Posted by Elizabeth on May 13, 2000, at 13:48:49
In reply to Re: ECT literature search, posted by SLS on May 12, 2000, at 9:02:26
> > > ECT is the treatment of choice in pregnant women with major depression.
> How prevalent is the practice of choosing ECT as the first treatment? Is there any difference in the rate of ECT usage between different countries? Sometimes, the treatment of choice of clinical researchers is not the treatment of choice of the local practitioner.
I don't know the answers to these questions (and I would like to -- they are good questions), but my guess is that SSRIs have more or less replaced ECT. They seem to be perfectly safe (though if I were in that situation I might want to see if I could get through the 1st trimester without the SSRI, just to be extra cautious).
I'd be kind of worried about exposing the fetus to the general anasthetics and neuromuscular blocking agents used in ECT, personally! Not sure this is justified, it's just my gut reaction.
> If someone is committed to a hospital for schizophrenia, psychotic mania, or psychotic or suicidal depression, is it not common for him to be forcibly treated with medication or placed in restraints?
A person should not be committed for any of those things. AFAIK, a particular diagnosis is *never* a sufficient reason to commit someone involuntarily (in any of the 50 States, anyway).
> I'm not saying that this is a bad thing. Why would ECT be exempt from this sort of rationale? After all, it is effective. Neuroleptics are not without side effect liability, either temporary or permanent.
Indeed, I think it's safe to say that there is no such thing as an active drug that has no side effects and no risks!
> Non-response to antidepressants is a prognosticator of poor response to ECT.
It's true. There's a selection bias at work, in that people who have ECT are usually those who've failed multiple antidepressants. Also, sometimes it's used as a last resort for conditions for which it's not necessarily indicated, such as severe nonmelancholic depression; this further affects the apparent success rate.