Navigating ECT and Medication Management

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…

1. Briefly describe the history of ECT from inception to the present.
2. Debunk common misconceptions about ECT.
3. Describe the major proposed mechanisms of action of ECT.
4. Describe the efficacy of ECT for common psychiatric illnesses.
5. List the indications, contraindications, side effects and risks of ECT.
6. 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.

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