Understanding Modern Electroconvulsive Therapy
What is ECT?
Modern ECT is very safe and effective. It is a viable treatment option for patients whose medication or other treatments have failed to ease symptoms associated with some mental health issues. Today’s ECT has evolved into a valuable treatment tool recognized by the National Institute of Mental Health, American Psychiatric Association, American Medical Association, and the U.S. Surgeon General.
ECT is offered at Bergen New Bridge Medical Center as an ambulatory service; no inpatient hospitalization is needed. Initially, ECT is recommended as 10 to 12 consecutive treatments every other day. For example, on Monday, Wednesday, and Friday, and after can be continued once per month as a maintenance procedure. Some patients may need more or fewer treatments.
Frequently Asked Questions about ECT
Why does ECT work?
While it is uncertain exactly how ECT helps certain psychiatric disorders, it has proven to be an effective therapeutic toolby promoting changes in how brain cells communicate with each other at synapses while potentially stimulating the development of new brain cells. ECT has the capacity to flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in conditions like depression and schizophrenia.
When is ECT used?
People with major depression typically first receive antidepressant medication and psychotherapy. These are often very effective treatments but they take time to work. This delay can pose a danger for patients whose depression is accompanied by delusions (false beliefs) or intense suicidal thoughts. ECT can work more quickly than antidepressants which is beneficial when patients are at immediate risk for self-injury or suicide.
ECT may also be prescribed when antidepressant medications have not been effective. It can be useful for older patients who are unable to tolerate antidepressants and for pregnant women who cannot take such medications. People suffering from bipolar disorder and schizophrenia may also benefit from ECT.
What happens during an ECT procedure?
Patients are asked not to eat or drink from midnight the night before their ECT treatment.
During the procedure, the patient receives a short acting anesthetic agent which puts the patient to sleep for approximately 5-10 minutes. A muscle relaxant is also used during the procedure to stop the patient’s muscles from moving during the treatment. Cardiac monitoring pads are placed on the patient’s chest to check on the cardiac status during and after the procedure. Four electrodes are placed on specific areas of the patient’s head. Two of these electrodes are for monitoring the brain waves. The other two are for delivering a short, controlled set of electrical pulses for a few seconds. The electrical pulses must produce a generalized seizure to be effective. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current.
Patients awaken about 5 to 10 minutes after the end of the treatment. Patients are then moved to the recovery room and remain there until their blood pressure, pulse and breathing return to their pre-treatment levels. Usually this takes about 20 to 25 minutes.
Patients who are given ECT on an outpatient basis must have someone drive them home after the procedure and stay with them until they go to sleep at night. People should not drive for 24 hours following ECT.
How long is an ECT procedure?
A single ECT session usually lasts one hour. This includes the time the patient will be in the treatment room (approximately 15-20 minutes) and the time spent in the recovery room (approximately 20-30 minutes).
Initially ECT is recommended as 10/12 consecutive treatments every other day. For example: Monday, Wednesday, Friday and then can be continued as maintenance once per month. Some patients may need more or fewer treatments.
These sessions improve depression in 70 to 90 percent of patients, a response rate much higher than that of antidepressant drugs.
Although ECT is effective, its benefits are short-lived. For this reason, patients take antidepressant medication after ECT or may continue receiving ECT periodically to prevent relapse.
What are the side-effects of ECT?
The immediate side effects of the procedure which may last for about an hour include:
- Muscle aches and soreness
- Disorientation and confusion
Patients may also develop memory problems. Memories formed closer to the time of ECT are at greater risk of being lost while those formed long before ECT are at less risk of being lost. The ability to form new memories is also impaired after a course of ECT treatments but this ability usually makes a full recovery in the weeks and months following the last treatment.
How can families help patients who will be receiving ECT?
The treatment team will enlist the family’s help in assessing a patient’s progress. Families can help by providing a gentle reminder of the day and date and reassuring their loved one that feeling confused is to be expected.
Family members should inform the nurse of any concerns they may have.