History of ECT Ugo Cerletti was a specialist in epilepsy and had done experiments with animals on the neuropathological

consequences of repeated epilepsy attacks. He experimented with many devices and animals to determine ideal parameters and perfecting the technique and then followed up with a series of electroshocks in human subjects with acute-onset schizophrenia - after 10 to 20 ECT shocks, patients began to improve In the past 60 years that it has been used, there have been significant improvements in the way it is administered and the conditions under which it is used to treat patients - when it was first developed, ECT was sometimes used to subdue and control patients in psychiactric hospitals. Troublesome patients received several shocks a day, many times without proper restraint or sedation - previously, patients would convulse like they would if they were having a grand mal seizurenow, synthetic muscle relaxants, such as succinylcholine, are now used - patients are anesthesized with short-acting agents - EEG seizure monitoring is now used Conditions treated with ECT - most common: major depression - mania - catatonic schizophrenia - parkinsons disease Mechanism of Action - unclear, but clearly due to the seizure that it produces - neurotransmitter theory: electricity sensitizes serotonin receptors and desensitizes receptors that help reabsorb dopamine and norepinephrine, causing them to stay in the synapse - seizures increase the synthesis and turnover of catecholamines, which leads to the downregulation of beta-adrenergic receptors other theories anticonvulsant- the brain learns to resist seizures, slowing abnormally overreactive brain circuits neuroendocrine cayses hypothalamus to release chemicals that change the chemistry of the entire body brain damage- memory loss and disorientation lead to the illusion of problems being gone

Medications Induction agents: methohexital, etomidate Paralytics: succinylcholine Sympatholytics: labetalol, esmolol Vagolytics: glycopyrolate, atropine