Practice of electroconvulsive therapy in a tertiary care hospital in Pakistan.

OBJECTIVES: This study aimed to describe the practice of an unmodified electroconvulsive therapy (ECT) in a typical urban hospital setting in Pakistan. METHODS: This is a retrospective naturalistic study of patients who received ECT at Rawalpindi General Hospital between June 2000 and June 2008 by chart review. All useful data that could be retrieved from the charts were recorded. RESULTS: The process of administering ECT at the hospital is described. During the study period, of a total of 5240 patients who were admitted to the hospital, 1520 (29%) were administered ECT. Of these, 1352 (88.9%) did not get any kind of anesthesia during the procedure. The mean age of patients was 34.89 years, and the leading diagnoses were depression (60.8%), bipolar disorder (17.8%), and schizophrenia (9.1%). The mean number of ECTs received for these diagnoses were 5.78, 5.52, and 6.34, respectively. A total of 249 (16.7%) patients discontinued ECT against medical advice. CONCLUSIONS: In countries with limited resources, ECT is practiced in a markedly different way from more developed countries; although administering ECT without anesthesia is not desirable, in the face of severe economic constraints, it is often necessary.

Which antidepressant would psychiatrists and nurses from a developing country choose for themselves?

OBJECTIVE: To determine the prescribing preference of mental health professionals in a developing country for antidepressants if they themselves developed a depressive illness. METHODS: A specifically designed self reporting questionnaire was used to investigate which antidepressant was the preferred choice of psychiatrists and nurses and the factors which influenced their decision making. RESULTS: Fluoxetine was the antidepressant most likely to be chosen by psychiatrists for themselves, followed by escitalopram and tricyclic antidepressant. A total of 21 (27.6%) nurses said that they did not know which antidepressant they would prefer for themselves and 22 (29%) said that they would choose a benzodiazepine. Majority of the psychiatrists (71.9%) had more experience with SSRIs, 26.6% with tricyclic antidepressants and only about 1.5% had used venlafaxine and mirtazapine. Efficacy and safety of antidepressants were the two most important factors in selecting an antidepressant. CONCLUSIONS: SSRIs are the preferred antidepressants of Pakistani psychiatrists and nurses for their patients and for themselves. Efficacy and safety of a drug are likely to play a greater role in drug choice than cost of the drug.