Electroconvulsive therapy continues to be a controversial treatment, with attitudes ranging from positive to negative, depending on one's psychiatric training, type of practice, and geopolitics. Like many clinicians who treat severely ill patients, I have seen its use save lives and have seen lives lost because it was withheld - its efficacy, reliability, and relative safety have ensured its continued use in the face of major public assaults and controversy.
This month's issue, guest edited by Kevin O'Connor, MD, and Teresa Rummans, MD, may not present much that is new to the sophisticated ECT maven, but the practitioner who uses ECT from time to time should find it interesting and useful. John R. Black, MD, leads off with a range of findings, using currently available imaging techniques, which may prove of significance in predicting clinical response and treatment-emergent side effects. Dr. O'Connor then reviews hypotheses concerning the therapeutic mechanism of ECT, both past and present. He and Dr. Black review studies pertinent to the question as to whether ECT causes neuronal damage, both reviewing the evidence critically and finding evidence for the accusation lacking.
Sheila Jowsey, MD, presents a very useful review of the effect of various medications on seizure threshold, seizure duration, and side effects. Margaret Weglinski, MD, extends this theme by reviewing new anesthetic agents used in ECT as well as agents that might make ECT safer or minimize side effects for certain patients. Dr. Rummans provides a useful review of the literature on medical indications for the use of ECT.
Rounding out this issue is a paper on the role of nursing in electroconvulsive therapy by two of our colleagues in nursing, Thomas S. Pileggi, RN, and Debra A. Ryan, RN. Some of us, depending on practice in various institutions, may be surprised to see how active and contributing a role nursing can play providing patient services associated with the use of ECT as a therapeutic modality.
Electroconvulsive therapy may be an old and recently controversial treatment, but it is still one of our most effective treatments when used with proper indications. This issue of Psychiatric Annals is evidence that our knowledge of its mechanism of action, clinical applications, enhancement of therapeutic effects, and reduction of treatmentemergent side effects continues to grow.