%0 Journal Article
%T Electroconvulsive therapy and determination of cerebral dominance
%A Milan Dragovic
%A Lindsay Allet
%A Aleksandar Janca
%J Annals of General Psychiatry
%D 2004
%I BioMed Central
%R 10.1186/1475-2832-3-14
%X Electroconvulsive therapy (ECT) is often regarded by the general public as a controversial procedure for the treatment of mental disorders. This is despite evidence of its safety and efficacy [1], and its benefit over anti-depressants in patients resistant to conventional medications and those with life threatening conditions such as catatonia and depressive stupor. The evidence suggests that in unipolar depression ECT has better efficacy when compared with older tricyclic antidepressants and monoamine oxidase inhibitors, as well as newer drugs such as paroxetine [2]. Notwithstanding the efficacy of ECT, its use is declining in some countries [3], while in a few others, including Italy ¨C where ECT was first introduced in 1938 by Cerletti and Bini ¨C it is prohibited. Aside from political reasons and public pressure, the declining trend in ECT use could be the result of the introduction of more effective antidepressants.A further possible explanation for the reduction in ECT use may relate to the concern over adverse effects of the procedure. There are a number of short-term side effects including headache, nausea and, sometimes, brief confusion. However, the main side effect of concern is memory impairment for past events (retrograde amnesia) and for current events (anterograde amnesia) that can last for several months after a course of ECT treatment. Some of these side effects are substantially reduced by advances in safety and the introduction of controlled-current ECT machines. The utilisation of muscle relaxants, anaesthetics and resuscitation equipment, and electroencephalographic monitoring during the application of ECT are considered now considered routine. In addition, ECT guidelines issued by the UK National Institute for Clinical Excellence [4] restrict the use of ECT only to patients with severe symptoms to which "an adequate trial of other treatment options has proven ineffective" (p. 5). The risk associated with ECT has also been reduced with the introdu
%U http://www.annals-general-psychiatry.com/content/3/1/14