Aside from effects in the brain, the general physical risks of<unk>  are similar to those of brief general anesthesia; the US Surgeon General's report says that there are "no absolute health contraindications" to its use. Immediately following treatment, the most common adverse effects are confusion and memory loss. Some patients experience muscle soreness after<unk> . A meta-analysis from 2017 found that the death rate of<unk>  is around 2.1 per 100,000 procedures. There is evidence and rationale to support giving low doses of benzodiazepines or otherwise low doses of general anesthetics, which induce sedation but not anesthesia, to patients to reduce adverse effects of<unk> . While there are no absolute contraindications for<unk> , there is increased risk for patients who have unstable or severe cardiovascular conditions or aneurysms; who have recently had a stroke; who have increased intracranial pressure (for instance, due to a solid brain tumor), or who have severe pulmonary conditions, or who are generally at high risk for receiving anesthesia. In adolescents,<unk>  is highly efficient for several psychiatric disorders, with few and relatively benign adverse effects. Cognitive impairment Cognitive impairment is sometimes noticed after<unk> . It has been claimed by some non-medical authors that retrograde amnesia occurs to some extent in almost all patients receiving<unk> . However, most experts consider this adverse effect relatively uncommon. The American Psychiatric Association (APA) report in 2001 acknowledges: “In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that<unk>  can result in persistent or permanent memory loss”. After treatment, drug therapy is usually continued and some patients will continue to receive maintenance<unk>  treatments. It is the purported effects of<unk>  on long-term memory that give rise to much of the concern surrounding its use. However, the methods used to measure memory loss are generally poor, and their application to people with depression, who have cognitive deficits including problems with memory, have been problematic. The acute effects of<unk>  can include amnesia, both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment). Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents. The use of either constant or pulsing electrical impulses also varied the memory loss results in patients. Patients who received pulsing electrical impulses, as opposed to a steady flow, seemed to incur less memory loss. The vast majority of modern treatment uses brief pulse currents. Retrograde amnesia is most marked for events occurring in the weeks or months before treatment, with one study showing that although some people lose memories from years prior to treatment, recovery of such memories was "virtually complete" by seven months post-treatment, with the only enduring loss being memories in the weeks and months prior to the treatment. Anterograde memory loss is usually limited to the time of treatment itself or shortly afterwards. In the weeks and months following<unk>  these memory problems gradually improve, but some people have persistent losses, especially with bilateral<unk> . One published review summarizing the results of questionnaires about subjective memory loss found that between 29% and 55% of respondents believed they experienced long-lasting or permanent memory changes. In 2000, American psychiatrist Sarah Lisanby and colleagues found that bilateral<unk>  left patients with more persistently impaired memory of public events as compared to right unilateral<unk> . Effects on brain structure Considerable controversy exists over the effects of<unk>  on brain tissue, although a number of mental health associations—including the APA—have concluded that there is no evidence that<unk>  causes structural brain damage. A 1999 report by the US Surgeon General states: "The fears that<unk>  causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals." Many expert proponents of<unk>  maintain that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent<unk>  researcher and former chief editor of the Journal of<unk> , stated in a 2007 interview that, "There are a number of well-designed studies that show<unk>  does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to<unk> ." Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime<unk>  treatments. Kellner stated "Rather than cause brain damage, there is evidence that<unk>  may reverse some of the damaging effects of serious psychiatric illness." Two meta-analyses find that<unk>  is associated with brain matter growth. Effects in pregnancy If steps are taken to decrease potential risks,<unk>  is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments. Suggested preparation for<unk>  during pregnancy includes a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During<unk> , elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended. In many instances of active mood disorder during pregnancy, the risks of untreated symptoms may outweigh the risks of<unk> . Potential complications of<unk>  during pregnancy can be minimized by modifications in technique. The use of<unk>  during pregnancy requires thorough evaluation of the patient's capacity for informed consent. Effects on the heart<unk>  can cause a lack of blood flow and oxygen to the heart, heart arrhythmia, and "persistent asystole". Deaths, however, are very rare after<unk> : 6 per 100,000 treatments. If they do occur, cardiovascular complications are considered as causal in about 30%.
Electroconvulsive therapy
Brief psychotherapy
Psychotherapy
Cognitive therapy
Suicide intervention
Institutional psychotherapy
Insight-oriented psychotherapy
MDMA-assisted psychotherapy