ECT For Depression

(ECT) elutroconvulsine therapyinduction of a senzure through electrical cument to brainIt affects changes neurotransmitters -it themItS like restartiny the brainmust commonly used for depressionBUT also forSchizotreatment IS usually 2-3x/WKbipolarfor a total of 6-12 treatments.mama-maintenance afterschilodfactive disorderIX /month to preventRelapseconsidered Invasiveneed informed consentlensure pt is coherent alertlawake and understands risks)Induced senzus are brief (30 60secs) induced by electricalcurrent (bnefas \ second only done onu!!!* procedureS/e::Oconsuntretrograde amnesia2 general6EEG monitors(pt wakes up con f usedanesthetic givenbrain wavesforgetful.) wake sup3muscle paralyzing1EkemonitorsHAmins terabout of 15agent (to prevent fx)cardidenauseaprecause4FCT workupresponses.confusion/AisonentationCXRECG8monitormuscle sovenesselevated b/p,UAbpCBC*memory returns to baselineBUNafter lemonths.electronytepanel(D/C benzos-tobeable to induce seizure. Transcramial magnetic stimulationnoninvasive procedure that uses MRI - -Strength magneticpulses to stimulate focal areas of the cerebral cortexmore.expensive than ECTbut same sucless rate.40/50 min sessions 3-5/wk X 4-6WKS total its is longer)thanpt is awake, alert dunng procedureQ memory issues afterONLY CONTRAINJICATION: can not have metal in thearea of stimulationI cochlear implants, brain stimulators,medication pumps.magmetic pulses cause electrical changes to flow and induce neurons to fine or become aetne.& pt will feel right tapping kmoking anhead,contraction of scalp and tightening of the far.Sle: mild.L pain on scalp sitefatiguelight headedness Vagns neme stimulation (VNS) us success ratethan ECT.realized that It also seemed to improve mood In aoriginated as a TX for epilepsy I butcimuianspopulation that normally experienced higher rates of depressionelectrical stimulation of the vasus nerve results in boosting the level ofProcedure usually done as outratient improving neurotransmitters, mood and there bya paeemaker - like dence IS implanted SX into the 9hallantidepressantsconnected to a thin flexible Wire that IS threaded upand wripped around the vagns nerve on theLside ofthe neck.1af ter imp lansation, an infrated magnetic wand IS heldagainst chest to program it pulses are delive red a rate offor 30 secs Q5mins X 24hrs S/e: neck pain on that sideC)sidedecreasecoughover timeparesthesiadyspneavoice alteration I hoarseness ocurs in 40% of pts.BIG close of to the laryngeal and phangngcalproximity of the had to the vagus branches neme, of the which L ISvagus haveDuringexercise or public speaking : dence corn betemporarily turned off. by putting 9magnet over the implant (to V 50B) Deep Brain stimulation (DBS)kind of similar to VNS In that the denice IS alsoInserted into the chest but the di fference IS thatthe electrodes are SX implanted directly into the brainthe to stimulate regions of thebrain identified to beunderative in depressionFDAapproved for Parkinsons , OCDrequires craniotomyoff Label use for MDDinvasive, BUTreversibler/o: intracranial hemorrhageStroke yb/c its directlysuzureson brown light therapy- has same effect as S/S meds Indepressiveaccepted as 1st line TX for SAD (seasonal affectivedisorder)light therapy's effectiveness IS thought tobe the influence of light on melatoninemelatonin IS secreted by pineal grandand IS necessary for maintaining and shiftingbiological rhythmsexposure to light supresses the noctumal secretion ofmelatonin which seems to home a therapeuticeffect on people t SAD.tx : 30-45 - mins of exposure daily to 1 10,000 -lux sanrie. 119! htmorning exposure IS best. (S/C HA /jitterness* St . John's Wort (available as OTC supplement)St Tohns more IS a plant (in pill form) that IS thought tothe amount of severenen I NE, and doramme in the brainresulting in antidemessant effectsthere mild/moderate depression.should 0 take in combination T other antidepressants(can lead to potentially life threathening increase in your bodyslevels of seretonin)also must AVOID foods T /tyramines/e: rapid heart rate, 61 distress,abdominal pain