Oct 18, 2021
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers electroconvulsive therapy with Dr. Wei-Yi Song, the Department Head of Psychiatry, Director of Mood Disorder Services, and Director of ECT Services in Victoria, BC, as well as a Clinical Professor at the University of British Columbia, and a past president of the Canadian Psychiatric Association.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
- Briefly describe the history of ECT from inception to the present.
- Debunk common misconceptions about ECT.
- Describe the major proposed mechanisms of action of ECT.
- Describe the efficacy of ECT for common psychiatric illnesses.
- List the indications, contraindications, side effects and risks of ECT.
- Understand how the procedure of ECT is performed.
Guest: Dr. Wei-Yi Song
Hosts: Jake Johnston (MS4), Dr. Shaoyuan “Randi” Wang (PGY1), Dr. Arielle Giest (PGY2), Dr. Alex Raben (Staff Psychiatrist)
Audio editing by: Jake Johnston
Show notes by: Jake Johnston
Interview Content:
- Introduction - 0:00
- Learning objectives - 01:54
- History of ECT - 02:45
- Common misconceptions - 06:36
- Mechanism of action - 12:03
-
- Summary - 16:06
- Indications - 16:47
- Contraindications - 20:58
- Side effects and risks - 23:31
- Efficacy of ECT - 29:00
-
- Major depressive disorder - 29:13
- Bipolar depression - 33:00
- Schizophrenia - 34:19
- Bipolar mania - 36:16
- Procedure - 38:50
-
- Steps of performing ECT - 39:20
- Considerations for electrode placement - 47:29
- Pulse width - 51:19
- Maintenance treatment - 53:32
- Closing - 59:09
Resources:
- Video showing ECT procedure: https://www.youtube.com/watch?v=9L2-B-aluCE
-
- One note on the realism of this depiction: an actual patient would not shake uncontrollably due to the muscle relaxants.
- Summary of electrode placement and pulse width: https://psychscenehub.com/psychinsights/electroconvulsive-therapy-summary-of-ranzcp-guidelines/
References:
- Baldinger, P., Lotan, A., Frey, R., Kasper, S., Lerer, B., & Lanzenberger, R. (2014). Neurotransmitters and electroconvulsive therapy. The journal of ECT, 30(2), 116–121. https://doi.org/10.1097/YCT.0000000000000138
- Francois, D. and DellaCava E. (2018). “10 myths about ECT”. Current Psychiatry. Accessed 2021-06-28 from MDedge.
- Kane, J., Rubio, J., Kishimoto, T., Correll, C., Marder, S., and Friedman, M. (2021). Evaluation and management of treatment-resistant schizophrenia. UpToDate. Accessed 2021-07-27.
- Kellner, C., Keck, P., and Solomon, D. (2021). Bipolar disorder in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
- Kellner, C. and Rasmussen, K. (2015). Contemporary ECT, Part 2: Mechanism of Action and Future Research Directions. Psychiatric Times. Accessed 2021-07-08.
- Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Overview of electroconvulsive therapy for adults. UpToDate. Accessed 2021-06-28.
- Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
- Petrides, G., Malur, C., Braga, R. J., Bailine, S. H., Schooler, N. R., Malhotra, A. K., Kane, J. M., Sanghani, S., Goldberg, T. E., John, M., & Mendelowitz, A. (2015). Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. The American journal of psychiatry, 172(1), 52–58. https://doi.org/10.1176/appi.ajp.2014.13060787
- Singh, A., & Kar, S. K. (2017). How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 15(3), 210–221. https://doi.org/10.9758/cpn.2017.15.3.210
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.