Electroconvulsive Therapy (ECT)

Overview

A small electric current is administered to your brain during Electroconvulsive Treatment (ECT), a medical procedure designed to induce brief seizures. It has been demonstrated that this therapy significantly improves mental health issues that are severe and resistant to treatment. With over 80 years of experience, ECT has been proven to be a safe and efficient treatment method through considerable study. Anesthesia is used in this treatment to ensure your comfort throughout the process.

Because of the way ECT has been portrayed in films, television shows, and other media, it frequently carries a bad reputation. When it comes to how ECT works, whether it’s scary or painful, and whether it works, these depictions of the procedure are mostly untrue. These depictions are not accurate, nor do they demonstrate how doctors carry out this treatment in a way that is both humane and safe.

Reasons for undergoing the procedure

ECT is an option for a wide range of ages and can be used to treat individuals with severe mental health conditions. Children (some states have age-specific limitations), teenagers, and adults of all ages can benefit from this procedure. ECT typically has the greatest effects on those over 60.

Severe mental health issues under the following conditions are the most common reasons for ECT:

• In cases where drugs prove ineffective.
• When an individual experiences catatonia, a severe shutdown of function.
• When a patient poses a risk to themselves or others and it will take several days or weeks for medicine to take action.

ECT can be used to treat a number of illnesses, such as the following:

• Depression (particularly in those over sixty years old).
• Schizophrenia (includes psychotic disorders and other ailments on the schizophrenia spectrum).
• Bipolar disorder and other conditions associated with manic episodes.

Risks

ECT has many drawbacks despite its great effectiveness.

• There’s a chance of losing memory. Most ECT recipients experience transient confusion and memory loss. Confusion typically goes away fast, and memory loss typically disappears completely in a few months. Nonetheless, some people do suffer from persistent memory issues. This can be less likely by using the right-unilateral electrode placement and cutting the electrical current duration.
• The process requires extensive medical care. Multiple highly trained providers must be present throughout each ECT procedure. This indicates that smaller healthcare facilities and communities frequently do not have access to this treatment.
• Physical side effects. Some patients report experiencing headaches, nausea, jaw pain, or muscle aches the day of an ECT therapy. Usually, medicine can be used to treat them.
• The results of this procedure might only be temporary. Following ECT, some patients require additional treatments. These “maintenance” treatments can be required for several weeks or even months. These follow-up sessions typically take place once a week or even once every few months. This is when taking medicine in addition to ECT can be helpful.

Before the procedure

Your doctor will explain the basics of ECT to you or a representative before you begin treatment. Additionally, they will ensure that you have no underlying medical disorders or other reasons why you might not be a good candidate for ECT.

Prior to ECT, a number of tests may be conducted, including but not restricted to the following:

• Blood and urine tests. Complete blood counts, basic or full metabolic panels, thyroid and renal functions, and other tests are a few examples.
• Skull, brain and spine diagnostic imaging. X-rays and Computed Tomography (CT) scans are two examples of this.
• Electrocardiogram (ECG or EKG). This test examines how well your heart is working and looks for any abnormalities or issues with the electrical system of your heart.

Cessation of food and beverages

Your doctor will have you fast before the operation because ECT includes general anesthetic. This entails quitting beverages two hours prior to the surgery and halting eating eight hours beforehand.

What you need to take off or remove

Before undergoing this operation, your doctor could advise you to take off any jewelry, medical equipment, accessories, or prostheses. Taking off your spectacles, contact lenses, hearing aids, dentures, dental plates, etc. are common examples. By doing this, the possibility of harm or choking from these objects is reduced.

Cessation of medication

The effectiveness of ECT treatment may be impacted by some medications, which may also change how it affects you. Your doctor could advise you to stop taking some medications altogether or to cut back on how much you take. Medication changes or stops should only be made in accordance with your doctor’s instructions.

During the procedure

Many medical professionals, such as a psychiatrist, anesthesiologist, and other qualified staff, are involved in ECT.

Anesthesia and other preparations

General anesthesia is used at the beginning of an ECT operation to induce deep sleep and prevent you from experiencing pain, discomfort, or worry. Your doctor will also administer a muscle relaxant to help prevent any strains or injuries that may occur during the seizure.

In order to safeguard your teeth, the providers will also place a bite guard in your mouth. Intravenous (IV) needle also placed into one of your veins, typically in your arm. This IV facilitates rapid administration of medications, either for anesthesia or to address any potential side effects.

Electrode placement

Electrodes, which act as contact points for the electric current to flow through, will then be applied by a doctor to your head’s skin. Your unique demands will determine the placement, and the doctors will select the one that has the least likelihood of producing adverse consequences. Providers can position the electrodes in three different ways.

• Right unilateral: Both electrodes are positioned on the right side of your head in this arrangement. Between your temple and the tip of your eyebrow will be one electrode. The location of the other electrode will be just above your right ear, close to the top of your head.
• Bifrontal: This method places electrodes just above the tip of your eyebrow on opposite sides of your forehead.
• Bitemporal: One electrode is positioned on each side of your head, aligning with the temple region.

A doctor will apply a conductive gel to the electrodes, which should shield your skin from burns and irritation. Even with the extremely low electrical current involved, burns and skin irritation are still possible outcomes.

Electricity requirements

Only 0.4 amps or so of electrical current are used during ECT treatments. Until the desired result is achieved, providers will begin the current at low levels and increase it.

For ECT, the electrical current duration is likewise quite short. In the majority of treatments, the administration of electrical current to your brain lasts only a few seconds.

Induced seizure

An electrical current is used by ECT to induce seizures, which are characterized by a sudden spike in brain activity that causes the impacted brain cells to fire quickly. Your brain’s electrical and chemical processes are altered as a result, improving the functionality of those specific brain regions.

ECT seizures usually last anywhere from 30 to 90 seconds. When a seizure lasts longer, medical professionals can use injectable drugs to halt it.

After the procedure

As you come out of anesthesia, the doctor will keep an eye on you once the seizure has stopped. In order to detect any potential side effects or other anesthesia-related issues, they will also monitor your vital signs.

After this operation, the majority of people are completely cognizant in 10 to 15 minutes and are able to stand and move around in 30 minutes.

Outcome

The majority of ECT recipients recover from the treatment soon. The majority regain consciousness in 15 minutes and are capable of standing up within 30 minutes.

Multiple treatments are part of the overall ECT treatment plan. This can occur many times a week for several weeks. Three ECT treatments are typically given to patients each week.

The exact mechanism by which ECT treats severe depression and other mental diseases is unknown. It is recognized, however, that a variety of chemical facets of brain activity are altered both during and following seizure activity. It’s possible that these molecular alterations compound one another to lessen the symptoms of severe depression and other mental diseases. Because of this, ECT works best for patients who undergo a comprehensive course of several treatments.

You’ll want continued treatment for depression even after your symptoms subside in order to avoid a relapse. Continued treatment may involve ECT with a reduced frequency; more frequently, antidepressants and other drugs, as well as psychological counseling (psychotherapy), are used.