From the Guidelines
Electroconvulsive Therapy (ECT) is contraindicated in patients with space-occupying intracranial lesions, recent cerebral hemorrhage, unstable vascular aneurysms, and high anesthesia risk, although recent myocardial infarction and severe cardiac disease may be considered relative contraindications in certain cases, as evidenced by studies suggesting that ECT can be safely administered after prospective assessment of risk of neurological complications has been completed 1.
Medical Contraindications to ECT
The primary concern with these conditions is increased risk of complications during ECT, as the procedure causes a temporary increase in cerebral blood flow, intracranial pressure, blood pressure, and heart rate during the induced seizure.
- Relative contraindications include active chest infection, and recent myocardial infarction, as well as tumors of the central nervous system associated with elevated cerebrospinal fluid levels, which may require cautious use of ECT and thorough risk-benefit analysis 1.
- Other conditions that may require caution when using ECT include cardiac pacemakers, implanted defibrillators, and intracranial metal implants, as well as severe pulmonary conditions, pregnancy, osteoporosis, glaucoma, and retinal detachment 1.
Pre-ECT Evaluation
Pre-ECT evaluation should include a comprehensive medical history, physical examination, basic laboratory tests, ECG, and sometimes neuroimaging to identify potential contraindications and minimize risks.
- A thorough risk-benefit analysis should be conducted for patients with relative contraindications, and modifications to the ECT procedure may be implemented, such as adjusting anesthetic agents, seizure duration, or electrode placement 1.
Special Considerations
- Mental retardation is not a contraindication for ECT, and there are reports of successful use of ECT in adult patients with mild to profound mental retardation who had severe mood symptoms, psychosis, or self-injurious behaviors 1.
- Psychiatric comorbidity should not be considered a contraindication for ECT, and disorders frequently comorbid with severe mood disorders, such as personality disorders, conduct disorder, oppositional defiant disorder, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and eating disorders, can be treated with ECT when indicated 1.
From the Research
Medical Contraindications to Electroconvulsive Therapy (ECT)
The medical contraindications to ECT include:
- Recent myocardial infarction: There is an increased risk of ventricular arrhythmias and cardiac rupture 2
- Deep vein thrombosis: This condition may pose a risk for ECT, although the exact nature of the risk is not well-defined 3
- Intracranial aneurysm and tumors: These conditions may increase the risk of complications during ECT 3
- Pheochromocytoma: This condition may pose a risk for ECT due to the potential for cardiovascular complications 3
- Sepsis: This condition may increase the risk of complications during ECT 3
- Pregnancy: There are reports of fetal deaths after ECT, although the risk-benefit ratio may still favor the use of ECT in certain cases 3
Mitigating Risks
The risks associated with ECT can be mitigated with:
- Safety protocols: Implementing safety protocols can help minimize the risks associated with ECT 3
- Adequate stakeholder communication: Communication between healthcare providers, patients, and families can help ensure that ECT is used safely and effectively 3
- Collaboration with anesthetists and specialists: Collaboration with anesthetists and specialists can help minimize the risks associated with ECT 3, 2, 4
- Consultation-liaison services: Consultation-liaison services can help ensure that patients receive comprehensive care during ECT 3
- ECT education: Education on ECT can help healthcare providers use the treatment safely and effectively 3