APPLYING RESEARCH TO THE CLINICAL APPLICATION OF ECT IN THE ELDERLY

Abstract

Dr. Kellner will present the available evidence on the demographic and clinical variables that determine the response to ECT in the elderly. The depressed elderly are the most responsive to ECT, but also have the most potential complications in terms of cognitive and medical side effects. Determining the if an older person should more appropriately start ECT or another somatic treatment starts with assessing their potential response and can help gauge the individual's risk/ benefit ratio in comparison to alternative treatments. Dr. Greenberg will review the data on adjunctive pharmacotherapy during ECT. Depending on your age, you may have learned that you should stop all psychotropic medication prior to starting ECT (in the days of the 6 week ECT hospitalization). That is no longer practical and patients are frequently treated on a number of medications which could effect the seizure threshold (e.g., benzodiazepine and anticonvulsant), cause delirium (e.g., lithium) or improve or decrease the response to ECT (e.g., antidepressants). Understanding how to manage concommitant psychiatric medications is an important part of the care of the older ECT patient. Finally Dr. Petrides will discuss the half-age method, a method to estimate the seizure threshold. The half-age method has been an important part of ECT technique for over a decade and Dr. Petrides will give important insights into how well it works and why it is relevant in the treatment of older patients.