What's to know about electroconvulsive therapy?
A small amount of electric current is passed through the brain in order to cause a brief seizure.
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.
Here are some key points about ECT. More detail is in the main article.
- The American Psychiatric Society (APA) has established clear guidelines for ECT use.
- ECT is considered safe for pregnant women, adolescents, and older people.
- Positive results can be seen in as few as one to two ECT treatments.
- Around 100,000 people a year receive ECT in the U.S.
- Symptoms improve in 70 to 90 percent of patients.
- There is no reliable evidence of long-term harmful effects.
What is ECT?
ECT 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.
How does it work?
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.
What to expect
A trained physician performs ECT treatments on either an inpatient or outpatient basis.
ECT 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 likely 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:
- jaw ache
- temporary anxiety, confusion, disoriented feelings, and fear
- 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 unlikely 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.
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.