Special considerations: Electroconvulsive therapy
Electroconvulsive therapy (ECT) is a therapeutic modality that uses iatrogenically induced seizures for biological therapy of medically resistant and acute cases of depression, psychosis, and bipolar disorder. This chapter discusses the relevance and anesthetic considerations of ECT in the geriatric population. The mechanism of the physiologic effects of ECT has not been fully elucidated to date. Various investigative modalities, including functional Magnetic Resonance Imaging, electroencephalogram, positron emission tomography, and single photon emission computed tomography have been used to identify various components of the physiologic changes. Old age is characterized by deteriorating physical status, lack of functional autonomy, and a high risk of comorbid illnesses, all of which reduce the quality of life. The common mental disorders in the elderly are depression, anxiety disorders, dementia, and delirium. ECT is an important therapeutic tool in the management of depressive illnesses and specific psychotic syndromes, especially in cases requiring urgent intervention such as catatonia, or those with severe suicidal intent.