Electroconvulsive therapy services during COVID-19 pandemic

Abstract

The COVID-19 pandemic has hit the electroconvulsive therapy (ECT) services hard worldwide as it is considered an elective procedure and hence has been given less importance. Other reasons include the risk of transmission of infections, lack of resources, and the scarcity of anesthesiologists due to their diversion to intensive care units to manage COVID-19 patients. However, ECT is an urgent and life-saving measure for patients diagnosed with depression and other severe mental illnesses who have suicidality, catatonia, or require a rapid therapeutic response. COVID-19 pandemic is a significant source of stress for individuals due to its impact on health, employment, and social support resulting in new-onset psychiatric illnesses and the worsening of a pre-existing disorder. Hence, a continuation of the ECT services during the COVID-19 pandemic is of paramount importance. In this narrative review, the authors from India have compiled the literature on the ECT practice during the COVID-19 pandemic related to the screening and testing protocol, necessity of personal protective equipment, modification in ECT Suite, electrical stmulus settings, and anesthesia technique modification. The authors have also shared their experiences with the ECT services provided at their institute during this pandemic. This description will help other institutes to manage the ECT services uninterruptedly and make ECT a safe procedure during the current pandemic.

Concurrent catatonia and COVID-19 infection – An experiential account of challenges and management of cases from a tertiary care psychiatric hospital in India

“…Also, lorazepam is a safer choice among benzodiazepines because of the absence of liver metabolism and therefore a decreased risk of prolonged action or drug-drug interactions as occurs with other drugs of this class ( Shah et al, 2021 ). ECT administration in the presence of COVID-19 infection requires a coordinated approach that can ensure the safety of both the patient and the treating team, details of which have been elaborated on in a previous publication from our centre ( Surve et al, 2021 ). To summarize briefly, in our PCU, a team comprising of a psychiatrist, an anesthetist, and nursing personnel administered ECTs.…”

“…However, providing these interventions in the background of COVID-19 infection poses several challenges ( Gouse et al, 2020 ). Benzodiazepines increase the risk of respiratory depression and general anesthesia for ECT increases the risk of aerosol-based spread, in addition to inherent risks in medically ill/unstable patients ( Surve et al, 2021 ).…”

Treatment of Catatonia in a Young Adult with COVID-19 Infection; Case Report and Review of the Literature on Electroconvulsive Therapy During the Covid-19 Pandemic

“…Additionally treatment frequency and anesthesiology techniques may be altered as appropriate. 6 , 15 …”

Electroconvulsive Therapy During the COVID-19 Pandemic

“…The manual ventilation, done through a oro-nasal mask, is counted among the procedures which create aerosol and probably presents the biggest risk for infection among hospital staff [9]. SARS-CoV-2 has a high affinity for salivary gland cells, and those infected can secrete a significant quantity of the virus through their saliva; during the ventilation process the virus can then pass from the oral cavity into the aerosol [10].…”