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Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT)

What Is Electroconvulsive Therapy (ECT)?

The Treatment 

Electroconvulsive therapy (ECT) is a treatment for severe episodes of major depression, mania, and some types of schizophrenia.  It involves the use of a brief, controlled electrical current to produce a seizure within the brain.  This seizure activity is believed to bring about certain biochemical changes which may cause your symptoms to diminish or to even disappear.  A series of treatments, generally six to twelve, given at a rate of three per week, is required to produce such a therapeutic effect, although sometimes a smaller or larger number may be necessary.

Description of the Procedure

The treatment is given in the ECT Treatment Area by doctors who have specialized training in ECT.  Before the treatment, a small needle is placed in an arm vein so that the medications to put you to sleep and relax your muscles can be given at the time of treatment.  In the Treatment Area you will be asked to lie down on a comfortable stretcher, after which a blood pressure cuff will be placed on your arm and number of electrodes will be placed on your scalp, chest, and finger, so that the electrical stimulus can later be given after you are asleep, and so that brain waves (EEG), heart waves (EKG), and body oxygen levels can be monitored.  You will then be provided oxygen to breathe by mask, and any pre-ECT medications, if indicated, will be given, followed by the anesthetic medication itself.

Within seconds after the injection of the anesthetic medication, you will be asleep, and the medication to relax your muscles will be given.  Within one to three minutes, your muscles will be relaxed.  A controlled electrical stimulus, lasting a fraction of a second to several seconds, will then be applied across the two stimulus electrodes, which will be described later.  Unilateral ECT has less effect on memory than bilateral ECT; however, some doctors believe that it may not be as effective in some patients.  The electrical stimulus will trigger a seizure within the brain, which typically lasts around a minute.  The muscular response to the seizure is greatly reduced by the muscle relaxant drug given prior to the stimulation.  Very little body movement occurs.

Within a few minutes after the seizure you will be breathing well on your own, and within five to ten minutes you will wake up.  Because of the anesthetic drug and the effects of having had the seizure, you will temporarily feel somewhat groggy.

Benefits of ECT

Although there have been many advances in the treatment of mental disorders in recent years, ECT remains the most effective, fastest and/or safest treatment for many cases, particularly when alternative treatments, usually medications, are either not effective or not safe.  Your doctor will discuss with you why ECT is being recommended in your case and what alternative treatments may be available.  ECT is most effective in major depression, where it has a strong beneficial effect in up to 80-90% of patients.  Still, there is no guarantee that ECT, or for that matter, any treatment will be effective.  In addition, while no guarantee that ECT (or an alternative treatment) may bring an episode of illness to an end, it will not in itself prevent another episode from occurring weeks, months, or years later.  Because of this situation, you and your doctor will need to consider preventative treatment to follow any ECT that you receive.  Such preventative treatment generally consists of medication, psychotherapy, and/or ECT (given as an outpatient at a much less frequent rate).

Risks/Potential Complications of ECT

All treatments have risks and side effects, even no treatment at all.  Prior to ECT you will undergo a careful medical, psychiatric, and laboratory evaluation to make sure that the treatments can be administered in the safest, most effective manner possible.  Your medications may also be adjusted to minimize the risk and maximize the effectiveness of the treatments.  For most patients, the side effects of ECT are relatively minor.  The risk of death is very rare, about 1 per 10,000 patients.  Serious complications, including temporary or permanent heart abnormalities, airway problems resulting in lack of oxygen to the brain, reactions to the medications used at the times of the treatment, injuries to muscle, bones, or other parts of the body, and greatly prolonged seizures or seizures occurring after the treatment, are also quite rare. More common side effects involve headache, muscle soreness, nausea, confusion and memory difficulties.  Headache, muscle soreness, and nausea are usually mild and can be prevented or at least diminished by medications. 

Confusion and memory problems may build up over a course of ECT, but generally begin to disappear as soon as the treatments have stopped.  These effects vary considerably from patient to patient, but are usually greater for larger numbers of treatments or when both sides of the head are stimulated (bilateral ECT).  However, you should also understand that because of the harmful effects that mental disorders themselves often have on memory function, some patients successfully treated with ECT actually report an improvement in memory.  Still, because of the possibility of memory loss, it is recommended that important life decisions be postponed until any major negative effects of ECT on memory have worn off (usually within a week or two following completion of the treatment course).  In this regard, the ability to learn and remember new information usually returns to one's level over a period of days to weeks after ECT.  The ability to remember material from the past, i.e., prior to ECT, likewise tends to return to normal over a similar time period, except that in this case, some memories from the recent past, mainly days to months prior to the treatments, may be delayed in recovery or even permanently lost.

Availability of Alternative Treatments

Medications may be available to treat your particular condition, and it is possible that some of them might work as well as, or better than, ECT.  The advantages and disadvantages of medication therapy have been discussed with you by your doctor.  Medication therapy has its own risks and complications.

Patient Referral

Patients need to be referred to St. Mary's ECT Service by a psychiatrist.  The office can call the ECT Coordinator at (812) 485-5004 and request an ECT referral form faxed to start the process.

 

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