ECT: Physiology, Indications, and Treatment

2019 ◽  
Author(s):  
Max Fink
Keyword(s):  
Bipolar Disorder ◽  
Major Depression ◽  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Suicide Risk ◽  
Dementia Praecox ◽  
Brain Wave ◽  
Grand Mal ◽  
Key Words Anesthesia ◽  
Pituitary Glands

Inducing grand mal seizures (electroshock, electroconvulsive therapy) developed as an effective treatment to alleviate the psychosis of dementia praecox. Clinicians quickly recognized that seizures also relieved depressed moods, suicide risk, catatonia, manic excitement, and delirium. It is an unheralded, often stigmatized, medical achievement. Seizures may be induced chemically or with electric or magnetic currents. Grand mal seizures must be repeated for persistent benefits. Not all seizures are equally effective. Effective seizures are marked by bilateral electroencephalographic brain wave changes and neuroendocrine discharges from hypothalamic-pituitary glands. Treatments are remarkably safe, with zero mortality. Immediate effects on memory are common but are almost always transient. They are not a practical deterrent to the treatments, although they are widely cited to reject its use. The stigmatization of induced seizures that places it as a “last resort” therapy is wasteful and unethical. It offers a remarkable opportunity for advancement in neuroscience.  This review contains 4 figures, 3 tables, and 90 references. Key words: anesthesia, bipolar disorder, catatonia, delirium, electroconvulsive therapy, electroencephalography, major depression, melancholia, neuroendocrine, seizures

Major Depression in Down's Syndrome

1989 ◽  
Vol 155 (2) ◽  
pp. 202-205 ◽  
Author(s):  
A. C. Warren ◽  
S. Holroyd ◽  
M. F. Folstein
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Major Depression ◽  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Trisomy 21 ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Behavioural Deterioration

Five patients with trisomy 21 (Down's syndrome (DS)), referred to us for evaluation of dementia, were instead found to have major depression. All had shown cognitive and behavioural deterioration and this had led to a mistaken diagnosis of Alzheimer's disease in two. We outline and contrast the features of major depression and Alzheimer's disease in DS, and suggest that electroconvulsive therapy is an effective treatment for major depression in DS.

Borderline Personality Disorder and Mood Disorders

2017 ◽  
Author(s):  
Eric A. Fertuck ◽  
Megan S. Chesin ◽  
Brian Johnston
Keyword(s):  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Borderline Personality Disorder ◽  
Major Depression ◽  
Personality Disorder ◽  
Mood Disorders ◽  
Suicide Risk ◽  
Borderline Personality ◽  
Mood Symptoms ◽  
Affective Instability

Borderline personality disorder (BPD) and mood disorder (MD) can be difficult to differentiate from each other due to several overlapping clinical features. Among BPD symptoms, chronic dysphoria can be mistaken for major depression, while affective instability may be confused with the depressed and elevated mood episodes of bipolar disorder (BD). Conversely, in those with BPD, co-occurring MDs can be difficult to rigorously assess and treat. Even though there is moderate to high co-occurrence between these conditions, BPD and MDs have distinct facets of impulsivity, affective instability, and mood symptoms. Furthermore, BPD, MD, and their co-occurrence predict courses of illness, prognosis, treatment outcomes, and suicide risk. Consequently, thorough assessment and differential diagnosis of these conditions should inform treatment planning and clinical management in both BPD and MD.

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