What is Electroconvulsive Therapy or ECT & When and Why Should it be Done?

What is Electroconvulsive Therapy or ECT?

Electroconvulsive Therapy is one among the many of treatments for depression and is considered to be an effective and safe method for treating severe depression and depression which is resistant to medications. Electroconvulsive Therapy or ECT is extremely beneficial for patients suffering from mania and other mental illnesses and is also one of the fastest methods to relieve symptoms in suicidal patients or severely depressed patients.

In Electroconvulsive Therapy, finely controlled electric current is applied through the electrodes that are placed on the patient’s scalp. The patient is kept under general anesthesia during Electroconvulsive Therapy or ECT. The electric current which passes through the nodes produces a brief seizure in the brain.

As mentioned before, Electroconvulsive Therapy is commonly used when the patient has severe depression and does not respond to other forms of therapy. Electroconvulsive Therapy is also used when patient becomes a severe threat to others or themselves or when it is considered dangerous to wait till the medications take their effect.

What is Electroconvulsive Therapy or ECT?

How Long Has Electroconvulsive Therapy Been in Use & Why is ECT such a Controversial Treatment?

Electroconvulsive Therapy or ECT has been in use for treating mental illness since the 1940s and 1950s; however, it is also one of the most misunderstood treatments by the general public. Most of the risks and side effects that are considered to occur from Electroconvulsive Therapy actually occur from incorrect administration of ECT, misuse of equipment or improperly trained staff.

There is also a misconception ion that Electroconvulsive Therapy can be used as a “quick fix” instead of long-term therapy or hospitalization for mental illness. It is also wrongly assumed that Electroconvulsive Therapy painfully “shocks” the patient out of the depression. The controversy around this Electroconvulsive Therapy or ECT is also fueled by unfavorable media coverage and news reports regarding this treatment.

How is Electroconvulsive Therapy Performed?

Before the commencement of Electroconvulsive Therapy, a muscle relaxant is given to the patient after which the patient is put to sleep with general anesthesia. A finely controlled electric current is applied through the electrodes which are placed on the patient’s scalp. This current produces a brief seizure in the patient’s brain. As the patient is given a muscle relaxant, the effects of the seizure often will be limited to slight movement of hands and feet. The patient is carefully monitored during Electroconvulsive Therapy or ECT. After a few minutes of the treatment, the patient wakes up and does not have any recollection of the treatment or the events surrounding it and is usually confused. This confusion after Electroconvulsive Therapy or ECT usually lasts for only a short period of time.

What is the Frequency of Electroconvulsive Therapy?

Electroconvulsive Therapy is commonly given about three times a week for a total of two weeks to a month.

When & Why Should Electroconvulsive Therapy be Done?

Electroconvulsive Therapy is done and is beneficial in the following situations:

  • When a patient does not eat anything and this leads to nutritional deficiencies.
  • When the patient’s depression does not respond to antidepressant therapy.
  • When there is a need for rapid treatment and result, for example if the patient is pregnant.
  • When the patient is not able to use antidepressant medication because of other medical conditions he/she has.
  • When the patient has psychotic features along with depression.
  • When the patient is in a catatonic stupor.
  • When treating mania.
  • When treating bipolar disorder which includes both depression and mania.
  • When treating patients who are extremely suicidal.
  • When treating older adults who can’t tolerate the side effects of antidepressants.
  • When treating patients who have had success previously with the treatment of Electroconvulsive Therapy.
  • When the patient is pregnant and can’t take medications as they might affect the unborn fetus.
  • When treating patients with major depression and schizophrenia.
  • When treating patients with psychotic mania or psychotic depression.

How Does Electroconvulsive Therapy Help in Treating Depression & Other Mental Illnesses?

No one knows the exact mechanism of how Electroconvulsive Therapy or ECT helps in treating depression and other mental illnesses including severe depression. However, Electroconvulsive Therapy or ECT is known to cause changes in the various chemical aspects of brain function during as well as after the seizure activity in the brain. These chemical changes in the brain can build upon one another which somehow leads to decrease in the symptoms of severe depression and other mental problems. This is the reason Electroconvulsive Therapy or ECT is effective in patients who have received a complete of multiple treatments.

What are the Risks of Electroconvulsive Therapy?

Electroconvulsive Therapy is generally considered to be a safe procedure but it does have some risks and side effects which are:

Confusion: The patient wakes up confused immediately after ECT. This confusion lasts from a few minutes to some hours. The patient does not remember anything about the treatment or where and why the patient is there. In rare cases, the confusion from Electroconvulsive Therapy or ECT can last for several days or even more. Older adults generally feel more confusion than young adults.

Memory Loss: There are some patients who suffer from memory loss and are not able to remember events which occurred right before Electroconvulsive Therapy and sometimes events which occurred weeks or months before ECT. Rarely the patient may also not be able to remember events from previous years. This is known as retrograde amnesia. Most of the times, these memory problems will improve in a month or two after the Electroconvulsive Therapy or ECT treatment ends.

Physical Side Effects: When the Electroconvulsive Therapy is given, some patients can experience headache, nausea, muscle ache or jaw pain. Medications will help relieve these physical side effects of Electroconvulsive Therapy or ECT.

Medical Complications: There are risks of medical complications with any type of medical procedure, particularly those which involves anesthesia. During Electroconvulsive Therapy or ECT, there is an increase in the blood pressure and the heart rate of the patient. Rarely, this can lead to serious heart problems. Patients having heart problems will be at risk for more problems after undergoing ECT.

What is the Preparation done Before Electroconvulsive Therapy?

Before undergoing Electroconvulsive Therapy, a full evaluation is conducted on the patient, which includes: patient’s medical history, physical exam, basic blood tests, psychiatric assessment, electrocardiogram (ECG) and a consultation with Anesthesiologist to explain the risks of anesthesia to the patient. All these tests are done to make sure that Electroconvulsive Therapy is safe for the patient.

What is the Duration of Electroconvulsive Therapy?

The duration of an Electroconvulsive Therapy or ECT procedure is about five to 10 minutes excluding the time taken for preparation and recovery. Electroconvulsive Therapy can be done as an outpatient procedure or when the patient is hospitalized.

What Happens Before & During Electroconvulsive Therapy Treatment?

  • As the patient will undergo general anesthesia, there are dietary restrictions placed on the patient before the ECT procedure. Patient should not consume any food or water after midnight and should only take a sip of water for morning medications. Specific instructions will be given to the patient by health care team before the Electroconvulsive Therapy or ECT procedure.
  • Patient is also given brief physical exam which includes checking the lungs and heart.
  • After this, an intravenous (IV) line is inserted in the patient through which fluids or medications can be given to the patient.
  • Next, the electrode pads are placed on the patient’s scalp. The size of each pad is about that of a silver dollar.
  • Electroconvulsive Therapy can be unilateral where the electric currents are concentrated on one side of the brain only or ECT can be bilateral where focused electric currents is given on both sides of the brain.

What Types of Medications are Given During Electroconvulsive Therapy?

At the commencement of the Electroconvulsive Therapy or ECT procedure, the patient is given the following medications through his/her IV:

  • An anesthetic is given to make the patient unconscious and unaware of the Electroconvulsive Therapy or ECT procedure.
  • Next, patient is given a muscle relaxant to prevent injury and to minimize the seizure.
  • Other medications can be given to the patient depending on the health condition of the patient and the patient’s previous response to ECT.

What is the Equipment used during Electroconvulsive Therapy Procedure?

  • A blood pressure cuff is placed around the ankle of the patient to prevent the muscle relaxant from entering the foot so that the foot muscles are not affected.
  • When Electroconvulsive Therapy or ECT procedure starts, the doctor monitors the seizure activity by watching for any foot movements.
  • Different monitors are used to check the patient’s blood pressure, heart and brain activity and oxygen use.
  • Patient can also be given oxygen via oxygen mask.
  • A mouth guard may also be given to the patient to help protect patient’s tongue and teeth from any injury.

How is the Seizure Induced during Electroconvulsive Therapy?

When the patient is asleep as a result of anesthetic and the muscles are relaxed, then the doctor presses a button present on the Electroconvulsive Therapy machine. Pressing this button releases a small amount of electric current to pass via the electrodes placed on the patient’s scalp to the brain, producing a seizure which typically lasts less than a minute. Because of the effect of the muscle relaxant and general anesthesia, patient remains relaxed and is not aware of the seizure. The only indication of the seizure in the patient will be a rhythmic movement of the patient’s foot if there’s a blood pressure cuff around the patient’s ankle. Whereas, inside the brain, the activity increases dramatically and electroencephalogram (EEG) records all the electrical activity that goes on in the patient’s brain. Abrupt, increased activity on the EEG is an indication of beginning of seizure, which is then followed by plateauing off which indicates that the seizure is over.

What Happens after the Electroconvulsive Therapy Procedure?

After some minutes, the effect of the muscle relaxant and anesthetic wears off. Patient is then taken to recovery area where he/she is monitored for any problems. After the patient wakes up, he/she tends to experience some confusion which can last for some minutes to a few hours or even more.

How often is Electroconvulsive Therapy Needed?

In USA, Electroconvulsive Therapy treatments are commonly given two to three times in a week and for three weeks to a month which makes a total of six to 12 treatments. A newer technique is used by some doctors which is known as right unilateral ultra-brief pulse electroconvulsive therapy which is done daily on weekdays. The type and the number of treatments which the patient needs depend on the severity of the patient’s illness and symptoms and the rate at which the improvement is seen in the patient.

How soon can the Patient return to Normal Activities after Electroconvulsive Therapy?

Some patients are advised not to drive or return to work about a week or two after the last complete series of Electroconvulsive Therapy or for at least 24 hours after the last Electroconvulsive Therapy or ECT.

What are the Results of Electroconvulsive Therapy?

Most of the patients start to notice an improvement in their depression symptoms after about five to six treatments of electroconvulsive therapy. Complete improvement may take more time. There is also a chance that Electroconvulsive Therapy may not work for some patients. When compared to ECT, response to antidepressant medications can take much longer time.

Does Patient Still Need Electroconvulsive Therapy Even After Improvement is Seen?

Even after improvement in the symptoms of depression patient still needs ongoing depression treatment for preventing relapse or recurrence. This ongoing depression treatment may consist of Electroconvulsive Therapy which is more often, but with less frequency. Ongoing depression treatment can also include antidepressants and psychotherapy.

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