Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) was developed in 1938 in Italy. It is among the safest and most effective treatments for depression, including bipolar depression. It is most commonly used to treat patients with depression who fail to respond to medications, are unable to tolerate the side effects of medication, or need a quick improvement in depressive symptoms. ECT has also been used to treat acute manic symptoms as well as psychotic episodes associated with schizophrenia. ECT can be a life-saving procedure for those with catatonic features associated with severe depression or schizophrenia.
How ECT Works
The mechanism of ECT remains unclear. However, it is believed that electricity delivered though the skull can cause neurons in the brain to release chemicals which cause the neurons to form new connections with other neurons. ECT has been referred to as a “reset button for the brain,” which not only directly improves depressive symptoms, but also allows current medications to work more effectively.
How ECT is Performed
While the patient is under full general anesthesia, a muscle relaxant is given and electrodes are applied to the scalp. A brief electrical stimulus is delivered. The effective stimuli produce a mild seizure which changes the activity of the brain. The brain stimulation is accompanied by mild muscle contractions usually lasting less than one minute.
The electrical stimulus can be delivered in one of three ways; right unilateral, bi-frontal or bi-lateral. Most patients begin treatments with a right unilateral stimulus. If, after several treatments, the patient is not improving, the stimulus can be changed. The benefit of changing to bi-frontal or bi-lateral is a faster improvement in mood. The risk is an increased chance of memory loss. The decision to change the electrical stimulus is made by the patient and the psychiatrist.
Goals and Benefits
The goal of ECT is to help patients achieve complete recovery from their symptoms. If a complete recovery is not achievable, then the goal is to get as much benefit as possible. More than 80 percent of the patients can have at least 50 percent improvement from their baseline.
ECT requires multiple treatments. The treatments are divided into two series of treatments, acute and maintenance. During the acute series, ECT treatments are given three times a week for a total of 6 to 12 treatments for the majority of patients. Prior to each treatment, the patient is evaluated for improvement.
When maximum improvement or complete recovery is achieved, maintenance treatments begin. The goal of the maintenance treatments is to prevent symptoms from re-occurring.
ECT is among the safest medical treatments given under general anesthesia. The risk of death or serious injury as a result of ECT is approximately 4 in 100,000 treatments.
Prior to receiving ECT, each patient undergoes blood tests, an EKG, a physical exam, and additional tests or exams if necessary. The results are reviewed by the anesthesiologist before the first treatment. For those with complex medical conditions, consultations from other specialties may be required before initiating ECT.
The most common side effects of ECT are headache, nausea, muscle aches, jaw pain, confusion and memory loss.
Headache, nausea, muscle aches and jaw pain are all treatable with medication. Confusion, as a result of general anesthesia or seizure activity, usually lasts for a short time.
Some patients receiving ECT experience short-term memory loss during the acute series of treatments. The degree of memory loss is not predictable. However, the degree of memory problem is commonly related to the number of ECT treatments, frequency of treatments, and electrode placements. Overall, right unilateral electrode placement causes less memory problems than bilateral electrode placement.
Once the treatments are spread out during the maintenance series, the majority of patients will recover their memories within six months. However, a small number of patients may have some permanent memory loss.