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ECT has the highest rates
of response and remission of any form of antidepressant treatment,
with 70%–90% of patients treated showing
Evaluation for ECT should identify potential indications
for caution or modifications in ECT technique or anesthesia, such
as recent myocardial infarction, cardiac arrhythmias, or intracranial
ECT may have cardiovascular side effects, which can
be managed by optimizing blood pressure control prior to ECT and
administering antihypertensive agents (e.g., short-acting beta-blockers
or calcium channel blockers) at the time of ECT. Arrhythmias, which
are usually transient, can also occur in conjunction with ECT and
can be managed with usual antiarrhythmic therapies if they do not
Patients may experience cognitive effects after ECT.
The most common of these effects is confusion that generally lasts
30–60 minutes after treatment. Retrograde amnesia may also occur
but typically resolves.
Treatments are usually administered two or three times
per week. An acute course of ECT typically consists of 6–12
treatments, until symptoms have remitted or clearly reached a plateau.