Abrams, Richard, and Walter B. Essman, eds. Electroconvulsive Therapy: Biological Foundations and Clinical Applications. New York: Spectrum, 1982. This book explains many aspects of ECT treatment. Indications for ECT are severe depression and mania both of which ECT is the treatment of choice because of its effectiveness. When proper sedation, muscle relaxation, and oxygenation are administered correctly, ECT is a very safe procedure. At the point in time when the book was written there was no evidence supporting permanent brain damage as an effect of properly administered ECT treatment. When ECT is compared to anti-depressant drugs, the death rate is much higher among those treated with anti-depressant drugs. Concerning children between the ages of five and fifteen, ECT had little benefit on the majority of mood-disorders, but did help a few depressive and manic episodes. The authors suggests that ECT is recommended for the elderly because of their sensitivity to psychotropic drugs, hospitalization-related deaths, dietetic complications, and systemic illness. This book is very informative and geared toward those with previous knowledge of ECT.

Burd, Jeremy, and Paul Kettl. "Incidence of Asystole in Electroconvulsive Therapy in Elderly Patients." The American Journal of Geriatric Psychiatry 6.3 (1998): 203-11. The use of Electroconvulsive Therapy on elderly patients was tested in this article. The research was focused on asystole (absence of heartbeat for 5 minutes) incidence in patients receiving ECT. A physical exam consisting of an electrocardiogram and blood count was conducted to determine if cardiac disease was present, which could alter the risk of heart complications in ECT. The finding was that the younger patients had more asystole incidents than older patients. The authors suggest that this could be due to the fact that young people's hearts have strong conduction systems and cardiac rhythms and therefore are more responsive to the effects of ECT. Moreover, it could be that the pathways that transmit the stimulation are not replaced yet by fat; which happens as the heart gets older. In addition to this, nerve transmission in velocity and amplitude decrease as a person ages. This article is technical, but is very informative for any interested reader.

Gomez, Gerda. "Electroconvulsive Therapy: Present and Future." Mental Health Nursing 25 (2004): 473-86. A positive summary of ECT in patient selection, mechanisms of action, administration, recovery, and maintenance. Nullification of past and current contraindications and risk factors associated with ECT and untoward effects are also included. It portrays an interesting vision of ECT from when it was first developed and used to future direction of ECT and research of the ECT method. Gomez argues the effectiveness of ECT with patients diagnosed with depression, schizophrenia, and bipolar disorder. The article explains that ECT was first used in 1938 in Italy then it spread to Russia, Europe, and then finally the United States. It has remained popular from the 1940s, 1950s, and 1960s, but it decreased in the 1970s because of effective antidepressants and the negative image of ECT on films. Currently about 50,000 patients receive ECT each year in the United States. This article is easy to read and is directed toward those without any prior knowledge in ECT.

Hermann, Richard C., et al. "Diagnoses of Patients Treated With ECT: A Comparison of Evidence-Based Standards With Reported Use." Psychiatric Services 50.8 (1999): 1059-065. This article includes a study that examines diagnoses for disorders treated with ECT in 1994-1995 that were found in a New England's insurance claims data. It examines these diagnoses to find if they were included in the number of psychiatric disorders that are treated successfully with ECT. It also examines characteristics of psychiatrist and hospitals that were more likely to use ECT for diagnosed psychiatric disorders, rather than other methods for the disorders. The finding was that during 1994-1995, 996 individuals had ECT treatments a number of about 1.6 courses per individual. 94.7 percent of patients treated with ECT had reported diagnoses. 86.5 percent of these diagnoses were included in the number of psychiatric disorders found to be treated successfully with ECT. Also, it was found that psychiatrists who graduated between 1940-1960 and 1961-1980 were more likely to use ECT for psychiatric disorders not included on the list. This article is directed toward those with preliminary knowledge in ECT.

Johnstone, Lucy. "Adverse psychological effects of ECT." Journal of Mental Health 8.1 (1999): 69-85. This article is a summary and analysis of the beliefs and theories held by the general public and psychiatrist concerning the practice of ECT. Johnstone includes negative aspects and acknowledges the lack of understanding for the adverse psychological reactions of ECT. Twenty people who received ECT treatment were interviewed concerning their attitude toward it before and after. Reports of their experiences are included. Results show that the majority of patients were very anxious beforehand. Biologically, these patients experienced memory loss, headaches, nausea, and confusion. A minority (13.1 percent) reported that because it was so disturbing they did not want it again. 23.7 percent believed it to be barbaric and inhumane. Brain damage, personality change, and death worry a minority. Sixty-nine percent were not informed about the convulsions in ECT. Only twenty-one percent said they were thoroughly informed about the procedure. This article is informative and easy to read, but is shocking concerning real life experiences of ECT treatment.

Nobler, Mitchell, et al. "Decreased Regional Brain Metabolism After ECT." American Journal of Psychiatry 158.2 (2001): 305-08. This research mainly focuses on the regional cerebral blood flow (rCBF) or regional cerebral metabolic rate after Electroconvulsive Therapy (ECT) of ten patients with major depression. The exact function of ECT is not known, but this research gives incite regarding the brain after ECT use. Positron emission tomography (PET) measures the regional metabolism and was used to show the parametric mapping of the brain before and after ECT. The evaluation of differences in the metabolic rate for glucose after ECT was done by the use of Statistical Parametric Mapping. The findings indicate that the use of ECT reduced the regional cerebral metabolic rate for glucose in the prefrontal cortex; which can lead to physiological disturbances resulting in cognitive loss. This research article is geared toward those with previous neuronal education.

Palmer, Robert L., ed. Electroconvulsive therapy: an appraisal. New York: Oxford UP, 1981. This book is an all-encompassing knowledgeable source of ECT treatment from past history to its present time. It includes effects of ECT on the elderly, reports of patients' complaints, patients' experience and attitudes, and ethical aspects. The earliest references of shock treatment involve the use of the electric eel found by Hippocrates. Scribonius Largus used the eel to treat headaches of Roman Emperor Claudius. Concerning ECT and the elderly, the outcome of a group testing was encouraging with all scores of depressed patients improving significantly until at three weeks all were normal. The majority of complaints were of memory loss. New learning was the most difficult at the beginning of recovery time. Fifty percent of patients said that going to the dentists was more upsetting. This book is thorough in its explanation of ECT treatment and although it is dated, it is seminal and helpful to researchers of psychiatric treatment.

Rey, Joseph, and Garry Walter. "Half a Century of ECT Use in Young People." The American Journal of Psychiatry 154.5 (1997): 595-602. This article reviews the safety of Electroconvulsive Therapy in young people and studies the evidence of possible inappropriate use on those under the age of 18. The study suggests that there is evidence that ECT is effective in the treatment of disorders and safe for elderly. But the question asked involves the effects of ECT on young people 18 and under. It also gives historical background of ECT use involving children. The first use of ECT on a child (3-year-old) happened in 1941. In the United States and France during the years of 1940s and 1950s young people received ECT and had encouraging results, but despite those results, the use of ECT in young people began to decline. This may have been due to possible harmful effects of ECT and the introduction to antidepressants. This article is geared toward those with a previous knowledge about ECT.

Rodgers, Ellie. "Electroconvulsive therapy (ECT)." Geri Metzger, ed. 2004. 24 Feb. 2005 <http:// my.webmd.com/hw.depression>. The treatment of ECT is used to treat severe depression. It is usually used for severe symptoms like delusions, hallucinations, or life-threatening thoughts. It is a last result after antidepressants and psychotherapy have been used and fail to give successful results. ECT treatments include an electrical charge for 1-4 seconds that produce a short seizure of 30-60 seconds. It is usually given about 2 to 3 times a week for a period of 2 to 3 weeks. Included with the ECT treatments are family therapy, psychotherapy, medication, and behavior therapy. ECT is believed to alter brain chemicals such as serotonin, endorphins, and adrenalin. After treatment, short memory loss, nausea, headache, and confusion should be expected. Long-term side effects of memory loss are possible and have been reported numerous times by ECT patients. This article is very easy to read and is very informative with the topical data concerning ECT.

Tew, James, et al. "Acute Efficacy of ECT in the Treatment of Major Depression in the Old-Old." American Journal of Psychiatry 156:12 (1999): 1865-870. This article compared the outcome of ECT on adult (59 and younger), young-old (60-74), and old-old (75 and older) patients with major depression. One-half of American patients who have ECT treatments are the elderly. This is due to the low tolerance of medications and disability associated with depression, therefore ECT is the next choice of treatment. This study assumed ECT treatment put greater burden on the old-old's physical body and that they experience additional cognitive impairment. It hypothesized that the old-old respond as well as the young-old and adult groups. The findings were that the burden of physical illness and cognitive impairment were higher, but the toleration level of the old-old was the same as the younger groups. Also, they show same or better response to ECT. This article is technical in the study results, but easy to understand in the explanation. It is information and geared toward readers with previous knowledge of ECT.

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