ECT For Depression and Anxiety

Basics of electroconvulsive therapy - uses and side effects

young woman who appears very depressed
What is electroconvulsive therapy (ECT), when is it used for depression, and what are the possible side effects?. Istockphoto.com/Stock Photo/KatarzynaBialasiewicz

ECT, or electroconvulsive therapy, is an alternative therapy for certain psychiatric illnesses that are not responding to traditional treatments.

Let's learn more about this therapy, including potential side effects, and what it's like to experience ECT.

What is Electroconvulsive Therapy (ECT)?

First developed in the 1930's by Bini and Lenletti, ECT continues to have an important role in the treatment of resistant psychiatric conditions.

ECT works by sending an electric current through the brain. This electrical current, in turn, is thought to alter the chemicals in the brain related to mood.

Though it has been misunderstood by the public, electroconvulsive therapy (ECT) can be a relatively safe procedure for some people with major depression which is resistant to typical therapies, like antidepressants and psychotherapy.

Where and How is ECT Done?

ECTs are given in safe environments—usually recovery rooms in hospitals where medical professionals and equipment are present. An anesthesiologist and an attending psychiatrist give the treatments, along with ECT trained nurses.

A person is gently sedated, with an anesthetic, and relaxed so there is no pain. The ECT produces a type of seizure in the brain. The treatment lasts only a few minutes. Observation of the treatment might reveal a wiggling of the patient's toes.

Shortly after the treatment, the patient wakes up, is checked thoroughly by medical personnel, and is allowed to go back home or to the hospital.

After an ECT, the patient may have a slight headache, some drowsiness, and temporary confusion, but anything more serious is extremely uncommon

Does ECT Cure Depression?

It's important to note that ECT is not a cure. Rather it's a method of buying precious time to find treatments which do work—for those individuals who are worsening or not responding to current treatment and/or medications.

What Does ECT Treat?

ECT is mostly used to treat major depression disorder, but it may also be used to treat other psychiatric illnesses, like mania or schizophrenia.

For catatonic depression (catatonia), in particular, ECT may result in response rates as high as 80 to 100 percent and appears to be more effective than any other treatment currently available.

Can ECT Be Used To Treat Anxiety?

Anxiety disorders are common psychiatric illnesses and include:

ECT may have a role in people who have an anxiety disorder that is not responding to traditional treatments and that is complicated by severe major depression. The concern of some psychiatrists is that while ECT may help with depressive symptoms, it could worsen anxiety symptoms—like worsening obsessional thought or panic attacks.

ECT and Schizophrenia

Just as people with depression who are not responding to available treatments may benefit from ECT, those with schizophrenia who are not responding to antipsychotics may benefit from this treatment.

ECT and Parkinson's Disease

Depression and other mood disorders are very common in people with Parkinson's disease.

There has been a lot of research in recent years looking at the role and benefit of using ECT or Parkinson's related depression.

Who is a Candidate for ECT? - An Example

ECTs are for people who are not responding to medication and other treatment methods for depression. The classic example is the use of ECT for a person with major depression disorder who does not respond to large doses of an antidepressant and psychotherapy. ECT is sometimes given in combination with other therapies in hopes that the combination will improve a person's symptoms more than ECT alone.

What are the Side Effects of ECT?

Over the short-term, side effects of ECT may include headaches, nausea, muscle aches, and confusion.

These symptoms are usually self-limiting and resolve in a matter of days. Retrograde amnesia may last longer than these other symptoms but rarely persists.

Long-term cognitive changes can be a side effect of ECT, with memory loss - mostly loss of memory regarding recent events - most common. A doctor will commonly ask memory or orientation-related questions after a person undergoes ECT to assess their degree of cognitive loss if any.

More severe possible side effects include cardiac pulmonary and brain-related effects. There is an increased risk of heart attack and heart rhythm disturbances in those who have coronary artery disease, and your doctor may recommend consulting with a cardiologist before having ECT.

It is important that patients are aware of this risk and all other potential risks and benefits of ECTs before consenting to treatment.

Overall Safety of ECT

Despite a general sense by the public that ECT is dangerous and outdated when used based on careful selection criteria it can be a relatively safe way of getting severe depression under control. Certainly, the risk of ECT needs to be carefully weighed against the risk of severe depression which is not responding to treatment, such as suicide risk and more.

What Isn't ECT Done More Often?

You may be wondering, "If ECT is generally well tolerated, why isn't it done more often?" Part of the reason is the negative public perception or stigma of ECT. In addition, there is both a lack of awareness among primary care physicians of the role ECT can play and a lack of providers who perform the procedure. It's important to note again, however, that ECT is a procedure that is performed when treatments such as medications and psychotherapy are ineffective in relieving severe depression or other psychiatric illness such as schizophrenia. When this is the case, the quality of a life of a person is very important to keep in mind when considering the treatment.

Alternatives to ECT

Before considering ECT, it's important to consider the possible alternatives.

Your psychiatrist may have had you try several different antidepressants from different classes. We still don't know why some people may respond better to one class than another, but it is probably related to the balance of neurotransmitters in the brain which can lead to depression.

Psychotherapy is also a mainstay and should be tried before considering ECT.

One alternative to ECT that has been used more often in recent years is transcranial magnetic stimulation. Learn more about the pros and cons of ECT vs TMS.

What Should I Do?

ECT is believed to be a safe intervention in carefully selected people that can be very effective in alleviating distressing psychiatric symptoms. As with any intervention, procedure, or medication, please speak with your doctor about any concerns you have before undergoing ECT.

Sources:

Andrade, E., Arumugham, S., and J. Thirthalli. Adverse Effects of Electroconvulsive Therapy. Psychiatry Clinics of North America. 2016. 39(3):513-30.

Luchini, F., Medda, P., Mariani, M., Mauri, M., Toni, C., and G. Perugi. Electroconvulsive Therapy in Catatonic Patients: Efficacy and Predictors of Response. World Journal of Psychiatry. 2015. 5(2):182-92.

Pourafkari, N., Pourafkari, L., and N. Nader. Electroconvulsive Therapy for Depression Following Acute Coronary Syndromes: A Concern for the Anesthesiologist. Journal of Clinical Anesthesia. 2016. 31:223-8.

Sicher, S., and J.Gedzior. Electroconvulsive Therapy: Promoting Awareness Among Primary Care Physicians. International Journal of Psychiatry in Medicine. 2016. 51(3):278-83.

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