Electroconvulsive Therapy (ECT) Service
Electroconvulsive Therapy (ECT) is a treatment option for patients suffering from severe depression who have been unsuccessful with other forms of treatment, such as antidepressant medication and psychotherapy. A thorough psychiatric evaluation must be completed to determine whether or not a patient is a good candidate for ECT. Other tests must be done prior to receiving such services including a physical, EKG, CT of the head, chest x-ray, and the patient must be medically cleared by a physician.
What is Electroconvulsive Therapy (ECT)?
Electroconvulsive therapy, or ECT, induces seizure activity by releasing an electrical pulse through a portion of the brain. ECT is used for people whose depression is severe or life-threatening or who cannot take antidepressant medication. ECT is often effective in cases where antidepressant medications do not provide sufficient relief of symptoms or in cases where the side effects caused by antidepressants are not tolerable.
In recent years, ECT has been much improved. A muscle relaxant is given before treatment. ECT is done under brief general anesthesia. Two electrodes are placed at precise locations on the head to deliver electrical impulses.
The stimulation causes a brief (about 30 seconds) seizure within the brain. The patient does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically given at the rate of three per week, are required. ECT resembles cardioversion, a common medical procedure in which the heart is stimulated electrically in order to restore normal function. However, ECT uses a much smaller amount of electricity.
What are the indicators for ECT?
The most frequent indication for ECT is severe depression. Bipolar disorder and schizophrenia are other illnesses that are effectively treated by ECT. Psychiatric evaluation will be obtained to determine the necessity of treatment.
What are the side effects of ECT?
Side effects may result from anesthesia, ECT treatment or both. Common side effects include temporary short-term memory loss, such as recent events, dates or what you ate that morning. Other side effects could include confusion, nausea, muscle aches and headache.
Due to epileptic, parasympathetic, and sympathetic responses, control of the patient's muscular sphincters can be altered. The patient can experience defecation (bowel incontinence) as result of the ECT procedure. Being compliant with "Nothing Taken by Mouth" 8 hours prior to ECT procedure, decreases incidence of this potential side effect.
Some people may have longer-lasting problems with memory after ECT, but this type of memory loss is rare. In most patients, the memory disturbances go away within a few hours.
Is ECT a frightening procedure?
Hollywood portrayals of ECT such as in "One Flew Over the Cuckoo's Nest" bear no resemblance to the actual modern ECT procedure, which is neither painful nor used as punishment. The actual procedure itself lasts only a few seconds and the patient wakes up from the effects of anesthesia within 5 to 10 minutes. It is a well-controlled, highly successful treatment option.
What is the success rate of ECT?
ECT is an effective medical treatment option, helping as many as 90 percent of patients who receive it. Most patients remain well for many months afterwards. The tendency to relapse after a favorable treatment outcome can often be countered by medication after a series of treatments. Maintenance treatments of ECT may be given depending on individual patient needs.
The ECT Patient Information Handout provides detailed information on electroconvulsive therapy (ECT) including the risks and benefits.
The motto for the treatment team is that all patients are deserving of R.E.S.P.E.C.T., which stands for ECT treatment that is Respectful, Effective, Safe, Personalized, Ethical, Competent, and Timely.
Psychiatric residents are also integral members of the ECT treatment team and learn about ECT under the direct supervision of psychiatric faculty. As part of their PGY-2 and/or PGY-3 years, residents spend 3 months on the ECT service. During this time, residents have the opportunity to provide longitudinal care for multiple patients receiving ECT. As a result, residents learn about the clinical evaluation and management of patients receiving ECT including clinical indications, benefits and side effects of treatment, aspects of informed consent, and technical aspects of ECT administration including monitoring, electrode placement, stimulus dosing, and anesthetic medications.
Helpful Links About ECT
- ECT: A Light in the Darkness : A non-profit group educating people about the effectiveness of Electro-Convulsive Therapy (or ECT) in helping individuals with depression. They include patients helped by ECT, family members and friends who have seen the benefits of ECT, and doctors who recognize the effectiveness of ECT.
- http://www.struckbyliving.com/ : The official website of Struck By Living: From Depression to Hope, a book by Julie K. Hersh.