Electroconvulsive Therapy

While there are no absolute contraindications to ECT, it should not be used when its associated risks outweigh its potential benefits. During the ECT procedure, intracranial pressure, heart rate, and blood pressure (and thus myocardial demand in oxygen) are increased. As a result, ECT should be avoided in patients with brain tumors, vascular aneurysms, recent myocardial or cerebral infarction, and severe pulmonary disease. Poor health status, rather than advancing age, increases the risk for the rare but potentially severe physical complications associated with general anesthesia and ECT, such as cardiac arrhythmias, aspiration pneumonia, spinal compression fractures, or mouth injury.

ECT does not appear to impair the ability to learn and retain new information and it is usually associated with subjective cognitive improvement. However, ECT may cause some objective cognitive impairment. This impairment typically consists of a transient inability to retrieve some memories, in particular for events occurring during the few months preceding or following the ECT course. In addition to these transient memory deficits, many patients also experience permanent memory loss for events occurring during the course of treatment, particularly events on treatment days. Cognitive impairment can be minimized with the use of the proper ECT techniques.

Elderly patients are at greater risks for prolonged confusion and even delirium, particularly when they suffer from a degenerative or vascular dementia. However, elderly patients presenting with a dementia syndrome associated with depression may experience a dramatic improvement in cognition when they are treated with ECT. Thus, cognitive impairment should not constitute by itself a contraindication to ECT.