What is Electroconvulsive Therapy?
Electroconvulsive therapy (ECT) is a treatment in which a patient under general anesthetic will have an electrical current passed through his or her brain, causing a seizure in the brain. This therapy was developed in the 1930s and has become a painless, safe, effective therapy for a number of psychiatric problems.
How does Electroconvulsive Therapy work?
Current theories suggest that the seizure activity causes changes in brain chemistry.
When is ECT used?
ECT is used primarily for depressive illnesses. It is usually reserved for situations where medications have not worked, but it may be the first choice of therapy for frailer, older patients for whom medications may be more of a problem. If a patient has responded well to ECT in the past, it may be his or her own first choice. ECT is also used occasionally in mania, schizophrenia, and in severe Parkinson's disease.
How is the procedure carried out?
Patients are treated in specific ECT suites or in hospital operating rooms. You will be given an intravenous line. Sensors monitoring your heart and brain waves will then be applied to your head, and you will be given a short-acting general anesthetic. Once you are asleep, you will be given a muscle relaxant. When you are completely asleep and your muscles are relaxed, a brief electrical current will applied to your brain either unilaterally (on one side), or bilaterally (on both sides). A brief seizure will follow, which will be modified by the muscle-relaxants so that medical staff may need to look carefully at brain wave monitors and observe your toe and hand movements to monitor it. The whole procedure takes only a few minutes. You will then be moved to a recovery area where a nurse will closely observe your pulse and blood pressure until you are awake enough to return to your room or go home.
How many treatments are required?
Usually patients with acute psychiatric problems require 6 – 12 treatments, given either 2 or 3 times a week. Occasionally more treatments will be required for maximum benefit.In order to keep patients well, outpatient maintenance ECT is sometimes recommended. In such cases the treating physician determines the number and frequency of treatments by assessing specific clinical problems and needs.
What are the benefits of ECT?
ECT has produced substantial improvement in most of the patients who have been treated with it. It has been shown to be effective in many who have not responded to other forms of treatment. In fact, between 50 – 70 percent of patients who previously did not respond to medications will respond positively to ECT. Many depressed patients have problems with their memory; after their depression is relieved, which may occur after having ECT, their memory may improve. Improvement is gradual over several treatments until most or all symptoms of a depression are relieved. You may notice an improvement of appetite early on, later an improvement in energy, and finally an overall sense of feeling better. The treatment team will work with you to monitor your individual symptoms and response.
What are the side effects?
Immediately after ECT, you may experience some nausea, headache, and muscle aches. These are most often managed by taking over the counter Tylenol. You may experience some acute confusion on the day of the ECT treatment, which most often resolves quickly. You may also forget recent events or events occurring around the time that you have the ECT. These memory problems are usually minor and may be decreased by slight changes in the procedure. Some patients experience longer-lasting problems with recalling memories from around the time of the ECT, and occasionally problems recalling some distant events. These memory effects generally subside once the ECT is completed. A few patients may have more severe problems remembering events from the distant past. Patients generally have fewer memory problems with unilateral ECT (one side of brain) compared to bilateral ECT (both sides of brain). Your treating psychiatrist will further explain this. You should always report possible side effects to your nurses or psychiatrist, so the treatment team can work to reduce them. ECT is considered very safe, and no more dangerous than a minor surgical procedure requiring a short general anesthetic. A current estimate of mortality in ECT is 2 in every 100,000 treatments. If you are worried about this, please discuss it with your psychiatrist.
Patient Preparation for ECT Therapy:
What will happen prior to the first ECT Treatment?
Consent – your doctor will explain the procedure and request that your sign a consent form
What will happen before, during and after each ECT Treatment?
NIGHT BEFORE: Bath/Shower and Shampoo
This aids in relaxation & promotes sleep
Clean hair provides for better conduction of the electric current
It is important that hair be dry before treatment is given, therefore hair should be washed the night before
The gel used with the electrodes leaves a sticky residue, you may prefer to shampoo after each treatment
he Morning of ECT Therapy
Remove jewelry, hair accessories, contact lens, glasses, hearing aids, and dentures.