Elektrokonvulsiv terapi inte passe. Oöverträffad effekt vid svår depression
Engelsk titel: Electroconvulsive therapy is not passe. An unsurpassed effect in severe depression
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Författare:
Odeberg, Håkan
;
Ottosson, Jan-Otto
Email: janotto@bredband2.com
Språk: Swe
Antal referenser: 58
Dokumenttyp:
Översikt
UI-nummer: 11011484
Sammanfattning
ECT has an unsurpassed effect in patients with psychotic depression and deep depression with risk of suicide. With increasing treatment intervals ECT prevents relapse and recurrence as effectively as a combination of drugs. The preventive effect is even stronger if ECT is given together with drugs.
Transient memory disturbance is an unavoidable side effect but brain lesions have not been proven. Electrically evoked seizures in animals lead to regeneration of neurons, glia cells and blood vessels.
Modern modifications of electrical stimulation (ultra-brief stimuli with pulse width below 0.5 ms) cause less memory disturbance but require longer treatment series and result in lower remission rates than brief-pulse stimulation (1.0 ms). Bitemporal placement of electrodes is more efficient than unilateral stimulation. Outcomes are optimized with minimal narcosis and avoidance of drugs that interfere with convulsive activity.
ECT satisfies the ethical principle of a favourable relation between doing good and not doing harm. Autonomy is respected in patients who are competent to make decisions.