Electroconvulsive therapy--1987.

Abstract

The noncontroversial fact regarding ECT seems to be that controversy exists in almost every area of its use, its art, and its science. The nature of the treatment itself, its history of abuse, unfavorable media presentations, special attention by the legal system, uneven distribution of use among facilities and practitioners, and lack of certified standards for psychiatric training in ECT have tended, in the past 2 decades, to swing the pendulum towards the use of tricyclic and other antidepressant agents for the treatment of severe depression. Despite recommendations for continual review of data and of clinical and research experience, few pertinent reports by anesthesiologists have appeared. Guidelines for the anesthesiologist have not been established. Due to the pervading presence in earlier studies of hypoxia, hypercarbia, and acidosis, it is futile to compare findings of unmodified ECT to modified ECT. More recent studies relating especially to cardiovascular abnormalities have also been difficult to evaluate because of widely varying formats, use of different agents and dosages, continuance or discontinuance of psychotropic drugs, and variability of ventilation and concentrations of oxygen. ECT is a modality that has not outlived its usefulness. With proper pretreatment, selection and evaluation of patients, use of appropriate modification techniques, and careful clinical management and monitoring during treatment, ECT can be both safe and effective, even in relatively high-risk patients. ECT provides an exciting challenge for concerned physicians to explore the role of brain function and behavior, and the effects of seizures on neuroendocrine mechanisms, neurohumoral mechanisms, cerebral metabolism, the blood-brain barrier, and ion transport systems. It may lead to further understanding of the action of general anesthetics, CNS depressant drugs, and the effects of stimulation of the central autonomic nervous system and the endocrine systems. A close interaction between basic and clinically oriented researchers holds the key to designing studies that can answer these critical questions, rather than continuation of studies that merely generate more data.