Chapter 21.Electroconvulsive Therapy and Other Forms of Brain Stimulation

Brain stimulation techniques, in particular electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), have become a rapidly evolving area in geropsychiatric practice. This chapter begins with a discussion of ECT, which involves the electrical induction of a series of seizures as a treatment for mental disorders, most notably major depressive disorder (MDD). Coverage of this topic includes the history of ECT, its indications and risks, the evaluation of patients, ECT technique (including a recently proposed experimental modification called focal electrically administered seizure therapy [FEAST]), and the management of patients following completion of an acute (i.e., index) ECT course, including the use of ECT to prevent relapse (maintenance ECT). Later sections cover other types of brain stimulation techniques, including magnetic seizure therapy (MST), TMS, transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), particularly in the treatment of elderly patients. Finally, the chapter ends with a brief discussion of what can be expected in the future of brain stimulation therapies.