Decreasing the use of unmodified electroconvulsive therapy in India
Electroconvulsive therapy (ECT) is the most effective treatment for depression and in many patients is life-saving. However, its practice varies widely throughout the world. When it was introduced in the 1930s, it was administered without anesthesia (“unmodified”). However, with the increasing availability of anesthesia this practice disappeared in the United States by the 1950s. Reports from the pre-anesthesia period describe terrified patients resisting the therapy. Nonetheless, in many developing countries, ECT continues to be practiced without anesthesia to this day. We propose to evaluate whether a simple, brief and safe sedating procedure administered just prior to ECT will reduce the rates of unmodified ECT and improve cooperation with and efficacy of the treatment. The proposed intervention will occur at the Chatrapati Shahuji Maharaj Medical University Hospital in Lucknow, India which continues to only use unmodified ECT because of insufficient financial and anesthesiology resources. The primary outcome measure will be a change in the rate of modified ECT use. Secondary outcome measures will include the rate at which ECT is offered and refused, patient anxiety just prior to ECT, treatment efficacy using inpatient length of stay and number of treatments as surrogates, charge dosing an d cost of procedure. We will also monitor for adverse effects of our intervention. We hypothesize that ECT patients will opt for modified treatment and that adverse effects will be minimal and costs will not rise prohibitively. If the intervention is successful, it could serve as a model for other institutions to follow.
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