Book contents
- Frontmatter
- Contents
- Preface
- Acknowledgments
- Chapter 1 Introduction
- Chapter 2 History of Psychotic Depression
- Chapter 3 Diagnosis in Psychotic Depression
- Chapter 4 Patients' Experience of Illness
- Chapter 5 Treatment in Historical Perspective
- Chapter 6 Treatment: Pitfalls and Pathways
- Chapter 7 Treatment: ECT, Medications, and More
- Chapter 8 Treatment by Type of Psychotic Depression
- Appendix 1 Summary Guide to Psychiatric Concepts
- Appendix 2 Summary Guide to Psychotropic Medication and Treatment
- References
- Index
Chapter 7 - Treatment: ECT, Medications, and More
Published online by Cambridge University Press: 10 September 2009
- Frontmatter
- Contents
- Preface
- Acknowledgments
- Chapter 1 Introduction
- Chapter 2 History of Psychotic Depression
- Chapter 3 Diagnosis in Psychotic Depression
- Chapter 4 Patients' Experience of Illness
- Chapter 5 Treatment in Historical Perspective
- Chapter 6 Treatment: Pitfalls and Pathways
- Chapter 7 Treatment: ECT, Medications, and More
- Chapter 8 Treatment by Type of Psychotic Depression
- Appendix 1 Summary Guide to Psychiatric Concepts
- Appendix 2 Summary Guide to Psychotropic Medication and Treatment
- References
- Index
Summary
The enormous personal improvements we have seen in patients who receive ECT and AMMs, and the suffering and incapacitation these patients escape, are beyond the ability of language to convey. We can spell out how to provide these treatments, and do so here. The information provided in this chapter is primarily for physicians, yet patients and their families can have a front row seat as they see how this fearful illness must properly be treated.
Electroconvulsive therapy
Catatonia, suicidal intent or activity, dangerous or unpredictable agitation, weight loss, inability to swallow medication, and severe impairment of self-care are reasons to begin ECT urgently in patients with an ECT-responsive type of psychotic depression. Failure of a previous medication trial, need for inpatient confinement, need for a prompt or reliable response (i.e., cannot wait), medication intolerance (because of age or medical problems), or patient preference are compelling reasons to choose ECT as the next treatment. Of course, patient preference is influenced by what the physician chooses to say (or omit) about the up- and downsides of treatment alternatives, and how this meshes with patients' desires for reliability, promptness, comfort, and avoidance of impairment or disempowerment.
A meta-analysis of forty-four treatment studies of psychotic depression concluded that ECT tends to be superior to the antipsychotic-TCA combination and is distinctly superior to tricyclics alone (Parker et al., 1992).
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- Psychotic Depression , pp. 192 - 234Publisher: Cambridge University PressPrint publication year: 2007
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