Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.
Much of the stigma attached to electroconvulsive therapy is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
Electroconvulsive therapy is much safer today. Although electroconvulsive therapy still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
Why it's done
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of a number of mental health conditions. It may be an effective treatment in someone who is suicidal, for instance, or end an episode of severe mania. ECT is used to treat:
Electroconvulsive therapy is sometimes used as a last-resort treatment for:
ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. In some cases ECT is used:
Although ECT is generally safe, there are known risks and side effects. These include:
How you prepare
Before having your first ECT treatment, you need a complete physical examination, in addition to a psychiatric evaluation. You may also see an anesthesiologist to go over risks associated with having anesthesia. These exams help make sure that ECT is safe for you.
A pre-ECT evaluation usually includes:
What you can expect
The ECT procedure takes about 10 or 15 minutes, with added time for preparation and recovery. ECT may be performed while you're hospitalized or as an outpatient procedure. In either case, it's done under general anesthesia, which means you'll be unconscious during the procedure. Your health care team will tell you how long you must avoid food and drinks before ECT treatment.
When it's time for the procedure, you may have a brief physical exam to check your heart and lungs. An intravenous (IV) catheter is inserted in your arm or hand through which medications or fluids can be given. During the procedure, monitors constantly check your heart, blood pressure and oxygen use. You may be given oxygen through an oxygen mask.
Doctors place electrode pads, each about the size of a silver dollar, on your head. ECT can be 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.
Anesthesia and medications
In addition to the anesthetic and muscle relaxant, you may be given other medications, depending on any health conditions you have or your previous reactions to ECT. You may also be given a mouth guard to help protect your teeth and tongue from injury.
Inducing a seizure
Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you're experiencing a seizure may be a rhythmic movement of a foot or a hand. But internally, activity in your brain increases dramatically. This is recorded by an electroencephalogram (EEG) in much the same way as an ECG measures your heart's activity. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you're monitored for problems. Upon awakening, you may experience a period of confusion lasting from a few minutes to a few hours or more.
Series of treatments
Many people begin to notice an improvement in their symptoms after two or three treatments with electroconvulsive therapy. Full improvement may take longer, though. Response to antidepressant medications, in comparison, can take several weeks or more.
No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses.
That's why ECT is most effective with multiple treatments. Most people who receive ECT have treatments three times a week, usually for two to four weeks. ECT is effective in most people who receive the full course.
Even after your symptoms improve, you likely will need ongoing treatment to prevent a recurrence. That ongoing treatment, known as maintenance therapy, doesn't have to be ECT, but it can be. More often, it includes antidepressants or other medications or psychological counseling (psychotherapy).
Last Updated: 2010-07-09
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