process of ECT is reviewed—indications, pre-ECT evaluation, treatment, and aftercare. It includes a special chapter that deals with the medical patient and various other conditions including pregnancy. All practioners of ECT should own this book.Google Scholar
  5. 5.
    Lafferty JE, North CS, Spitznagel E, Isenberg K: Laboratory screening prior to ECT. J ECT 2001, 17:158–165.PubMedCrossRefGoogle Scholar
  6. 6.
    Abramczuk JA, Rose NM: Pre-anesthetic assessment and the prevention of post-ECT morbidity. Br J Psychiatry 1979, 134:582–587.PubMedCrossRefGoogle Scholar
  7. 7.
    Shiwach RS, Reid WH, Carmody TJ: An analysis of reported deaths following electroconvulsive therapy in Texas, 1993–1998. Psych Serv 2001, 52(8):1095–1097. Reveals data that helped support the use of ECT, as well as new estimates of mortality and morbidity.CrossRefGoogle Scholar
  8. 8.
    Scarano VR, Felthous AR, Early TS: The state of electroconvulsive therapy in Texas. Part I: reported data on 41,660 ECT treatments in 5971 patients. J Forensic Sci 2000, 45:1197–1202. Reveals data that helped support the use of ECT, as well as new estimates of mortality and morbidity.PubMedGoogle Scholar
  9. 9.
    Eagle KA, Brundage BH, Chaitman BR, et al.: Guidelines for perioperative cardiovascular evaluation for noncardiac surgery: report of the American College of Cardiology and American Heart Association Task Force on practice guidelines 1996. Circulation 1996, 93:1278.PubMedGoogle Scholar
  10. 10.
    Jiang W, Alexander J, Christopher E, et al.: Relationship of depression to increased risk of mortality and rehospitalization with congestive heart failure. Arch Intern Med 2001, 161:1849–1856.PubMedCrossRefGoogle Scholar
  11. 11.
    Frasure-Smith N, Lesparance F, Talajic M: Depression following myocardial infarction: impact on 6-month survival. JAMA 1993, 270:1819–1825.PubMedCrossRefGoogle Scholar
  12. 12.
    McCall WV: Asystole in electroconvulsive therapy: report of four cases. J Clin Psychiatry 1996, 57:199.PubMedGoogle Scholar
  13. 13.
    Burd J, Kettl P: Incidence of asystole in electroconvulsive therapy in elderly patients. Am J Geriatr Psychiatry 1998, 6:203.PubMedGoogle Scholar
  14. 14.
    Beyer JL, Weiner RD, Glenn MD: Electroconvulsive Therapy A Programmed Text, edn 2. Washington, DC: American Psychiatric Press; 1998. The self-paced, programmed review of ECT. It is essential for all physicians learning the practice of ECT, as well as an excellent review for the already experienced provider.Google Scholar
  15. 15.
    O’Brien PD, Morgan DH: Bladder rupture during ECT. Convuls Ther 1991, 7:56–59.PubMedGoogle Scholar
  16. 16.
    Irving AD, Drayson AM: Bladder rupture during ECT. Br J Psychiatry 1984, 144:670.PubMedGoogle Scholar
  17. 17.
    Tess A, Smetana GW: Medical consultation for electroconvulsive therapy. UpToDate volume 10 number 2. Scholar
  18. 18.
    Stoudemire A: Cardiovascular complications of ECT [letter]. Am J Psychiatry 1994, 151:790.PubMedGoogle Scholar
  19. 19.
    Castelli I, Steiner LA, Kaufann MA, et al.: Comparative effects of esmolol and labetalol to attenuate hyperdynamic states after electroconvulsive therapy. Anesth Analg 1995, 80:557–561.PubMedCrossRefGoogle Scholar
  20. 20.
    Fuenmayor AJ, El Fakih Y, Moreno J, Fuenmayor AM: Effects of electroconvulsive therapy on cardiac function in patients with out heart disease. Cardiology 1997, 88:254–257.PubMedGoogle Scholar
  21. 21.
    Kadoi Y, Saito S, Seki S, et al.: Electroconvulsive therapy impairs systolic performance of the left ventricle. Can J Anesth 2001, 48:405–408.PubMedGoogle Scholar
  22. 22.
    Lapid M, Rummans T, Hofmann V, et al.: ECT and automatic internal cardioverter-defibrillator. J ECT 2001, 17:146–148.PubMedCrossRefGoogle Scholar
  23. 23.
    Ottaway A: Atrial fibrillation, failed cardioversion, and electroconvulsive therapy. Anaesth Intensive Care 2002, 30:215–218.PubMedGoogle Scholar
  24. 24.
    Gardner MW, Kellner CH, Hood DE, Hendrix GH: Safe administration of ECT in a patient with a cardiac aneurysm and multiple cardiac risk factors. Convuls Ther 1997, 13:200–203.PubMedGoogle Scholar
  25. 25.
    Rasmussen KG: Electroconvulsive therapy in patients with aortic stenosis. Convuls Ther 1997, 13:196–199.PubMedGoogle Scholar
  26. 26.
    Lee HB, Jayaram G, Teitelbaum ML: Electroconvulsive therapy for depression in a cardiac transplant patient. Psychosomatics 2001, 42:362–364.PubMedCrossRefGoogle Scholar
  27. 27.
    Clary GL, Palmer SM, Doraiswamy PM: Mood disorders and chronic obstructive pulmonary disease: current research and future needs. Curr Psych Rep 2002, 4:213–221.CrossRefGoogle Scholar
  28. 28.
    Rasmussen KG: Electroconvulsive therapy in patients taking theophylline. J Clin Psychiatry 1993, 54:427–431.PubMedGoogle Scholar
  29. 29.
    Viguera A, Welch C, Bigatello L, Drop LJ: Hemodynamic responses to electroconvulsive therapy in a hypertensive patient with end-stage pulmonary fibrosis. Anesth Analg 1998, 87:737–741.PubMedCrossRefGoogle Scholar
  30. 30.
    Darnell JC, Jay SJ: Recurrent postictal pulmonary edema: a case report and review of the literature. Epilepsia 1982, 23:71–83.PubMedGoogle Scholar
  31. 31.
    Mulroy JJ, Mickell JJ, Tong TK, Pellock JM: Postictal pulmonary edema in children. Neurology 1985, 35:403–405.PubMedGoogle Scholar
  32. 32.
    Sinom RP: Physiologic consequences of status epilepticus. Epilepsia 1985, 26:S58-S66.Google Scholar
  33. 33.
    Terrence CF, Rao GR, Perper JA: Neurogenic pulmonary edema in unexpected, unexplained death of epileptic patients. Ann Neurol 1981, 9:458–464.PubMedCrossRefGoogle Scholar
  34. 34.
    Buisseret P: Acute pulmonary edema following grand mal epilepsy and as a complication of electric shock therapy. Br J Dis Chest 1982, 76:194–198.PubMedCrossRefGoogle Scholar
  35. 35.
    Wayne S, O’Donovan C, McCall W, et al.: Postictial neurogenic pulmonary edema: experience from an ECT model. Conv Therapy 1997, 13:181–184.Google Scholar
  36. 36.
    Chaturvedi S, Chadda RK, Rusia U, Jain N: Effect of electroconvulsive therapy on hematological parameters. Psychiatry Res 2001, 104:265–268.PubMedCrossRefGoogle Scholar
  37. 37.
    Petrides G, Fink M: Atrial fibrillation, anticoagulation, and electroconvulsive therapy. Convuls Ther 1996, 12:91–98.PubMedGoogle Scholar
  38. 38.
    Kardener SH: EST in a patient with idiopathic thrombocytopenic purpura. Dis Nerv Syst 1968, 29:465–466.PubMedGoogle Scholar
  39. 39.
    Gonzalez-Arriaza HL, Mueller PS, Rummans TA: Successful electroconvulsive therapy in an elderly man with severe thrombocytopenia: case report and literature review. J ECT 2000, 17:198–200.CrossRefGoogle Scholar
  40. 40.
    Sincoff RC, Giuffra LA, Blinder MA, Isenberg KE: Successful electroconvulsive therapy given to a patient with von Willebrand’s disease. J ECT 2000, 16:68–70.PubMedCrossRefGoogle Scholar
  41. 41.
    LaGrone D: ECT in secondary mania, pregnancy, and sickle cell anemia. Convuls Ther 1990, 6:176–180.PubMedGoogle Scholar
  42. 42.
    Nobler M, Sackeim H: Mechanisms of action of electroconvulsive therapy: functional brain imaging studies. Psychiatr Ann 1998, 28:23–29.Google Scholar
  43. 43.
    Patkar AA, Hill KP, Weinstein SP, Schwartz SL: ECT in the presence of brain tumor and increased intracranial pressure: evaluation and reduction of risk. J ECT 2000, 16:189-197. 44. Salaris S, Szuba MP, Traber K: ECT and intracranial vascular masses. J ECT 2000, 16:198–203.CrossRefGoogle Scholar
  44. 45.
    Saad DA, Black JL, Krahn LE, Rummans TA: ECT post eye surgery: two cases and a review of literature. J ECT 2000, 16:409–414.PubMedCrossRefGoogle Scholar
  45. 46.
    Madan S, Anderson K: ECT for a patient with a metallic skull plate. J ECT 2001, 17:289–291.PubMedCrossRefGoogle Scholar
  46. 47.
    Kohler CG, Burock M: ECT for psychotic depression associated with a brain tumor [letter to the editor]. Am J Psychiatry 2001, 158:2089.PubMedCrossRefGoogle Scholar
  47. 48.
    Moscarillo FM, Annunziata CM: ECT in a patient with a deep brain-stimulating electrode in place. J ECT 2000, 16:287–290.PubMedCrossRefGoogle Scholar
  48. 49.
    Saito S, Kadoi Y, Nara T, et al.: The comparative effects of propofol versus thiopental on middle cerebral artery blood flow velocity during electroconvulsive therapy. Anesth Analg 2000, 91:1531–1536.PubMedCrossRefGoogle Scholar
  49. 50.
    Wajima Z, Yoshikawa T, Ogura A, et al.: Intravenous verapamil blunts hyperdynamic responses during electroconvulsive therapy without altering seizure activity. Anesth Analg 2002, 95:400–402.PubMedCrossRefGoogle Scholar
  50. 51.
    Saito S, Kadoi Y, Iriuchijima N, et al.: Reduction of cerebral hyperemia with antihypertensive medication after electroconvulsive therapy. Can J Anesth 2000, 47:767–774.PubMedCrossRefGoogle Scholar
  51. 52.
    Weiner RD, Coffey CE, Krystal AD: Electroconvulsive therapy in the medical and neurologic patient. In Psychiatric Care of the Medical Patient, edn 2. Edited by Stoudemire A, Fogel BS. New York: Oxford University Press; 2000:419–428. This chapter fully details comorbid diseases present in patient receiving ECT. Organ systems and diseases include central nervous system disorders, cardiovascular diseases, endocrine, metabolic, hematologic, pulmonary, gastrointestinal, musculoskeletal, and ophthalmologic disorders; other conditions included are pregnancy and the elderly.Google Scholar
  52. 53.
    Rasmussen KG, Rummans TA, Richardson JW: Electroconvulsive therapy in the medically ill. Psychiatr Clin North Am 2002, 25:177–193. In this review, the focus of medical illnesses is answered with the following conditions in mind: is ECT effective in such medically ill patients? Does ECT cause deterioration in the medical condition? Does modification of technique lessen risk.PubMedCrossRefGoogle Scholar
  53. 54.
    Normand PS, Jenike MA: Lowered insulin requirements after ECT. Psychosomatics 1984, 25:418–419.PubMedGoogle Scholar
  54. 55.
    Reddy S, Nobler MS: Dangerous hyperglycemia associated with electroconvulsive therapy. Convuls Ther 1996, 12:99–103.PubMedGoogle Scholar
  55. 56.
    Finestone DH, Weiner RD: Effects of ECT on diabetes mellitus: an attempt to account for conflicting data. Acta Psychiatr Scand 1984, 70:321–326.PubMedGoogle Scholar
  56. 57.
    Netzel PJ, Mueller PS, Rummans TA, et al.: Safety, efficacy, and effects on glycemic control of electroconvulsive therapy in insulin-requiring type 2 diabetic patients. J ECT 2002, 18:16–21.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2003

Authors and Affiliations

  • Eric J. Christopher
    • 1
  1. 1.Departments of Internal Medicine and PsychiatryDuke University Medical Center and Durham Veteran’s AdministrationDurhamUSA

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