Electroconvulsive therapy in the eighties: technique and technologies.

This paper reviews the special indications for ECT. Included among these are delusional depression, affective illness which occurs in the geriatric population, depressions which are not responsive to pharmacologic intervention; depressed manic or schizophrenic patients who do not tolerate medication side effects; and drug-refractory Parkinson's disease. Technological advantages which have increased the safety of the procedure while reducing the side effects include: brief pulse electrical stimulation of the seizure, nondominant unilateral placement of electrodes, and simultaneous monitoring of EEG and EKG during the procedures. Finally, the five steps designed to address psychological issues as they relate to ECT are outlined and ECT is placed into the perspective of an overall therapeutic strategy in treating the patients.