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  1. Indication of ECT use
    1. Acute depression                          
    2. Depression , mania , schizophrenia c is refractory to drug T/t
    3. Intolerable side effects                  
    4. Depression with psychotic features or suicidal risk
    5. Catatonic schizophrenia                            
    6. In conditions where are want early controls very poor intake, postpartum state.
  2. Absolute contraindication –
    1. None, Raised ICT is now a relative contraindication of E.C.T. Side effects of ECT’s
    2. Reversible amnesia which is both anterograde and retrograde more of retrograde: more with bilateral ECT
    3. Confusion in post ictal period, headache, Muscle Ache etc.
    4. Fractures, dislocations: with direct ECT
Mechanism of action:
  1. Most accepted mechanism is redistribution of amines in synaptic cleft.
  2. Marker of ECTs is increase in brain derived nerve growth factor (BDNF).
  3. Other modalities of treatment are rTms (Repetitive Transcranial magnetic stimulation) and Vagus nerve Stimulation.
  4. Drug of choice for severe depression is - TCA (Tricyclic Antidepressants)
  5. For Mild to moderate depression all drugs are equally effective and choice depends upon side effect profile of drug.
For Refractory depression - FDA approves combination of fluoxetine and olanzapine.
  1. Seasonal affective disorder (SAD) is considered as a different entity compared to other recurrent mood disorders because of their higher responsiveness to light therapy and decreased activity seen in the orbitofrontal and inferior parietal cortical areas.
  2. It is also called as winter blues and winter depression.
  3. Phototherapy is the gold standard treatment for SAD.
  4. It is the process of exposing an individual to a source of white light with 5000-15000. Lux, the UV rays are filtered off to avoid undesirable effects.
  5. It is commonly administered during the early morning hours.
  6. The probable mechanism of action is by affecting the levels of melatonin.

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