Electroconvulsive Therapy

Electroconvulsive Therapy

Q. What is electroconvulsive therapy (ECT) and when is it used?
ECT is an effective form of treatment for people with depressions and other mood disorders. ECT may be used when a severely depressed patient has not responded to antidepressants, is unable to tolerate the side effects of antidepressants, or must improve rapidly. Some depressed people simply do not respond to antidepressants or mood controlling drugs, and ECT is a way for such people to be effectively treated. ECT is utilized in the treatment of both mania and depression. There are some people who because of severe physical illness are unable to tolerate the side-effects of the medications used to treat mood disorders. Many of these people can be successfully be treated with ECT. Pregnant women and people who have recently had heart attacks can be safely treated with ECT. Because of time pressure regarding occupational, social, or family events, some people do not have the time to wait for antidepressants or mood regulating medications to become effective. As ECT quite regularly brings about improvement within two or three weeks, people who are under such time pressure are also excellent candidates for ECT.

Q. Exactly what happens when someone gets ECT?
The physician must fully explain the benefits and dangers of ECT, and the patient give consent, before ECT can be administered. The patient should be encouraged to ask questions about the procedure and should be told that consent for treatments can be withdrawn at any time, and in the event that this happens, the treatments will be stopped. After giving consent, the patient undergoes a complete physical examination, including a chest x-ray, electrocardiogram, and blood and urine tests. A series of ECTs usually consists of six to twelve treatments. Treatments can be administered to either in-patients or out-patients. Nothing should be taken by mouth for 8-hours prior to a treatment. An intravenous drip is started and through it medications to induce sleep, relax the muscles of the body, and reduce saliva are given. Once these medications are fully effective, an electrical stimulus is administered through electrodes to the head. The electrical stimulus produces brain wave (EEG) changes that are characteristic of a grand mal seizure. It is believed that this seizure activity leads to the clinical improvement seen after a series of ECT. About 30-minutes after the treatment the patient awakens from sleep. While confused at first, the patient is soon oriented enough to eat breakfast, and return home if the treatments are being done in an outpatient setting.

Q. How do individuals who have had ECT feel about having had the treatments?
In studies of people treated with ECT it has been found that 80% of such people report that they were helped by the treatments. About 75% say that ECT is no more frightening than going to the dentist.

Q. How long do the beneficial effects of ECT last?
While ECT is a highly successful way of helping people come out of depressions, it has to be followed by antidepressant therapy. If antidepressants are not administered after a series of ECTs, there is a 50% relapse rate within 6-months.

Q. Is it true that ECT causes brain damage?
There is no scientific evidence that ECT causes brain damage. A woman who had over 1,000 ECT died of natural causes, and her brain was examined for evidence of ECT-induced brain damage. None was found. ECT does cause memory problems. These memory problems may take a number of months to clear. A small number of people who have received ECT complain of longer lasting memory problems. Such problems do not show up on psychological tests, it is not clear what causes them.

Q. Why is there so much controversy about ECT?
There is little controversy about ECT among psychiatrists. Much of the opposition to ECT seems political in nature and originates in the anti-psychiatry groups that oppose the use of Ritalin for the treatment of children with attention deficit disorder, and who oppose the use of Prozac for the treatment of depressed people.