A Brief Look at Electroconvulsive Therapy (ECT)

Depression and other mental illnesses have had many different options for treatment since the beginning of psychiatry. In Moving Forward: The Last Fifty Years of Psychiatry I discussed some of the ways that treatments have evolved.

One form of treatment is Electroconvulsive Therapy, otherwise known as ECT. This is used when other, less invasive treatments have not been effective for a patient. It may not work for everyone, but it is still considered a safe treatment.

In its earlier stages of use, electricity was often used without anesthesia, leading to broken bones, memory loss, and other negative side effects. It is commonly used today to treat schizophrenia, bipolar affective disorder, and treatment-resistant depression.

A Glimpse Into the Past

ECT was discovered by accident when early asylum workers (I use “asylum” only because of the time frame in which ECT was discovered) realized that patients that had epilepsy improved after a seizure.

A Portuguese psychiatrist, Ladislas Meduna, started experimenting with different ways to induce seizures. In 1934, he found that a stimulant, Metrazol, produced seizures if given in high doses.

(I’ll wait while you, the reader, cringes.)

This worked because he was able to note that psychotic behaviors decreased after a seizure. The treatment soon became known as convulsive therapy.

However, after a convention on this treatment, the drug was found to produce a feeling of “morbid apprehension” before the convulsions, so psychiatrists began to look for other ways to induce seizures.

Meanwhile, in Italy, at about the same time, a neurologist named Ugo Cerletti was working with dogs to create similar results by delivering electrical shocks to their heads. (Not cool at all.)

There is a legend that he saw the same thing occur in a butcher shop with pigs before they were slaughtered and they were in a coma-like state. He wondered if this would work with humans. Cini and his colleague created the first ECT machine and treated their first patient, a man with schizophrenia.

I wonder, honestly, how they got consent for this. I hate saying it, but they probably didn’t obtain consent.

The treatment worked as they had hoped and the man’s condition improved a lot. In the 1940s, this became a technique all over the world, including the United States. By the 1950s, the earliest antidepressants showed up- the ones that had major side effects, like tardive dyskinesia.

ECT later stopped being used due to falling out of favor with many throughout the US, because it was seen as inhumane and torturous. It has come back into use, and as of 2012, about 1 million people receive it annually. All of this information is from Psychology Today

What are the risks? The benefits?

ECT has been associated with memory loss and difficulty with learning. Some have issues with remembering events that occurred in the weeks before the treatment, but the memory issues can be permanent in some patients. The memory issues usually improve within a few months. ECT may not be an option for those with heart problems because the procedure increases the heart rate.

On the day of ECT, some patients report fatigue, nausea, confusion, and other slight effects. Confusion is seen more in older patients.

The main benefit of ECT is that it is a faster treatment than medication. In some cases, this can save lives.

Is ECT Effective? What are the Steps?

According to Psychiatry.org, ECT creates great improvement in about 80% of the patients that choose it. Some patients are candidates if they become catatonic, suicidal or otherwise need rapid treatment for life-threatening depression.

To prevent the return of symptoms, those who are treated with ECT need to maintain ECT treatment under the guidance of their psychiatrist or another prescribing doctor. They usually also take medication and/or attend therapy.

Most patients receiving ECT will do so 2-3 times a week, totaling 6-12 treatments, depending on their situation.

Getting to ECT:

The patient will need the following:

• Psychiatric assessment
• Medical exam
• ECG to check heart health
• Informed consent
• Basic blood tests

The patient, of course, should discuss all options for treatment with their psychiatrist before making any decisions. They should be aware of any risks, benefits and side effects of any treatment plan they choose, ECT included.

The patient is then given general anesthesia and a muscle relaxant. Electrodes are attached to the scalp and the brain is stimulated with a brief series of electrical pulses. The seizure in the brain occurs for less than a minute, and the patient awakens after about 10 minutes.

ECT can be done as an in or outpatient procedure.

Once Upon A Time..

As a Mental Health Associate, I was assigned to accompany patients to two other facilities for ECT treatments once or twice a week. (This was before I transferred to the unit for the kids with autism.)

All of the patients were adults. Their vitals were taken before they left and after they returned. They left very early on 1st shift, meaning about 7:10 AM, and they were not allowed to eat after midnight before treatment.

We sat in the waiting room, were called back and I was allowed to sit in the triage area with the patients but that was as far as I could go. Once they went back for treatment, I had to go back to the waiting room, where I usually read a book until everyone was done.

While the patients were in the triage area, they were taken to the bathroom, just in case they needed to do so. They were hooked up to heart monitors and filled out paperwork.

Once the patients were done with ECT, they stayed in recovery for about 30 minutes, then we went back to the main facility and I took their vitals as soon as we got back so the nurses could track any issues. They were usually hungry and wanted to go back to bed.

I don’t have all the experience there is, but this hopefully gives you a better view.

ECT can be used when other treatments don’t work or aren’t an option. Medication and therapy are additional tools. Anyone who chooses to use this treatment should be well informed before doing so.

What are your thoughts? Leave them in the comments!