Electroconvulsive therapy

The use of electroconvulsive therapy (synonyms - electroconvulsive therapy, electroshock therapy) for the treatment of mental disorders has a nearly 70-year history. Nevertheless, this method of stressful biological effects has not lost its relevance to the present day and constitutes a worthy alternative to psychopharmacotherapy. At the same time, the long period of successful clinical application of electroconvulsive therapy did not make it understandable the mechanism of action and the causes of the occurrence of side effects and complications. This can be explained not only by the complexity of simulating a seizure on animals, equivalent to that of mentally ill people, but also by the fact that even a single procedure of electroconvulsive therapy causes simultaneous changes in virtually all neurotransmitter systems of the brain, potentiates multiple electrophysiological, neuroendocrine and neuroimmune reactions, verification the values of which are very difficult.

For the period of its existence, electroconvulsive therapy has undergone significant changes in clinical, methodological and theoretical-experimental terms. Application since the 50's. XX century. General anesthesia and muscle relaxants led to a reduction in patient mortality, a significant reduction in the risk of traumatic injuries. The use of short-term pulse stimulation, started in the 1980s, significantly reduced the severity of cognitive side effects and first demonstrated the fact that the type of electric current is the main determinant of side effects. The studies that followed showed that the electrode deposition option and the electric charge parameters determine both the effectiveness of the treatment and the severity of the side effects. Methods of electroconvulsive therapy aimed at potentiating a convulsive fit in the prefrontal cortex by modifying the location of the electrodes, induction of focal seizures by means of fast alternating magnetic fields have been developed.

Experimental studies were aimed at studying the mechanisms of action of electroconvulsive therapy. Serleti (1938) also linked the positive results of the use of electricity to potentiate convulsions with secretion in the brain of "acroagonins" in response to shock. Later it was established that, similar to TA, electroshock therapy causes an increase in the "synthesis of noradrenaline, and changes in the serotonin system are less distinct, the influence on presynaptic receptors is poorly expressed. However, electroconvulsive therapy can lead to the development of hypersensitivity of serotonin receptors. Modern data on the effect on the cholinergic (down-regulation of cholinergic receptors) and the dopamine system is not sufficient to explain the antidepressant effect of electroconvulsive therapy. It is shown that electroconvulsive therapy, like TA, increases the content of y-aminobutyric acid in the brain, which gives grounds for talking about the possible inclusion of the y-aminobutyric acid-ergic system in the antidepressant effects of electroconvulsive therapy. Perhaps, electroconvulsive therapy increases the activity of the endogenous opioid system.

Indications for use of electroshock therapy

According to the recommendations of the Ministry of Health of the Russian Federation, the main indications for the appointment of electroconvulsive therapy are as follows.

• Depressive disorder (primary episode or recurrent course). The purpose of electroconvulsive therapy is indicated in the absence of effect after three courses of intensive therapy with antidepressants of various chemical groups, antiperspirant pharmacological measures (SSRIs or MAO inhibitor + lithium carbonate, MAO inhibitor + tryptophan, MAO inhibitor + carbamazepine, mianserin + TA, MAO inhibitor or SSRIs), two (complete or partial deprivation of sleep, phototherapy, plasmapheresis, normobaric hypoxia, reflexotherapy, laser therapy, unloading and dietary th therapy). Electroshock therapy is the first choice method for depressive states with repeated attempts at suicide or persistent refusal of food and fluids, when antidepressant therapy can lead to
• Bipolar affective disorder - to break the cyclic flow (more than four affective phases per year) in the absence of the effect of normotimics.
• Paranoid form of schizophrenia (primary episode or exacerbation of the disease). Electroconvulsive therapy is used in the absence of effect from oral or parenteral psychotropic medication for 3-4 weeks (three-fold change of neuroleptic: "traditional" neuroleptic, neuroleptic of another chemical structure, atypical antipsychotic), antiretroviral measures (complete or partial deprivation of sleep, plasmapheresis , normobaric hypoxia, reflexotherapy, laser therapy, unloading therapy, one-stage abolition of psychotropic drugs).
• Catatonic schizophrenia. Indications for electroshock therapy coincide with those in paranoid form, with the exception of stupor. In conditions that threaten the patient's life, such as the inability to eat and drink fluids, electroconvulsive therapy serves as the first choice therapy.
• Febrile schizophrenia. Electroconvulsive therapy is the first choice therapy. The effectiveness of electroconvulsive therapy in this pathology correlates with the duration of the febrile period. The purpose of electroconvulsive therapy is most effective in the first 3-5 days of the attack before the development of somato-vegetative disorders. Sessions of electroconvulsive therapy must be combined with complex intensive infusion therapy, which is aimed at correcting the main indices of homeostasis.
• The above recommendations summarize the domestic experience of the clinical application of electroconvulsive therapy and do not take into account some aspects of the application of electroconvulsive therapy in other countries. In particular, according to the recommendations of the American Psychiatric Association and the British Royal Society of Psychiatrists, electroconvulsive therapy is indicated under the following conditions.
• A major depressive episode or recurrent severe depressive disorder with the following symptoms:
  • attempted suicide;
  • severe suicidal thoughts or intentions;
  • a condition that threatens life - refusal to eat or drink;
  • stupor;
  • severe psychomotor retardation;
  • depressive delirium, hallucinations.

In these cases, electroconvulsive therapy is used as a first-line emergency therapy, which is due to the high efficiency and the speed of the onset of the effect. Electroconvulsive therapy can also be used in cases where there is no response to antidepressant therapy conducted during 6 months in effective doses when two antidepressants with different mechanisms of action change, adding lithium carbonate, lnothyronine, MAO inhibitors, cognitive-enhancing drugs to therapy, accession of psychotherapy. In elderly patients, the duration of therapy with antidepressants may exceed 6 months.

Heavy mania:

• with a physical condition that threatens the patient's life;
• with symptoms that are resistant to treatment by mood stabilizers in combination with antipsychotic drugs.

Acute schizophrenia. Electroshock therapy serves as a method of selecting the 4th stage. It is used when clozapine is ineffective in therapeutic doses.

Catatonia. If treatment with benzodiazepine derivatives (lorazepam) is not effective at therapeutic doses: intravenously (iv) 2 mg every 2 hours for 4-8 hours.

Preparation for electroconvulsive therapy

Before conducting electroconvulsive therapy, it is necessary to collect in-depth anamnestic information about the patient's health status with specification of the transferred somatic diseases. In the presence of acute pathology or exacerbation of chronic diseases, appropriate therapy is necessary. It is necessary to conduct laboratory tests of blood and urine, electrocardiography (ECG), roentgenography of the lungs and spine, consultation of the therapist, ophthalmologist and neurologist, and, if necessary, other specialists. The patient must give written consent to conduct electroshock therapy.

Electroconvulsive therapy is performed on an empty stomach. All preparations for constant reception, except for insulin, should be taken 2 hours before the session of electroconvulsive therapy. It is necessary to assess the compatibility of drugs that the patient receives as a permanent therapy, with the means used in conducting electroconvulsive therapy (anesthesia, muscle relaxants). The patient should remove dentures, jewelery, a hearing aid, contact lenses, empty the bladder. It is necessary to measure blood pressure, pulse, body temperature, body weight, and in patients with diabetes, to determine blood glucose.

Justification of electroconvulsive therapy

The course of electroconvulsive therapy with bilateral application of electrodes leads to a change in the indices of regional glucose metabolism in patients suffering from endogenous depression. There is a reliable relationship between clinical improvement and the level of regional cerebral glucose metabolism. The most pronounced changes in glucose metabolism affect frontal, prefrontal and parietal cortical areas. The most significant decrease in metabolism occurs bilaterally in the upper parts of the frontal lobes, the dorsolateral and medial prefrontal cortex, the left inner part of the temporal lobe. At the same time, the indicators of regional glucose metabolism in the occipital lobe increase significantly. Reducing regional glucose metabolism leads to the development of side effects and complications of electroconvulsive therapy. Therefore, a decrease in regional cerebral glucose metabolism in the left temporal region after electroconvulsive therapy and a reliable relationship between the number of sessions and the percentage of reduction in glucose metabolism in the left middle temporal gyrus deserve attention. Development of memory disorders and cognitive deficits.

Electroconvulsive therapy stimulates microstructural changes in the hippocampus associated with synaptic plasticity. The mediator of the synaptic reorganization is the cerebral neurotrophic factor, whose content in the hippocampus and dental gyrus increases due to prolonged use of electroshock therapy or antidepressant medication.

Electroconvulsive therapy can promote neurogenesis, the extent of which correlates with the number of sessions of therapy. New cells continue to exist at least 3 months after completion of treatment. Long-term use of electroshock therapy increases synaptic interconnections in the conductive ways of the hippocampus, but depletes long-term potentiation, leading to memory disorders. There is a hypothesis that it is the depletion of synaptic potentiation that leads to cognitive side effects of electroconvulsive therapy.

The results of electrophysiological and neuroimaging studies demonstrated a correlation between the regional effect of electroconvulsive therapy and the clinical response to treatment. These studies again confirm the great importance of the prefrontal cortex. The magnitude of delta activity in this area of the cortex on the EEG taken during the inter-attack period is reliably associated with the best clinical response to treatment. Moreover, the reduction in glucose metabolism in the anterior frontal region is strongly correlated with the clinical results and the efficacy of the treatment.

Another area of research of electroconvulsive therapy is the clarification of indications and contraindications to its use. The most sensitive to this method are depressive states of various genesis. Electroshock therapy is effective in psychoses of the schizophrenic circle, especially in the depressive-paranoid form of schizophrenia. With the catatonic form of schizophrenia, the improvement is often short-lived and unstable. Representatives of the Leningrad psychiatric school received data on the high effectiveness of electroconvulsive therapy in patients suffering from involutional melancholia, depression associated with organic and cerebrovascular diseases of the brain, depressions in whose structure an important place is occupied by hypochondriac syndromes, obsessive-state syndromes and depersonalization phenomena. Studies conducted in the Department of Biological Therapy of the Mentally Ill at the Scientific Research Psychoneurological Institute (NIPNI) them. V.M. Bekhterev, showed that with the final states of schizophrenia with a disrupted thinking and schizophasic disorders, it is possible to succeed only with prolonged use of electroconvulsive therapy in combination with psychopharmacotherapy. In these cases, negativity decreases and tolerance to neuroleptic drugs increases.

In many countries, standards for the treatment of mental disorders have been developed, regulating indications for electroconvulsive therapy. Electroconvulsive therapy is considered as a variant of emergency care in life-threatening conditions (first-choice therapy), a means of overcoming therapeutic resistance (second and third-choice therapy), a variant of maintenance therapy in patients with bipolar disorders (refractory to treatment, expressed by manic or depressive episodes, the presence of psychotic signs or suicidal thoughts).

The purpose of treatment

Reduction of psychopathological symptoms and overcoming of resistance to psychopharmacological therapy in patients with schizophrenia, depressive and bipolar affective disorders, by calling generalized paroxysmal brain activity with the development of tonic-clonic seizures with the help of an electrical stimulus.

Methods of conducting

Specially trained personnel participate in the procedure; psychiatrist, anesthesiologist and nurse. To conduct electroconvulsive therapy, a special room with an electro-convulsor, a couch, an oxygen inhaler, an electric pump, a glucometer meter, a blood pressure gauge, an ECG apparatus, an oximeter, a capnograph, a set of tools and medicines to provide emergency care in case of complications (laryngoscope, set of intubation tubes, rotator extensions, tongue holders, spatula, strophanthin-K. Lobelin, atropine, caffeine, niketamide, magnesium sulfate, 0.9% sodium chloride solution, 40% dextrose solution, thiop sodium sodium, suxamethonium iodide). All performed procedures of electroconvulsive therapy are recorded in a special journal. Currently, sessions of electroconvulsive therapy are recommended to be performed with the use of anesthesia and muscle relaxants. However, there are techniques that do not require general anesthesia. Before the procedure, the patient is laid on the couch. To prevent the bite of the tongue, the patient must grasp the rubber roller with his teeth. As a means for anesthesia apply 1% solution of thiopental sodium from the calculation of 8-10 mg / kg. After the onset of narcotic sleep, a solution of muscle relaxant (suxamethonium iodide) is injected intravenously. The initial dose of 1% solution of suxamethonium iodide is 1 ml. In the course of therapy, it is possible to increase the dose of muscle relaxant. The drug is administered before fibrillar twitchings in the muscles of the distal parts of the extremities. Miorelaxation occurs in 25-30 seconds. After that, electrodes are applied. Selection of a convulsive dose for the development of a seizure is individual. In most patients, the minimal convulsive dose varies between 100-150 V.

The clinical picture of the electroconvulsive seizure is characterized by the consecutive development of tonic and clonic seizures. The amplitude of convulsions varies, duration - 20-30 seconds. During a fit, breathing is turned off. If you hold your breath for more than 20-30 seconds, you must press down on the lower part of your sternum, and if this method is ineffective, start artificial respiration. After a fit, a short period of psychomotor agitation is possible, after which a dream comes. After a dream, the patients come to consciousness, they do not remember the seizure. With insufficient current strength, abortive seizures or absences develop. In an abortive fit, there are no clonic convulsions. Abortive seizures are ineffective, and absences are not effective at all and are often accompanied by complications. After the session, the patient should be monitored for 1 day for the purpose of preventing or arresting complications. Electroconvulsive therapy should be carried out 2-3 times a week. For severe psychotic symptoms, electroconvulsive therapy is recommended 3 times a week. The number of sessions of electroconvulsive therapy is individual and depends on the patient's condition, usually 5-12 procedures per course of treatment.

Currently, electroconvulsive therapy is used in two modifications, differing in the setting of electrodes. In bilateral electro-convulsive therapy, the electrodes are placed symmetrically in the temporal regions 4 cm above the point, which is located in the middle of the line drawn between the outer corner of the eye and the auditory meatus. With unilateral electroconvulsive therapy, the electrodes are installed in the temporal parietal region on one side of the head, with the first electrode located in the same place as in the bitemporal electroshock therapy, and the second electrode in the parietal region at a distance of 18 cm from the first. This position of the electrodes is called the position dellia. There is another way of applying electrodes for unilateral electroconvulsive therapy, when one electrode is applied at the junction of the frontal and temporal regions, the other - above the frontal lobe pole (12 cm anterior to the first electrode). This position is called the frontal. Currently, this modification is rarely used because of the frequent development of complications. Both methods have advantages and disadvantages. The choice of the method of electroconvulsive therapy depends on many factors that determine the effectiveness of therapy and the development of side effects during treatment.

Recommendations for preferential choice of bilateral electroshock therapy

A rapid onset of the effect and greater efficacy implies the use of this method in severe urgent states (intentions or attempts at suicide, refusal to eat, lack of critical attitude towards one's illness), lack of unipolar electroconvulsive therapy, dominance of the right hemisphere or inability to determine the dominant hemisphere.

Recommendations for preferential choice of unilateral electroconvulsive therapy

• The current mental state of the patient is not urgent, does not threaten the life of the patient.
• The patient suffers from organic brain damage, in particular Parkinson's disease.
• In the anamnesis there is information about the effectiveness of previously conducted unilateral electroconvulsive therapy. 

To conduct sessions of electroconvulsive therapy, special devices are used - electro-convulsors, which provide dosed application of a frequency-frequency, sinusoidal or pulsed electric current. All devices must meet modern requirements: a wide level of current dosing from 60-70 V (up to 500 V and higher, the presence of the EEG registration unit, the ECG recording unit, the monitor of muscular motor activity during the seizure, the computer on-line analysis unit, which allows the doctor The criterion for the effectiveness of a convulsive fit is the appearance on the EEG of high frequency wave peaks ("polyspike activity"), followed by slower wave complexes, There are three cycles per second, followed by a phase of complete suppression of electrical activity.In our country, such parameters correspond to the electroconsulator Elikon-01. In the USA, they use the "Thymatron System IV", "MECTRA SPECTRUM", in the UK - "Neeta SR 2" .

Efficiency of electroconvulsive therapy

The effectiveness of electroconvulsive therapy in depressive syndromes has been the subject of numerous studies. It is shown that improvement occurs in 80-90% of patients without drug resistance and in 50-60% of therapeutically resistant patients. Patients receiving electroconvulsive therapy usually have a greater symptom score and are chronic or resistant to therapy than patients who received other antidepressant medications. However, most studies prove the best clinical outcomes with the use of electroshock therapy. The number of remissions after electroconvulsive therapy reaches 70-90% and exceeds the effect of any other types of antidepressant therapy.

In patients with delusional symptoms, the effectiveness of electroconvulsive therapy is higher and the effect is faster than in patients without delusional symptoms, especially when combined with neuroleptics. Elderly patients respond to electroconvulsive therapy better than younger patients.

Electroshock therapy is effective for manic conditions. The effect of treatment is more pronounced than with depressive syndromes. In acute manias, the effectiveness of electroconvulsive therapy is comparable to that of lithium salts and is equivalent to that of neuroleptics. Electroconvulsive therapy can be successfully performed in patients with mixed states.

Patients suffering from bipolar affective disorders need fewer sessions of electroconvulsive therapy, which is associated with a tendency to a rapid increase in the threshold of seizures.

[1], [2], [3], [4], [5], [6],

Factors affecting the effectiveness of treatment

Factors affecting the effectiveness of electroconvulsive therapy can be divided into three groups:

• factors associated with the localization of electrodes and the parameters of the electric current;
• factors related to the nature of the mental disorder;
• factors related to the structure of the patient's personality and the presence of concomitant pathology.

[7], [8]

The factors associated with the localization of electrodes and the parameters of the electric current

The primary determinants of convulsive and post-convulsive manifestations of electroconvulsive therapy are electrode localization and electrical current parameters. Depending on the intensity of the stimulus and the position of the electrodes, the frequency of the antidepressant response varies from 20 to 70%. It is proved that with the bilateral position of the electrodes, the therapeutic effect is more pronounced than with the right-sided unilateral position. However, the amount of cognitive impairment in this case is also significantly greater. There is evidence that bifrontal overlapping of electrodes has a therapeutic effect equal in efficiency to bifrontotemporal with less pronounced side effects. According to other data, bifrontal stimulation with depression is more effective than unilateral, with an equal incidence of side effects. There is an assumption that better control of the pathways of electrical current propagation can reduce cognitive side effects and increase the effectiveness of therapy when focusing the effects in the frontal cortex.

Great importance is attached to the parameters of the electrical stimulus - the width of the pulse wave, the frequency and duration of the stimulus. The expression of the positive effect depends on the dose: the effectiveness of therapy increases with increasing pulse power, however, the severity of cognitive side effects also increases.

Factors related to the nature of the mental disorder

The effectiveness of electroconvulsive therapy in endogenous depression has been most studied. After electroconvulsive therapy, 80-90% of patients without drug resistance and 50-60% of therapeutically-resistant patients have an improvement. The number of patients who meet the criteria for remission after electroconvulsive therapy is significantly higher compared with placebo (71 and 39%, respectively), but also with TA (52%). The use of electroshock therapy reduces the duration of inpatient treatment of patients. When conducting the course of electroconvulsive therapy, a faster improvement is observed in patients with severe depression, especially in persons with delusional experiences in the structure of the depressive syndrome. In 85-92% of patients with delirious depression after electroconvulsive therapy, a distinct improvement is observed. The same indices with the use of TA monotherapy or neuroleptics are 30-50%, and with combined therapy - 45-80%.

In patients with schizophrenia, neuroleptics are the first choice. However, some controlled studies show that patients with acute schizophrenia with distinct catatonic or affective symptoms respond better to the combined treatment of electroconvulsive therapy and neuroleptics than to monotherapy with neuroleptics. There is evidence that electroconvulsive therapy is effective in other nosological forms, such as psycho-organic syndrome, RL, Parkinson's disease, late dyskinesias, exogenous mania. However, whether it is a nonspecific action, spontaneous flow or therapeutic effect of electroconvulsive therapy, remains unclear.

[9], [10], [11], [12],

Factors related to the patient's personality structure and the presence of concomitant pathology

Concomitant pathology and disease of dependence in a patient receiving electroconvulsive therapy can serve as predictors of clinical outcomes of treatment. More than 25% of patients have comorbid personality disorders and their reliable association with an unsatisfactory response to treatment.

[13], [14], [15], [16], [17], [18], [19],

Contraindications to electroconvulsive therapy

Contraindications to electroconvulsive therapy in Russian and foreign recommendations are different. According to the recommendations of the Ministry of Health of the Russian Federation ("Methodological recommendations: application of electroconvulsive therapy in psychiatric practice", 1989), all contraindications to electroconvulsive therapy should be divided into absolute, relative and temporary. Temporary contraindications include febrile infectious and purulent inflammatory processes (pneumonia, cholecystitis, pyelonephritis, cystitis, purulent inflammation of throat, etc.). In these conditions, electroconvulsive therapy is temporarily delayed, and the treatment is interrupted. Absolute contraindications include uncontrolled heart failure, surgical intervention on the heart in an anamnesis, the presence of an artificial pacemaker, deep vein thrombosis, myocardial infarction, last 3 months, severe uncontrolled arrhythmias, decompensated heart defects, heart and aortic aneurysms, hypertensive stage III disease with uncontrolled blood pressure, open form of pulmonary tuberculosis, exudative pleurisy, exacerbation of bronchial asthma, head tumor ozga, subdural hematoma, glaucoma, internal bleeding. Relative contraindications include hypertensive disease of stages I and II, mild forms of coronary insufficiency, expressed disorders of heart rhythm and conduction, bronchiectasis, bronchial asthma in remission, chronic liver and kidney disease at the stage of remission, malignant neoplasms, peptic ulcer of the stomach and duodenum .

In accordance with the recommendations of the British Royal Society of Psychiatrists, there are no absolute contraindications to electroconvulsive therapy. However, in situations of increased risk, it is necessary to weigh the risk-benefit ratio of the treatment for the patient's health. Allocate conditions in which the conduct of electroconvulsive therapy may have a high risk of complications. In these situations, when the doctor decides to conduct electroshock therapy, the patient should be carefully examined and consulted by the appropriate specialist. On the condition of increased risk, the anesthetist should be notified. He should correct the dose of muscle relaxants, drugs for anesthesia and premedication. The patient and his relatives are also notified of an increased risk when performing electroconvulsive therapy. To the conditions connected with the raised risk at carrying out of electroshock therapy, carry surgical interventions on heart in the anamnesis, presence of the artificial driver of a rhythm, a deep vein thrombosis, a myocardial infarction transferred during last 3 months, an aneurysm of an aorta, reception of antihypertensive and antiarrhythmic preparations, a cerebrovascular disease (cerebral aneurysm, cases of ischemic neurological deficiency after electroconvulsive therapy), epilepsy, cerebral tuberculosis, dementia, disorders training, the condition after a stroke (without the statute of limitations), craniotomy. To conditions of the raised or increased risk at carrying out of electroshock therapy also carry:

• gastroesophageal reflux (during the session of electroconvulsive therapy, it is possible to throw gastric juice into the trachea and develop aspiration pneumonia);
• diabetes mellitus (to reduce the risk of the procedure, blood glucose control is necessary, especially on the day of the session of electroconvulsive therapy, if a patient receives insulin therapy, he must give an injection before performing electroconvulsive therapy);
• diseases of bones and sarvas (to reduce the risk of complications | recommend increasing the dose of muscle relaxants);
• glaucoma (requires monitoring of intraocular pressure).

[20], [21], [22], [23]

Complications of electroconvulsive therapy

The nature of side effects and complications of electroconvulsive therapy is one of the decisive factors in choosing this method of treatment. Fears of severe irreversible side effects of electroshock therapy have become one of the reasons for the sharp decrease in the number of courses conducted. Meanwhile, side effects with the use of electroconvulsive therapy develop rarely (in 20-23% of cases), as a rule, poorly expressed and short-lived.

Only 2% of patients can state the development of serious complications. The morbidity and mortality associated with electroconvulsive therapy is lower than with antidepressant medication, especially in elderly patients with multiple somatic pathologies. The mortality of patients receiving electroconvulsive therapy in severe depressive disorders is lower than that of other methods, which can be explained by a smaller number of suicides. As with other manipulations that require anesthesia, the risk increases with somatic disorders.

Modern conditions for conducting electroconvulsive therapy (unilateral application of electrodes, the use of muscle relaxants and oxygen, individual titration of the convulsive threshold) led to a significant decrease in the incidence of side effects. Dislocations and fractures, which before the use of muscle relaxants were a frequent complication, are almost never found.

The most common complications of electroconvulsive therapy are as follows.

• Short-term anterograde and retrograde amnesia are the most common side effects of electroconvulsive therapy. As a rule, they are short-lived and last from several hours to several days, almost always reversible and relate to events that occurred immediately before or after the session of electroconvulsive therapy. In some cases, long-term local memory impairment may occur for events occurring at a time that is remote from the time of the electroconvulsive therapy. The use of appropriate methods of treatment (oxygen, unilateral stimulation, two-day intervals between sessions) can lead to reduction of memory disorders.
• Spontaneous seizures are rare. They occur in patients with already existing organic disorders. Spontaneous epileptic seizures after electroconvulsive therapy occur in 0.2% of patients - no more than the average in the population. Often there are changes in the EEG (changes in total activity, delta and theta waves), which disappear within 3 months after the end of the course of electroconvulsive therapy. Histological changes that would indicate irreversible brain damage were not detected in either experimental animals or in patients.
• Disorders of respiratory and cardiovascular activity: prolonged apnea, aspiration pneumonia (when saliva or the contents of the stomach get into the respiratory tract).
• Transient rhythm disturbances, arterial hypotension or hypertension.
• Damage to the musculoskeletal system: sprains, vertebral fractures, dislocations.
• Organic psychoses with orientation disorders and irritability develop in 0.5% of patients and are short-term, reversible. The risk of their occurrence decreases with the unilateral application of electrodes and the use of oxygen.

Currently, IT is used, sleep deprivation, transcranial magnetic stimulation, vagal stimulation, light therapy, transcranial electrotherapy stimulation, atropine-comatose therapy.

[24], [25], [26], [27], [28], [29]