Translated by Zepu Ren and edited by Jianxiong An
Dr. Kellner is a professor and chair of the Department of Psychiatry at the University of Medicine and Dentistry of New Jersey, assistant dean of the School of Medicine, and editor-in-chief of the American Journal of Electroconvulsive Disorders from 1994-2004. Yang Yong, Department of Psychiatry, Suzhou Guangji Hospital
1. What is MECT?
MECT (Modified Electric Convulsive Therapy), i.e. modified electroconvulsive therapy or modified electroconvulsive therapy, is the administration of appropriate pulsed current stimulation after general anesthesia and muscle relaxation under multi-parameter physiological supervision, which causes extensive cortical discharge and induces a series of physiological changes in brain cells, thus achieving the purpose of treatment.
Main procedures of MECT.
The currently commonly used procedure for electroconvulsive therapy is general anesthesia, muscle relaxation, and energization (giving a small amount of current to induce extensive cortical firing). Because the operation is performed under general anesthesia, the patient does not feel any pain or discomfort. 2.
2. Scope of application of MECT.
2 Patients with monophasic or biphasic depression for whom medication has failed or is ineffective.
2 Depressed patients with severe suicidal, irritable, psychotic symptoms, or reduced self-care resulting in dehydration or malnutrition.
2 Manic patients with ineffective or poorly treated medication
2 schizophrenia with hallucinations, delusions, and excitable irritability, especially in the early stages of the disease
2 Catatonia: catatonia caused by schizophrenia, depression and other disorders
2 Others: Parkinson’s disease with comorbid depression, malignant syndrome, refractory epilepsy, pain, obsessive-compulsive or anxiety disorders, and patients with affective disorders, schizophrenia, obsessive-compulsive disorder, pain, epilepsy, and other disorders who do not want to be treated with medication.
MECT may be the preferred treatment option for the following conditions.
? Those with severe disease requiring rapid efficacy.
? when other treatments are riskier than MECT.
? Patients with poor drug efficacy at previous episodes who have responded well to MECT.
? The patient prefers MECT treatment
3. What is the rationale for MECT treatment?
MMECT can act on multiple systems and multiple regions of the brain.
Anti-epileptic effect: MECT causes a series of epileptiform discharges, whereby the brain acquires a new mechanism to terminate epileptiform discharges. One of the most important developments in psychopharmacology in the treatment of mood disorders in the last 20 years is the introduction of anti-epileptic class of mood stabilizers, and the anti-epileptic effect may be related to the antidepressant effect of MECT.
Neuroendocrine mechanism: MECT causes the release of peptides from the brain, which improves mood; MECT corrects neuroendocrine abnormalities in depressed patients – abnormal hypothalamic-pituitary-adrenal axis function, and dexamethasone suppression tests return to normal.
4. How many treatments does MECT require to obtain a cure?
Most patients see significant clinical results on the same day of the first treatment. Most patients with depression are cured after 6-12 electroconvulsive treatments.
5. When should I choose MECT?
In many cases, MECT should be considered as early as possible; it is inappropriate to wait until the condition is severe or after many medications have been administered.
6. What are the contraindications to MECT?
MECT is a very safe and effective treatment method, and there are no absolute contraindications to MECT.
? Unstable or severe cardiovascular disorders such as myocardial infarction, unstable angina, inadequate blood supply heart failure, valvular heart disease, aneurysm or vascular malformation.
? increased intracranial pressure in some patients with brain tumors or intracranial occupational injuries.
? Patients with recent cerebral infarction
? Severe respiratory diseases such as severe chronic pulmonary obstruction, asthma, pneumonia, etc.
7. Can MECT cause memory impairment?
MECT can cause three types of memory impairment: acute impairment of consciousness, cis-amnesia and retrograde amnesia. Acute impairment of consciousness is caused by seizures and general anesthesia and typically lasts 20-30 minutes before recovery. Parallel amnesia appears during treatment and mostly disappears 1-2 weeks after the end of treatment. Retrograde amnesia is the inability to remember something that happened during treatment and is recovered in most patients.
Memory impairment was more common in the past, but with improvements in MECT technology, memory impairment is now much less common with treatment than before.
8. Can repeated MECT treatments damage the brain?
There is substantial evidence that MMECT does not cause structural damage to the brain. In fact, MMECT causes the release of nutrients from the nerves, thus protecting the brain.
9. Do I have to stop taking antidepressants and mood stabilizers during MECT treatment?
Previously, all medications were discontinued during MECT, but it is safe to continue taking most antidepressants during MECT, and there is now evidence that combining medications with MECT may improve outcomes and prevent relapse after MECT. In addition, the newer antidepressants in common use today are much less toxic to the heart than tricyclic antidepressants. The combination of medications with MECT is common in clinical practice.
Some medications can interfere with MECT treatment, such as antiepileptic drugs, antiepileptic class of emotion stabilizers, and benzodiazepines.
10. Does MECT treatment need to be extended if it is effective?
MECT has 2 disadvantages: memory impairment and high recurrence rate. Nowadays, MECT is usually given 3 times a week, and after achieving a cure, consolidation therapy is routinely given: reduced to 1 time a week, then 1 time every 2 weeks. Also, MECT is often combined with medication during treatment to prevent relapses. For patients with multiple relapses, MECT maintenance therapy can be considered: 1 time per month after consolidation therapy (treatment interval can be adjusted).
11. Can patients who have previously failed MECT undergo MECT again?
It is important to carefully review the previous treatment and the patient’s condition before treatment, and to choose carefully, especially if there is an unanticipated cognitive impairment.
Sometimes, MECT is ineffective because the number of treatments is not sufficient. Studies have shown that more than 10 treatments are ineffective before MECT can be considered ineffective, and the therapist should assess the diagnosis to ensure that no other factors influence the efficacy of MECT and individualize the specific parameters set after half of the general course of treatment (10C12 sessions).
12. Are patients who have failed to respond to pharmacological treatment effective with MMECT?
It is not clear. Theoretically, yes, but it is difficult to conduct studies in this area; another possibility is that patients who are partially effective with drug therapy can be cured with MECT in combination. Drug maintenance therapy may prevent relapse in cured patients.