Electroconvulsive Therapy Side Effects

Electroconvulsive Therapy: Side Effects

Mortality
The risk of death with ECT is very low: around 1 per 10,000 patients. This rate is comparable to the rate that would be expected from a series of brief anesthetic procedures alone. Most deaths occur in high-risk cases, which are therefore associated with a greater mortality rate. The most common cause of death with ECT is cardiovascular decompensation, and other causes include prolonged apnea, status epilepticus, and cerebral herniation (e.g., in unrecognized cases of brain tumor).

Systemic Morbidity
The systemic morbidity associated with ECT is related to the known physiological effects of induced seizures in a setting of general anesthesia and muscular relaxation. Both sympathetic and parasympathetic discharges occur and produce transient disturbances in cardiac rate and rhythm and elevated blood pressure. Although they are most often benign, these changes are rarely associated with more pathological arrhythmias or cardiac ischemia. Cardiovascular complications are most likely to occur in patients whose cardiac status is already severely compromised. Risks from these complications are increased in such persons, and pharmacological prophylaxis may be indicated (American Psychiatric Association Committee on ECT 2000; Zielinski et al. 1993). Prolonged apnea and status epilepticus are rare events, although resources to manage their occurrence should be available. Bone fractures and other musculoskeletal injuries are prevented by adequate muscular relaxation, whereas injuries to teeth or soft tissues of the mouth are minimized by use of an oral protective device during the application of the electrical stimulus. More common systemic side effects include headache, muscle pain, and nausea, all of which are usually mild and can be managed supportively, with attention to appropriate pharmacological prophylaxis, if indicated (American Psychiatric Association Committee on ECT 2000).

Electroconvulsive Therapy Introduction Indications