Electroconvulsive Therapy (ECT)

ECT: A form of treatment for depression

Heart rate monitor, patient and doctors in background
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Electroconvulsive therapy (ECT) is a form of treatment for depression which involves the application of a brief electrical pulse to the scalp in order to produce a seizure. Generally, a series of treatments is given over a period of weeks.

Who Is a Candidate for ECT?

ECT is considered most appropriate for severe or delusional depression, as well as acute mania and certain schizophrenic syndromes. To determine whether a patient is a good candidate for ECT, doctors should consider the following:

  • Is there a need for a rapid, definitive response, such as when the patient is at immediate risk of suicide or is experiencing acute symptoms of mania which are putting their well-being at risk?
  • Does the patient have medical conditions which make drug treatment more risky, such as the first trimester of pregnancy?
  • Does the patient have medical conditions which ECT might exacerbate, such as increased pressure inside the skull due to brain lesions, a recent history of heart attack or large aneurysms?
  • Have other treatments failed?
  • Has the patient responded to ECT previously?

What Happens Before ECT?

In preparation for the procedure, patients are given a medical check up. Any medications which might cause problems during treatment may need to be discontinued or carefully monitored. Malnourished patients should have their electrolytes checked and corrected if necessary. Any problems with the patient's teeth need to be addressed because the jaw clenches during the treatment and weakened teeth could break.

Treatment is generally scheduled for early morning. The night before, the patient's hair is thoroughly washed and no creamy hair products or skin lotions can be applied afterward. The patient is not allowed to eat or drink after midnight to decrease risk during anesthesia.

What Happens During ECT?

In the treatment room, the patient will have a pulse oximeter attached to monitor blood oxygen levels.

Electrodes will be attached to the body to perform an electrocardiogram (ECG) to monitor heart activity and an electroencephalogram (EEG) to monitor brain activity. A blood pressure cuff is placed on the patient's arm to monitor blood pressure. Intravenous access is secured for the administration of drugs.

Anesthesia is induced and the patient is given oxygen throughout the procedure. A muscle relaxant is given intravenously and, after it has taken effect, a bite block is placed in the patient's mouth and the jaw is gently held shut. The electrical stimulus is then applied using carefully selected parameters until a seizure occurs that lasts at least 30 seconds. During the seizure, blood pressure and heart rate and rhythm are monitored.

What Happens After ECT?

Once the patient's breathing has returned to normal, the patient is observed for at least a half hour. Rarely, vomiting will occur.

The majority of patients will be mildly confused following the procedure, for a period ranging from 15 minutes to several hours.

A minority of patients will become agitated.

What Are the Risks of ECT?

Modern ECT is much more humane and safe than it once was, but there are some risks.

  • As with any procedure where you are put under anesthesia, there is a small possibility of death.
  • Rarely, irregular heart rates and rhythms will occur.
  • Short-term memory loss that may last for weeks may occur and may include events that happened several weeks before the treatment. Although most patients experience some degree of memory loss, brain damage has not been shown to occur.
  • The most common side effects are muscle aches, headaches and soreness immediately after the procedure.

What Are the Benefits of ECT?

  • About 80 percent of patients who receive a full course of treatment with ECT find rapid relief from their symptoms.
  • ECT works for patients who have not had success with other treatments.

What Are the Patient's Legal Rights?

Both law and medical ethics require that patients who receive ECT must give their informed consent. This means that the procedure should be fully explained to the patient and the patient must willingly accept it. Patients have the right to refuse treatment, even if they have previously given consent. If the patient lacks the capacity to give informed consent, a decision must be made by a court of law before he can be treated.

References:

Electroconvulsive Therapy. NIH Consensus Statement Online 1985 Jun 10-12 [cited April 19, 2007]; 5(11):1-23.

Moore & Jefferson: Handbook of Medical Psychiatry, 2nd ed., Copyright 2004 Mosby, Inc.

The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, Privileging. A Task Force Report of the American Psychiatric Association, 1990.

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