5 Unmodified ECT was indeed associated with serious complications such as extremity fractures and compressive spinal fractures. However, for more than 50 years ECT has been administered under general anesthesia with neuromuscular relaxants, and this has eliminated these serious complications.6 Interestingly, the fear of permanent braindamage caused by ECT was recently placed Inhibitors,research,lifescience,medical in a different

perspective by reports that ECT might actually increase new neuron growth (neurogenesis) in the hippocampus.7 In order to minimize short- and longer-term memory deficits associated with ECT, major research efforts have been invested in trying to limit the stimulus path and to adapt the stimulus intensity to the seizure threshold of the individual patient.8 There are two main modalities of ECT, differentiated by electrode placement: bilateral and unilateral ECT In bilateral Inhibitors,research,lifescience,medical ECT the electrical stimulus traverses both cerebral hemispheres, while in unilateral ECT only the nondominant cerebral hemisphere is stimulated. In both cases, effective treatment requires that a generalized seizure be elicited. Although unilateral ECT results Inhibitors,research,lifescience,medical in fewer cognitive adverse effects, its efficacy relative to bilateral ECT was a source

of controversy for many years.9 Recently, Sackeim and colleagues found that high-Sepantronium Bromide nmr dosage unilateral ECT (electrical dosage 500% above seizure threshold) and moderately suprathreshold bilateral ECT (electrical dosage 150% above seizure threshold,) are equivalent in response rate.10 Importantly, high-dose unilateral ECT is not associated with increased cognitive adverse effects. These findings underscore an important basic concept in ECT: although the seizure may seem to be an all-or-none Inhibitors,research,lifescience,medical event, not every generalized seizure has antidepressant properties. Stimulus intensity relative to threshold is a major factor in the efficacy of the therapy.11,12 Technique of ECT administration Pretreatment evaluation includes complete medical history, physical, neurological, Inhibitors,research,lifescience,medical and preanesthesia examinations, and relevant laboratory tests. Patients’ concurrent medications should be noted, since they might affect the

seizure threshold or interact with other medications used during ECT (Table I). Pretreatment preparations include 6- to 12-hour fasting, removal of dentures or other foreign objects from the patient’s mouth, insertion of a bite block into the mouth, and preoxygenation (100% O2 at a rate of 5 L/min). Table I. Drug coadministration with electroconvulsive therapy Anesthetic Adenosine agents should induce rapid unconsciousness and recovery and minimally affect hemodynamic parameters or seizure threshold.18 The most commonly used anesthetic is methohexital (0.75 to 1.0 mg/kg), due to its rapid onset, short duration of action, minimal anticonvulsive effect, and rapid recovery.19 Other anesthetics include thiopental, propofol, and etomidate. A muscle relaxant agent is administered 1 to 2 minutes after the anesthetic agent.