Electroconvulsive therapy, or ECT, is a safe and effective treatment that may reduce symptoms related to depression or mental illness. During ECT, certain parts of the brain are stimulated using small electric currents. ECT seems to cause changes to the chemistry of the brain. It is most often used only when other treatments provide little or no relief from symptoms. Your doctor may recommend that you have ECT treatment. The decision whether or not to have this treatment is also yours. This program explains electroconvulsive therapy. It covers what it is, how it is done, and alternative treatments. The benefits and risks of ECT are also discussed. Follow-up treatments, known as maintenance treatments, are explained.
Definition
Electroconvulsive therapy (ECT) is a medical treatment for severe mental illness in which a small, carefully controlled amount of electricity is introduced into the brain. This electrical stimulation, used in conjunction with anesthesia and muscle relaxant medications, produces a mild generalized seizure or convulsion. While used to treat a variety of psychiatric disorders, it is most effective in the treatment of severe depression, and provides the most rapid relief currently available for this illness.
Purpose
The purpose of electroconvulsive therapy is to provide relief from the signs and symptoms of mental illnesses such as severe depression, mania, and schizophrenia. ECT is indicated when patients need rapid improvement because they are suicidal, self-injurious, refuse to eat or drink, cannot or will not take medication as prescribed, or present some other danger to themselves. Antidepressant medications, while effective in many cases, may take two-six weeks to produce a therapeutic effect. Antipsychotic medications used to treat mania and schizophrenia have many uncomfortable and sometimes dangerous side effects, limiting their use. In addition, some patients develop allergies and therefore are unable to take their medicine.
Precautions
The most common risks associated with ECT are disturbances in heart rhythm. Broken or dislocated bones occur very rarely.
Preparation
Patients and relatives are prepared for ECT by being shown video tapes that explain both the procedure and the risks involved. The physician then answers any questions these individuals may have, and the patient is asked to sign an “Informed Consent Form.” This gives the doctor and the hospital permission to administer the treatment.
Once the form is signed, the doctor performs a complete physical examination, and orders a number of tests that can help identify any potential problem. These tests may include a chest x ray, an electrocardiogram (ECG), urinalysis, spinal x ray, brain wave (EEG), and complete blood count (CBC).
Some medications, such as lithium and a type of antidepressant known as monoamine oxidase inhibitors, should be discontinued for some time before treatment. Patients are instructed not to eat or drink for at least eight hours prior to the procedure in order to reduce the possibility of vomiting and choking.
Aftercare
After the treatment, patients are moved to a recovery area. Vital signs are recorded every five minutes until the patient is fully awake, which may take 15-30 minutes. Some initial confusion may be present but usually disappears in a matter of minutes. There may be complaints of headache, muscle pain, or back pain. Such discomfort is quickly relieved by mild medications such as aspirin.
Risks
Advanced medical technology has substantially reduced the complications associated with ECT. These include slow heart beat (bradycardia), rapid heart beat (tachycardia), memory loss, and confusion. Persons at high risk for ECT include those with recent heart attack, uncontrolled blood pressure, brain tumors, and previous spinal injuries.
Normal results
ECT often produces dramatic improvement in the signs and symptoms of major depression, especially in elderly individuals, sometimes during the first week of treatment. While it is estimated that 50% of these patients will experience a future return of symptoms, the prognosis for each episode of illness is good. Mania also often responds well to treatment. The picture is not as bright for schizophrenia, which is more difficult to treat and is characterized by frequent relapses.
A few patients are placed on maintenance ECT. This means they return to the hospital every one-two months, as needed, for an additional treatment. These individuals are thus able to keep their illness under control and lead a normal and productive life.