What to Expect During Electroconvulsive Therapy (ECT)

What to Expect During Electroconvulsive Therapy

What to Expect During Electroconvulsive Therapy (ECT)

It seems archaic, treating someone’s mental illness by shocking their brain with electricity. Most people think it is a technique from a bygone era, something akin to a lobotomy or casting out demons. Many people are often surprised to learn that electroconvulsive therapy still takes place today.

I turned to electroconvulsive therapy (ECT) during a particularly difficult time in my life. My depression was unbearable, my anxiety was control, and I fought suicidal thoughts daily. My severe depression can often be my strongest enemy.

It can impair every area of my life. Sometimes it is so debilitating, I am unable to function. I can’t work, I can’t have a social life, I can’t do much more than survive.

It was after multiple inpatient psychiatric hospitalizations that I was presented with the option of trying ECT.

I was initially very skeptical. I had no idea it was a treatment still used today. Visions of insane asylums filled with chains ran through my head. I was in the psychiatric unit of a local hospital when I was offered the option of trying ECT.

I learned that the hospital had many patients being treated with ECT multiple times every week. I was stuck in a cycle of hopelessness and despair, coupled with endless medication changes in a search for something that could finally help my depression.

I was growing tired with no end in sight. I agreed to give ECT a try.

ECT works by administering a small electric shock to your brain which triggers a seizure. The seizure is thought to affect the neurotransmitters in your brain.

There is still a lot that is unknown about why and how ECT works, but the change in brain chemistry has been found to potentially alleviate symptoms in someone with severe mental illness.

ECT can be used to treat severe or treatment-resistant depression, severe mania, catatonia, and aggression in people with dementia.

I’ve done multiple rounds of electroconvulsive therapy (ECT) and I am very familiar with the process. Knowing what to expect can help dispel the fear and uncertainty associated with this therapy.

I stayed in the hospital for my first round of treatments, but they can be performed outpatient as well. I would have treatments three times a week over the next month.

I was very anxious before my first treatment, but I soon learned there was not much to be afraid of.

The procedure would always be performed in the morning as I would need to fast for 12 hours beforehand. In my hospital, ECT was performed in a room off to the side of the surgical recovery room. My psychiatrist and an anesthesiologist were both present. Earlier, a nurse had started an IV to give me fluids.

I was brought into the room and made to feel comfortable on the bed. My doctor then placed a band around my head with two small metal electrodes that sat near my temples. A conductive gel was rubbed on my head to help the connection between my skin and the electrodes.

The anesthesiologist placed an oxygen mask over my mouth and pushed some medications through my IV. One of the medications was a paralytic. This would prevent my body from convulsing during the seizure. A blood pressure cuff was inflated around my ankle.

This would stop the paralytic from affecting my foot so that my doctor could monitor the seizure. My foot would be allowed to twitch, while the rest of my body would stay relaxed.

I would also be given anesthesia medications. I would feel a small rush when the medicine was pushed and then everything would fade to black. I was always unconscious during the procedure and never felt any pain. The doctor would then administer a small jolt of electricity through the electrodes attached to my head. I don’t remember any of this. The procedure only lasted 5 to 10 minutes.

Suddenly, I would be waking up in the recovery room next door. I would feel groggy, just waking up from any other surgery. I would continue to receive fluids and oxygen while I woke up. Occasionally I would have a headache, but there was a nurse ready with some pain medication if I needed it.

I would spend about 20 to 30 minutes waking up and then I was taken back to my unit. I would usually feel tired for the next hour or so, but then I felt ready to go about my day. For me, I always felt the most relief on the day of my treatments. I would have my procedure in the morning and would usually feel decent the rest of the day.

My depression would certainly creep in at times, but I could tell that the ECT was helping.

Electroconvulsive therapy remains a controversial subject with many psychologists and other professionals on both sides of the issue. The effects of ECT are different for everyone. I’ve spoken to people who said that ECT was a miracle treatment for them. I know of a woman whose depression was nearly cured after she received treatment.

I needed several rounds before I felt any benefits. For quite awhile, I felt that ECT was only temporarily effective with the benefits lasting for maybe a few days. The longer I received the treatments, the longer I would feel relief. It certainly wasn’t a cure for me, but I would say that the improvements I did feel were worth it.

There are side effects and risks involved with ECT and it is important to be aware of them. Confusion, memory loss and headaches occur most often. There are also risks associated with the anesthesia, but those are more rare. Toward the end of my treatments, I started to have some memory problems.

There were a few times I would wake up in the recovery room and it took several minutes for me to remember why I was there. I would have a hard time hanging on to small details and I would struggle to remember past events. When the memory loss started to get worse, I made the decision to stop doing ECT.

The side effects stopped progressing right away and my memory began to improve.

I have not had any ECT for a couple of years now. Luckily, my depression has improved. Finally, finding a good mix of medication has helped tremendously, but I definitely feel this treatment has been a factor in helping me recover from depression.

I hope that sharing my experience can potentially help others who might be considering ECT. I want to dispel some of the myths and help take the mystery electroconvulsive therapy.

The treatment is not for everyone, but hopefully this information can help you make the right decision for your needs.

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Source: https://themighty.com/2018/05/what-to-expect-electroconvulsive-therapy-ect/

Electroconvulsive Therapy and Other Depression Treatments

What to Expect During Electroconvulsive Therapy (ECT)

When medication fails to ease the symptoms of clinical depression, there are other options to try. Brain stimulation techniques such as electroconvulsive therapy (ECT), for example, can be used to treat major depression that hasn't responded to standard treatments.

The least invasive of these techniques is called transcranial magnetic stimulation (TMS), in which a magnetic field is created by a device held above the head, causing a weak electrical signal to be applied to the prefrontal cortex, the region of the brain that is connected to mood.

Vagus nerve stimulation (VNS) is another treatment for depression that uses a surgically implanted pacemaker- device that electrically stimulates a nerve that runs up the neck into the brain. The nerve is called the vagus nerve. With ECT, an electric current is briefly applied through the scalp to the brain, inducing a seizure.

In addition, alternative therapies such as yoga and hypnosis sometimes work for mild depression.

ECT is among the safest and most effective treatments available for depression. With ECT, electrodes are placed on the patient's scalp and a finely controlled electric current is applied while the patient is under general anesthesia.

The current causes a brief seizure in the brain. ECT is one of the fastest ways to relieve symptoms in severely depressed or suicidal patients.

It's also very effective for patients who suffer from mania or a number of other mental illnesses.

ECT is generally used when severe depression is unresponsive to other forms of therapy. Or it might be used when patients pose a severe threat to themselves or others and it is too dangerous to wait until medications take effect.

Although ECT has been used since the 1940s and 1950s, it remains misunderstood by the general public. Many of the procedure's risks and side effects are related to the misuse of equipment, incorrect administration, or improperly trained staff.

It is also a misconception that ECT is used as a “quick fix” in place of long-term therapy or hospitalization. Nor is it correct to believe that the patient is painfully “shocked” the depression.

Unfavorable news reports and media coverage have contributed to the controversy surrounding this treatment.

Prior to ECT treatment, a patient is given a muscle relaxant and is put to sleep with a general anesthesia. Electrodes are placed on the patient's scalp and a finely controlled electric current is applied. This current causes a brief seizure in the brain.

Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding it, and is often confused. The confusion typically lasts for only a short period of time.

ECT is usually given up to three times a week for a total of two to four weeks.

According to the American Psychiatric Association, ECT can be beneficial and safe in the following situations:

  • When a need exists for rapid treatment response, such as in pregnancy
  • When a patient refuses food and that leads to nutritional deficiencies
  • When a patient's depression is resistant to antidepressant therapy
  • When other medical ailments prevent the use of antidepressant medication
  • When the patient is in a catatonic stupor
  • When the depression is accompanied by psychotic features
  • When treating bipolar disorder, including both mania and depression
  • When treating mania
  • When treating patients who have a severe risk of suicide
  • When treating patients who have had a previous response to ECT
  • When treating patients with psychotic depression or psychotic mania
  • When treating patients with major depression
  • When treating schizophrenia

While ECT uses an electric current to induce seizure, TMS creates a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness. The current is caused by the magnetic field created by an electromagnetic coil that delivers the pulses through the forehead.

Approved by the FDA in 2008 for treatment-resistant depression, TMS works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments. Also, un ECT, TMS does not require sedation and is administered on an outpatient basis. Patients undergoing TMS must be treated four or five times a week for four to six weeks.

Research has shown that TMS produces few side effects and is both safe and effective for medication-resistant depression. However, its effectiveness as currently performed appears to be less than that of ECT.

A vagus nerve stimulator (VNS) device was approved by the FDA for adult patients with long-term or recurrent major depression. Some patients who undergo VNS may have been taking many medications for depression yet continue to suffer with its symptoms.

How VNS works: The small stimulator is implanted under the skin of the collarbone and runs under the skin to the vagus nerve in the neck. The device emits electrical pulses to stimulate the brain.

Alternative treatments can sometimes provide relief that traditional Western medicine cannot. While some alternative therapies have become accepted as part of modern health care practice, others still have not been proven safe or effective.

Whether or not they are scientifically proven, alternative therapies, by providing forms of relaxation and relief from stress, may have a place in healing and general health and well-being. Examples of alternative therapies include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, and massage.

In general, alternative therapies by themselves are reasonable to use for mild but not more severe forms of clinical depression.

Experimental therapies are treatments that are not regularly used by doctors. Their safety and effectiveness are still being studied.

Some experimental therapies currently being investigated for treatment of depression include:

  • Hormone replacement therapy (HRT) in women: Depression is more common in women than in men. Changes in mood with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), post-childbirth, and postmenopause are all linked with sudden drops in hormone levels. Hormone replacement is a treatment currently used to relieve symptoms of menopause such as night sweats and hot flashes. HRT can also help prevent bone-thinning osteoporosis. However, the true contribution of hormones to depression is not known. Be sure to tell your doctor if you have had depression before and are considering HRT.
  • Intravenous ketamine:The anesthetic agent ketamine has been shown in preliminary studies to produce a rapid (within hours) improvement in depression for same patients.
  • Riluzole: This medicine, originally used to treat motor neuron disorders such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig's Disease), has been shown also to affect neurotransmitters involved in depression, and in early studies has begun to show promise in treating depression that is unresponsive to more traditional medicines.

Even when treatment such as ECT, TMS, vagus nerve stimulation, or other alternative therapies is successful, depression can return.

Psychotherapy and/or maintenance antidepressant medication can help prevent depression from coming back. Psychotherapy does this by correcting the beliefs, perceptions, and behaviors that contribute to your depression.

If you do experience recurring symptoms, don't hesitate to seek help again.

The outlook for depressed people who seek treatment is very promising. By working with a qualified and experienced mental health care professional, you can regain control of your life.

SOURCES:

National Institute of Mental Health: “What is Depression?” ''Brain Stimulation Therapies.''

FDA: “The Lowdown on Depression.”

American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.

Fieve, R, MD. Bipolar II, Rodale Books, 2006.

Connelly, KR. Journal of Clinical Psychiatry, April 2012.

Carpenter, LL. Depression and anxiety, July 2012.

© 2017 WebMD, LLC. All rights reserved. Interpersonal Therapy

Source: https://www.webmd.com/depression/guide/electroconvulsive-therapy

Electroconvulsive Therapy (ECT)

What to Expect During Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a procedure in which a brief application of electric stimulus is used to produce a generalized seizure.  It is not known how or why ECT works or what the electrically stimulated seizure does to the brain.  In the U.S.

during the 1940’s and 50’s, the treatment was administered mostly to people with severe mental illnesses.

  During the last few decades, researchers have been attempting to identify the effectiveness of ECT, to learn how and why it works, to understand its risks and adverse side effects, and to determine the best treatment technique.

  Today, ECT is administered to an estimated 100,000 people a year, primarily in general hospital psychiatric units and in psychiatric hospitals.  It is generally used in treating patients with severe depression, acute mania, and certain schizophrenic syndromes.  ECT is also used with some suicidal patients, who cannot wait for antidepressant medication to take effect.

How is it administered?

ECT treatment is generally administered in the morning, before breakfast.  Prior to the actual treatment, the patient is given general anesthesia and a muscle relaxant.  Electrodes are then attached to the patients scalp and an electric current is applied which causes a brief convulsion.

  Minutes later, the patient awakens confused and without memory of events surrounding the treatment.  This treatment is usually repeated three times a week for approximately one month.  The number of treatments varies from six to twelve.

  It is often recommended that the patient maintain a regimen of medication, after the ECT treatments, to reduce the chance of relapse.

To maximize the benefits of ECT, it is crucial that the patient’s illness be accurately diagnosed and that the risks and adverse side effects be weighed against those of alternative treatments.

  The risks and side effects involved with the use ECT are related to the misuse of equipment, ill-trained staff, incorrect methods of administration, persistent memory loss, and transient post-treatment confusion.

Why is ECT so controversial?

After 60 years of use, ECT is still the most controversial psychiatric treatment.  Much of the controversy surrounding ECT revolves around its effectiveness vs. the side effects, the objectivity of ECT experts, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization.

Because of the concern about permanent memory loss and confusion related to ECT treatment, some researchers recommend that the treatment only be used as a last resort.  It is also unclear whether or not ECT is effective.

  In some cases, the numbers are extremely favorable, citing 80 percent improvement in severely depressed patients, after ECT.  However, other studies indicate that the relapse is high, even for patients who take medication after ECT.

  Some researchers insist that no study proves that ECT is effective for more than four weeks.

During the last decade, the “typical” ECT patient has changed from low-income males under 40, to middle-income women over 65.  This coincides with changing demographics.

  The increase in the elderly population and Medicare, and the push by insurance companies to provide fast, “medical” treatment rather than talk therapy.

  Unfortunately, concerns have been raised concerning inappropriate and even dangerous treatment of elderly patients with heart conditions, and the administration of ECT without proper patient consent.

Is ECT an option?

The patient and physician should discuss all options available before deciding on any treatment.  If ECT is recommended, the patient should be given a complete medical examination including a history, physical, neurological examination, EKG and laboratory test.

  Medications need to be noted and monitored closely, as should cardiac conditions and hypertension.

  The patient and family should be educated and informed about the procedure via videos, written material, discussion, and any other means available before a written consent is signed.

The procedure should be administered by trained health professionals with experience in ECT administration as well as a specifically trained and certified anesthesiologist to administer the anesthesia.

  The seizure initiated by the electrical stimulus varies from person to person and should be monitored carefully by the administration team.  Monitoring should be done by an EEG or “cuff” technique.

The nature of ECT, its history of abuse, unfavorable medical and media reports, and testimony from former patients all contribute to the debate surrounding its use.  Research should continue, and techniques should be refined to maximize the efficacy and minimize the risks and side effects resulting from ECT.

Other Resources

National Institute of Mental HealthPublic Inquiries6001 Executive BoulevardRoom 8184, MSC 9663Bethesda, MD 20892-9663Phone Number: (301) 443-4513Toll-Free Number: (866) 615-6464TTY Line: (301) 443-8431TTY Toll-Free: (966)415-8051Fax Number: (301) 443-4279

Email Address: nimhinfo@nih.gov

Website URL: www.nimh.nih.gov

American Psychiatric Association1000 Wilson Blvd, Suite 1825Arlington, VA 22209-3901Phone Number: (703) 907-7300

Email Address: apa@psych.org

Website URL: www.psych.org

Source: http://www.mentalhealthamerica.net/ect

Electroconvulsive therapy: Benefits and risks

What to Expect During Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is a safe, controlled procedure for depression and other psychological disorders that have not responded to other treatments.

A small amount of electric current is passed through the brain in order to cause a brief seizure.

Depression affects around 15 million Americans, making it the leading cause of disability in the United States (U.S.), but it can be hard to treat.

Between 60 and 70 percent of people with major depressive disorder respond to antidepressant medications. Electroconvulsive therapy (ECT) may help people for whom these and other treatments have not been effective.

ECT is given under anesthesia in both outpatient and inpatient hospital settings. Between 70 and 90 percent of patients experience a rapid improvement in symptoms.

It may also help people who are acutely ill with mania, psychosis, catatonia, agitated dementia, post-traumatic stress disorder (PTSD), and suicidal thoughts.

Share on PinterestECT can be an effective treatment when drugs and counseling have not worked.

ECT, formerly called electroshock therapy, has been used to treat several psychiatric conditions since 1938.

In its early use, people undergoing the treatment often experienced damage to teeth and bones and significant pre-treatment anxiety.

In the 1960s, the use of ECT fell significantly, as antidepressants and antipsychotic medications became available.

However, not everyone responds well to drug therapy, and with improved treatment procedures and better management of side effects, ECT can now be an effective treatment with a high safety record.

Nevertheless, continued opposition to its use and the portrayal of ECT as harmful have made the public wary of the procedure. The stigma remains.

Today’s evidence shows ECT as a valuable, often underused treatment that could help manage and reduce symptoms in people with serious and persistent psychiatric illnesses.

ECT delivers a small electric pulse to the brain for 1 to 2 seconds, while an individual is under general anesthesia.

This causes brain cells to fire in unison, resulting in a brief seizure. As the individual is asleep and their muscles are relaxed, the only evidence of the seizure is through the brain’s wave activity as seen on a monitor.

The reason for the effectiveness of ECT is unknown.

The electric pulse is thought to trigger an immediate increase in dopamine and serotonin, the body’s main neurotransmitters associated with depression.

ECT also causes a release of important hormones and of natural mood-elevating chemicals, known as endorphins.

Antidepressants stimulate a similar reaction, but it can take several weeks and different drug combinations to receive the same effect.

A trained physician performs ECT treatments on either an inpatient or outpatient basis.

Share on PinterestECT may help people whose depression has not responded to other treatment.

In the U.S., treatment usually happens three times a week, and a treatment cycle can last from 6 to 12 treatments.

A psychologist or psychiatrist refers a patient to ECT. The ECT provider then meets with the patient to check that the treatment is necessary.

The specialist evaluates the patient’s overall health and commences the informed consent process. The consultation also provides a chance to address any concerns about ECT. The individual also meets with an anesthesiologist.

Family involvement is encouraged throughout, to help the patient and their family understand ECT. Families also learn how to care for and monitor their loved one while treatment lasts.

For convenience, these procedures are often completed on the same day as the first ECT treatment.

Depending on pre-existing medical conditions, other screening tests, such as ECG, and some blood tests, may be completed before starting treatment.

The individual receiving therapy is involved in all decision-making regarding any changes in or termination of the treatment. The informed consent process for ECT is more detailed than most in medical and dental procedures.

The patient receives a muscle relaxant and anesthesia through an intravenous drip (IV). Once these take effect, the electric pulse is administered through electrode pads placed on either temple.

The session lasts less than 5 minutes. During this time, the heart rate and rhythm, blood pressure, temperature, and blood oxygen levels are all closely monitored.

The patient spends up to an hour in recovery, and when fully awake they can leave the facility.

No driving is allowed for the next 24 hours.

Those whose symptoms do not improve may need to follow up with medication-based management or further maintenance ECT sessions.

ECT can cost between $300 and $800 per session, and as the average number of sessions is 8, treatment costs can range from $2,400 to $6400.

If an insurer covers treatment for mental health problems, they will ly fund ECT, provided it is clinically indicated.

ECT is well tolerated, meaning that many side effects are rare. It is safe to used during pregnancy, in adolescence, and in older age.

The main adverse effect is a possible loss of memories relating to the time before and immediately after treatment. This affects each person differently. It can sometimes last for several months following treatment.

It happens because the part of the brain that retrieves memories is largely affected by the electrical stimulation.

However, experienced practitioners can lessen this side effect by individualizing treatment and modifying certain factors such as lead placement, type of anesthesia, and the time interval between treatments.

Other side effects, especially after the earlier sessions, may include:

  • headache
  • jaw ache
  • temporary anxiety, confusion, disoriented feelings, and fear
  • nausea
  • shakiness
  • muscle stiffness
  • fatigue and intense sleepiness
  • possible hallucinations

Older people may be more unsteady and falls more often. Pain relief and anti-nausea medication can help reduce these unwanted effects.

Complications of ECT are rare, and unly to be life threatening. As with any procedure performed under anesthesia, there is a risk of serious heart problems or other reactions to anesthesia.

The examining doctor should grant specialist medical clearance and precautions in patients with certain or unstable medical conditions.

These include a recent heart attack, brain surgery or head injury, chronic obstructive pulmonary disease, asthma, stroke, or pneumonia.

ECT is not a first-line treatment. Most practitioners do not consider referral for ECT until many months or years of medication and other therapy without results.

However, it can be a safe and effective, low-risk option for individuals experiencing a variety of mental-health and brain-related disorders.

Source: https://www.medicalnewstoday.com/articles/297655

What to Expect with Electroconvulsive Therapy (ECT)

What to Expect During Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT), also known as electroshock therapy, is a safe and effective medical procedure that gives your brain electrical stimulation to help with depression, manic-depressive illness and schizophrenia.

ECT is between 60 and 90 percent effective in major depression, and adults of nearly all ages can receive treatment.

Electroconvulsive therapy (ECT), also known as electroshock therapy, is a safe and effective medical procedure that gives your brain electrical stimulation to help with depression, manic-depressive illness and schizophrenia.

ECT is between 60 and 90 percent effective in major depression, and adults of nearly all ages can receive treatment.

The first step in getting ECT is to get a referral from your psychiatrist. The referral cannot come from a primary care physician, psychologist or nurse.

ECT is usually considered if your psychiatrist has tried several antidepressant medication trials and you still have significant depression symptoms. If you are severely depressed, actively suicidal or not eating and drinking, ECT may be considered earlier as the first line of treatment.

We receive the largest number of referrals for ECT treatment in central Indiana and give you access to the latest ECT technology. IU Health has more than doubled its number of treatments at its IU Health Methodist location since 2011, offering more than 1,800 treatments in 2016.

ECT Sessions

Your ECT treatment will most ly be an outpatient procedure in a comfortable, non-surgical setting. You won’t even need to change into a gown. Since your ECT will be in the morning on an empty stomach, you will be given a light breakfast after your session. A team of psychiatrists, anesthesiologists and nurses conduct the treatment.

You will be asleep for your ECT session and electrodes will be placed on your head. You will not feel any discomfort when the electrical stimulation is given. You will wake up in the recovery area 5 to 10 minutes after the procedure.

ECT duration

ECT is given in a series of treatments, usually three times per week. Don’t be alarmed if you don’t see results right away, because it can take between six and 12 treatments before there are benefits. Your treatment will be complete when there is a sustained response.

You may need a longer course of ECT if you have relapsed previously after completing ECT or have had an extremely severe depressive episode. Maintenance ECT is typically given weekly for four treatments, then every other week for two months, then monthly for two treatments. This helps reduce the return of depressive symptoms.

The first step in getting ECT is to get a referral from your psychiatrist. The referral cannot come from a primary care physician, psychologist or nurse.

ECT is usually considered if your psychiatrist has tried several antidepressant medication trials and you still have significant depression symptoms. If you are severely depressed, actively suicidal or not eating and drinking, ECT may be considered earlier as the first line of treatment.

We receive the largest number of referrals for ECT treatment in central Indiana and give you access to the latest ECT technology. IU Health has more than doubled its number of treatments at its IU Health Methodist location since 2011, offering more than 1,800 treatments in 2016.

What to Expect from an Electroconvulsive Therapy (ECT) Treatment

What to Expect During Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy — or ECT as it’s commonly known — is a brief medical procedure that involves applying short electrical bursts to the brain through external electrode pads on your head. These electrical bursts create a seizure, which has been shown to help relieve symptoms associated with severe depression.

The entire procedure lasts about 15 minutes, although you may be in the hospital for about an hour to include time for prep and recovery from the treatment. ECT treatments are usually grouped together in 6 to 12 treatments at a time, generally given three times a week for 2 to 4 weeks.

The number of treatments you will need depends on the severity of your symptoms and how rapidly they improve.

Before your first ECT treatment, your doctor needs to make sure the procedure is safe for you.

Your psychiatrist will ly refer you to a physician for a physical examination, an electrocardiogram (ECG) to check your heart’s health, and laboratory tests (basic blood tests), to ensure there are no medical conditions that would preclude you from receiving ECT treatment. You may also be referred to an anesthesiologist to go over the risks associated with having anesthesia.

Modern electroconvulsive therapy is administered under general anesthesia, to ensure it is a safe and pain-free experience. You will therefore be unconscious during the treatment. As with any medical procedure involving general anesthesia, your doctor will talk to you about the associated risks and things to avoid before coming in for treatment.

Before ECT is administered, you’ll be given an IV (intravenous catheter), which is inserted in your arm or hand through which medications and fluids can be given. Sometimes you will be provided with a mouth guard to help ensure you don’t accidentally bite your tongue and help protect your teeth during the seizure. Some doctors also may administer oxygen through an oxygen mask.

Electrode pads will be placed on your head, which will be the pads that actually administer the small electrical impulse that will trigger a seizure in your brain.

ECT can either be administered unilateral, in which only one side of the brain is subject to electricity, or bilateral, in which both sides of the brain receive electrical currents. An electroencephalogram (EEG) is also connected, which measures your brain activity.

The EEG lets the doctor knows when a seizure is occurring, which can be confirmed by watching for movement in your hand or foot.

Short-acting, general anesthesia is injected in the IV to bring about unconsciousness, as well as a muscle relaxant to help prevent your body from convulsing during the seizure. A blood pressure cuff is placed around your forearm or ankle area, preventing the muscle relaxant from paralyzing those particular muscles.

After the general anesthesia has taken effect and you are fully unconscious — the doctor will test to make certain you are — the ECT procedure then begins.

ECT is administered through an ECT machine, which allows the doctor to prescribe an exact amount of electrical impulse and duration that may differ somewhat from patient to patient depending upon the severity of their symptoms and other factors. The doctor presses a button on the machine which starts the ECT treatment cycle.

The machine sends a small amount of electricity through the electrodes on your head, which then passes into your brain through your skull. This electricity produces a short seizure that lasts no more than 60 seconds.

You are unconscious during this process, so you don’t feel a thing. However, your brain is thought to be resetting itself because of the seizure, clearing its neuropathways and lifting the common symptoms of depression. Sudden, increased activity on the EEG lets the doctor know the start of a seizure, followed by a leveling off that shows the seizure is over.

A few minutes later, the effects of the anesthesia and muscle relaxant will begin to wear off. You’ll be taken to a recovery area, where you’re monitored and given time to recover from the anesthesia and procedure. Upon awakening, you may experience a period of confusion lasting from a few minutes to a few hours or more.

What to Expect from an Electroconvulsive Therapy (ECT) Treatment

Source: https://psychcentral.com/lib/what-to-expect-from-an-electroconvulsive-therapy-ect-treatment/

Electroconvulsive Therapy (ECT) Service | Department of Psychiatry

What to Expect During Electroconvulsive Therapy (ECT)

The Electroconvulsive Therapy Service at UNC is a consultation service in the Department of Psychiatry specializing in evaluations for and treatment with Electroconvulsive Therapy (ECT). The psychiatrist currently treating the patient must make the referral.

Telephone 984-974-2198 (for information & appointments)
Fax 919-962-9729

What is ECT?

Stated simply: ECT is the application of a small amount of electricity (electro-) to the human brain to generate a brief grand-mal seizure (convulsive). The procedure (therapy) is done while the person is anesthetized and the muscles are relaxed.

Why is ECT used?

ECT is the most effective treatment for biological depression and in many cases, the more severe the depression, the more ly it is that ECT will work. Response rates for an uncomplicated depression can be as high as 90%.

For refractory depressions (those that haven’t responded to conventional medication treatment), the response rate is still in the 70-80% range in many studies.

For depression where the diagnosis is less clear or particularly where there may be a combination of diagnoses, ECT may still be effective against depressive symptoms but the response rate is significantly lower (50-60%) and the response is often less satisfying to the patient.

ECT has always been relatively safe. Now that the procedure has evolved ( most other treatments in medicine), we are able to administer the treatments in a way that is not particularly stressful for the patient, making it an increasingly sought after treatment.

How does ECT work?

It’s not clear ‘how’ ECT works exactly, but then it’s not clear how antidepressants work exactly either. We can measure neurochemical and physiological changes in the brain after a response to ECT, which are similar to the changes seen in patients who respond to antidepressant medications.

Also, we know that some of the properties of the brain clearly change during ECT, suggesting physiological alterations and possibly system re-regulation. For example a person’s seizure threshold often rises over the course of treatment, requiring higher dosages of electricity to generate a seizure.

ECT does not cure Major Depressive Disorder (MDD) or Bipolar Disorder. It treats episodes of depression or mania. In other words, a response to ECT does not mean that the person will not get sick again in the future.

Serious mood disorders are often relapsing disorders in most people and some preventive strategy is required even after a response to ECT (medicines or maintenance ECT are the two choices usually).

It is useful to think about treatment as involving two goals: ‘getting well’ and ‘staying well’.

How is ECT done?

ECT is a medical procedure that is done in the Outpatient Procedures area at UNC Hospitals utilizing many of the same anesthesiologists and nurse anesthetists who work in the UNC operating rooms. The procedure involves a ‘light’ anesthesia using a short-acting anesthetic agent such as methohexital or propofol.

After a patient is put to sleep, his (or her) muscles are paralyzed and oxygen is administered by mask (intubation is rarely required). A small amount of electricity is then used to generate a generalized seizure of about 20-60 seconds duration. The maximum amount of electricity we use is 100 joules, though most patients require much less than this.

(Defibrillation is around 300 joules).

It is important to realize that a ‘course ‘ of ECT entails a series of treatments given 2-3 times per week until maximal improvement has occurred. Most patients require 6 to 12 total treatments.

ECT is frequently given on an outpatient basis, though at UNC we often start patients as an inpatient.

This is especially true for older patients or patients with complicated medical problems so that they may be monitored for any unusual response to ECT, including the extent of memory impairment (if any) or other side effects. (See below.)

What are the side effects of ECT?

Side effects of ECT can be divided into those due to the anesthesia and those due to the treatment itself. Nausea is sometimes seen as a result of sensitivity to the anesthetic agents used. Muscle aches from the paralytic agents is not uncommon as well. Post treatment sedation is of course not unexpected.

From ECT itself you see some expected cardiovascular changes from the seizure (a sympathetic outflow) that can cause a brief tachycardia (increased heart rate) and/or hypertensive response. Patients often get post-treatment headaches (probably due to vasodilatation).

All of these side effects can usually be successfully managed by medications as necessary.

The biggest concern most people have about ECT is the potential for memory loss. It is normal to have some impairment in memory after a seizure. For example, a person may forget what happened right before the seizure (retrograde amnesia) and have trouble remembering what happened in the time period right after waking up (anterograde amnesia).

This is to be expected in all persons to some degree and is the same phenomenon seen in individuals with epileptic (grand-mal) seizures. Due to the fact that patients getting ECT may be having 2-3 treatments per week for a number of weeks, this confusion can accumulate over time so that much of the period of time represented by the course of ECT may remain foggy.

Fortunately, for most people, these memory problems are time-limited, of minimal significance, can be dealt with by anticipating them ahead of time, and by having additional assistance available if needed during the course of treatment. However, some people have reported more persistent and longer-lasting memory effects, especially regarding personal memory of past events.

Right now, it is not possible to predict who will have more severe memory problems, but techniques such as using unilateral placement instead of traditional bilateral placement have been utilized to try to minimize these effects.

Finally, it should also be noted that for many individuals memory is reported to be ‘better’ after the acute course of ECT because of resolution of the depression and its effects on concentration.

The death rate in ECT is about the same as the death rate for ‘light anesthesia’, which means it’s very rare, and about the same as would occur in other simple procedures such as a colonoscopy. When deaths do occur, it is usually due to cardiovascular complications.

Certain populations, such as those with serious heart disease, recent stroke or heart attacks, or with brain tumors, are at higher risk of serious medical complications. Much of the consultation work-up is geared towards identifying these high risk situations and mitigating them if ECT is still to be pursued. In some situations, we will not do ECT because of the medical problems.

Even so, ECT is remarkably safe even in some of the most seriously medically ill patients who have concurrent depression.

A Final Word about ECT

ECT is often a life-saving treatment, which has been withheld from many until late in the course of their illness because of the social stigma, not because of the science. It could very well be a first line treatment were it not for the continuing stigma.

Future advances in technology promise to improve the treatment further.

In fact, with experimental treatments such as repetitive Transcranial Magnetic Stimulation (rTMS) it may soon be possible to induce painless ‘localized’ seizures in the dysfunctional parts of the brain which wouldn’t require the patient to even be asleep!

Why does the stigma persist?

ECT is often still portrayed in the media in the relatively brutal way it was first done, i.e. without anesthesia.

Anesthetic agents are anticonvulsants, and it required an advance in the science of anesthesia before we could anesthetize patients, generate a seizure, and avoid the muscle movement associated with seizures.

Unfortunately, people don’t know enough about ECT and so can be swayed by these inaccurate portrayals. If you tried to show surgery being done without anesthesia, people would not believe it because they ‘know better’.

Also, ECT began to be used in this country at about the same time we began executing criminals with electricity in the Electric Chair. Ever since, the notion of electricity to the head has been seen as ‘punitive’.

In fact, in many media portrayals of ECT over the years, the treatment has been depicted as punishment (One Flew Over the Cuckoo’s Nest for example).

Combine this with the lingering stigma of mental illness being the patient’s fault, and you can see why the ECT stigma still persists.

Bilateral versus Unilateral ECT

Refers to the placement of the stimulus electrodes on a patient’s scalp (which directs the current path). In traditional bilateral ECT, the electrodes are placed on the right and left temples, allowing simultaneous stimulation of both sides of the brain.

This assures a good quality seizure in the parts of the brain that need to be affected, but also allows electricity to pass over the left-temporal lobe of the brain. This is where most people have their language and memory centers. The effect is to cause (theoretically) more memory problems.

Unilateral electrode placement allows both electrodes to be kept on one-side of the brain (the non-dominant side), which avoids having electricity pass directly through the language and memory centers mentioned above. However it requires that the seizure (which will now start on one side of the brain only) to generalize or move across to the other side of the brain.

This doesn’t always happen successfully, leading to less treatment effect. Most new ECT patients at UNC will be started on unilateral ECT and switched only if not responding adequately.

Bipolar Disorder

A type of recurrent mood disorder characterized typically by both manic episodes and depression (See Depression).

Some individuals may have primarily manic episodes; others may have mostly depressions with rare manic periods, while others may have mixed symptoms of both mania and depression. Episodes can be infrequent or rapid-cycling (i.e. at least 4 episodes over the last 12 months).

Lithium has been the traditional medication used to treat this disorder though many other agents are now available as well. Note that ECT works very well for both mania and depression.

ECT – Electroconvulsive Therapy

A treatment modality using small amounts of electricity to generate a grand-mal seizure in a patient, in an attempt to treat various psychiatric disorders, especially depression.

Depression (Major Depressive Disorder)

A common psychiatric illness characterized by depressed, irritable or apathetic mood or loss of pleasure (anhedonia) and four or more of the following: changes in sleep and/or appetite, loss of pleasure and/or interest in daily activities, impairment of concentration or memory, low energy, agitation or mental slowing, feelings of worthlessness or excessive guilt, hopelessness, helplessness and/or recurrent suicidal thoughts. Symptoms need to be present for at least 2 weeks and be severe enough to cause some functional impairment.

Depression

Depression is a medical illness known as a mood disorder, and it is treatable.

Clinical depression should not be confused with temporary feelings of sadness (“feeling blue” or “down in the dumps”) that are part of life’s disappointments.

Depression lasts longer; is far more severe; impairs work, relationships, physical and other activities; and it includes more than a sad mood. Symptoms include trouble with sleep, appetite, energy and self-esteem.

Mania

A period of persistently elevated, expansive or irritable mood that lasts for a week of longer and includes at least three of the following (four if irritable mood): inflated self-worth, decreased sleep, racing thoughts or flight of ideas, excessive of pressured speech, hyperactivity, excess pleasure seeking and/or distractibility.

Seizure Threshold

The energy level at which electricity will induce a seizure. This varies for individuals and is usually higher in males and the elderly.

Certain medications and medical conditions can alter a person’s seizure threshold.

The UNC ECT service uses a ‘threshold titration model’ to determine the person’s actual seizure threshold so as to minimize the amount of electricity used for the treatments.

Joule

The joule (pronounced DJOOL) is the standard unit of energy in electronics and general scientific applications. One joule is defined as the amount of energy exerted when a force of one newton is applied over a displacement of one meter. One joule is the equivalent of one watt of power radiated or dissipated for one second.

Defibrillation

The arrest of fibrillation of the cardiac muscle (atrial or ventricular) with restoration of the normal rhythm, if successful.

Transcranial magnetic stimulation (TMS)

TMS is the use of powerful rapidly changing magnetic fields to induce electric potentials in the brain by electromagnetic induction without the need for surgery or external electrodes. TMS was originally developed as a tool in brain research, and has been used to stimulate or suppress brain activity in experiments on human subjects.

TMS is currently under study as a treatment for severe depression and auditory hallucinations. It is particularly interesting as it may provide a viable treatment to certain aspects of drug resistant mental illness, particularly as an alternative to electroconvulsive therapy.

Although research in this area is in its infancy, there is now strong evidence that TMS is an effective treatment for both depression and auditory hallucinations, with more symptoms and disorders being researched.

Source: https://www.med.unc.edu/psych/patient-care/adult/outpatient/electroconvulsive-therapy-ect-service/