Electroconvulsive Therapy

What is the MINIMUM number of ECT sessions typically required to achieve a therapeutic response in severe depression, and what is the standard treatment frequency?

A 52-year-old woman with severe depression and psychotic features has failed trials of sertraline, venlafaxine, and augmentation with aripiprazole over 6 months. She presents with suicidal ideation, refusing food and fluids, and expressing delusions of guilt and worthlessness. Her husband reports acute worsening over 2 weeks. Vital signs are stable; physical examination is unremarkable. The psychiatrist plans electroconvulsive therapy (ECT). Which of the following is the MOST important pre-ECT medical evaluation to perform?

A 52-year-old woman with severe depression and psychotic features has failed trials of sertraline, venlafaxine, and augmentation with aripiprazole over 6 months. She presents with suicidal ideation, poor oral intake, and significant functional decline. Her vitals are stable: BP 128/82 mmHg, HR 88/min, RR 16/min. ECG shows normal sinus rhythm with QTc 410 ms. Baseline cognitive screening (MMSE) is 29/30. She is deemed a candidate for electroconvulsive therapy (ECT). Which of the following is the MOST appropriate pre-ECT investigation that must be completed before proceeding?

A 38-year-old man with bipolar I disorder, currently manic with psychotic features, has been hospitalized for 3 weeks. He is agitated, grandiose, and refusing food and fluids. Trials of lithium (level 0.9 mEq/L), valproate (level 85 µg/mL), and risperidone 6 mg/day have failed to achieve mood stabilization. He remains at high risk of self-harm. His wife consents to ECT. Before the first session, the patient's serum sodium is 132 mEq/L (normal 135–145), potassium is 3.2 mEq/L (normal 3.5–5.0), and magnesium is 1.6 mg/dL (normal 1.7–2.2). What is the MOST appropriate management before proceeding with ECT?

Which of the following is the primary mechanism by which electroconvulsive therapy (ECT) produces its therapeutic effect in severe depression?