Electroconvulsive therapy – The Last Option?

As part of treatments for depression, we cannot do without the mention of electroconvulsive therapy which many people say they would only think of when faced with the worst possible scenario. Whether you should consider this for yourself or not will be a decision you will have to take on your own. This brief is short summary directly aimed at the most important points you need to know.

SCARY INDEED

The most controversial modality in the treatment of depression is electroconvulsive therapy (ECT), also known as electric shock therapy. Much of the scare and concern about ECT arise from the shocking way in which the treatment has been portrayed by the popular media.

The imagination of having electrical currents forced through one’s brain will only bring to mind a picture of torture, fear and terror.

 What is ECT?

Electroconvulsive therapy is a treatment for severe mental illness or treatment resistant depression. The brain is stimulated with a strong electrical current which induces a seizure, similar to those of epilepsy. In a manner that is not understood, this seizure rearranges the brain’s neurochemistry, resulting in an elevation of mood.

In recent years the method of administering ECT have evolved and has become safer and less traumatic compared to the past ways, thus this treatment has made a comeback.

How effective is ECT in treating mental disorders?

The efficacy of ECT has been established most convincingly in the treatment of delusional and severe clinical depressions, which make up a clinically important minority of depressive disorders.

Some studies find ECT to be as effective as antidepressants, while others find ECT to be superior to medication. The literature also indicates that ECT, when compared with antidepressants, has a more rapid onset of action.m

ECT has also been shown to be a safe and effective treatment for mania.

Before the discovery of lithium, ECT was the mainstay treatment for mania as well as for severe depression. It is still often effective for mania when lithium and antipsychotic drugs fail. For example, in one study ECT was given for eight weeks to seventeen patients who had failed to respond to lithium. All of them recovered.

Although ECT can jolt people out of severe depression and mania, recovery is not necessarily permanent. Relapse rates in the year following ECT are likely to be high unless maintenance antidepressant medications are subsequently prescribed. In other instances, “maintenance doses” of ECT are given two to six times a year to prevent relapse. ECT is also useful in certain types of schizophrenia, although antipsychotic drugs remain the first line of treatment.

How is ECT administered?

Once the patient (or his or her guardians) and the physician have decided that ECT may be indicated, the patient undergoes a pre-treatment medical workup that includes a history, physical, neurologic examination, electrocardiogram (EKG), and laboratory tests.

Typically, ECT is administered in the early morning after an eight-to twelve-hour period of fasting, although mid-afternoon treatments are also used. A number of medications and muscle relaxants are given to the patient, and stimulus electrodes are placed on the head, either on one or both temporal lobes (for unilateral or bilateral ECT, respectively).

After the muscle relaxant has taken effect, the brain is stimulated with an electrical pulse lasting from a quarter of a second to two seconds. The pulse induces a seizure which usually lasts from 30 seconds to two minutes, during which time the patient is closely monitored.

After the treatment, the patient is brought to a recovery room where he or she remains until waking. The number of ECT treatments in a course of therapy varies between six and twelve. Treatments are given three times a week, for two to four weeks. Following ECT, most depressed patients are continued on antidepressant medication or lithium to reduce the risk of relapse. Sometimes, physicians give maintenance doses of ECT to their patients on an outpatient basis.

What are the risks and adverse effects of ECT?

ECT is clearly less dangerous than it once was. Over the years, safer methods of administration have been developed, including the use of short-acting anesthetics, muscle relaxants, and adequate oxygenation, which have reduced the risk of physical injury and mortality.

Yet even under optimal conditions of administration, the ECT seizure produces two main reactions-transient post-treatment confusion, and spotty but persistent memory loss.

Immediately after awakening from the treatment, the patient experiences confusion, temporary memory loss, and headache. Some people compare their experience to having a bad hangover. The time it takes to recover clear consciousness may vary from minutes to several hours, the exact length depending on the type of ECT administered (stimulating both hemispheres produces more confusion than unilateral ECT), as well as individual differences in the patients’ response patterns.

The second side effect of ECT is memory loss which persists after the termination of a normal course of treatment. This amnesia seems to surround events that occurred around the time of the treatment, either several weeks before or after. For example, the patient may not remember who took him to the hospital or what gifts he gave a month before the treatment. The ability to learn and retain new information does not seem to be adversely affected, although learning difficulties may exist during the first few weeks after the treatment.

Because there is also a wide difference in individual perception of the memory deficit, the subjective loss can be extremely distressing to some and of little concern to others. For example, many patients who complain about autobiographical memory loss say that being free of depression is well worth whatever memory disruption they experience. Others insist, however, that they have suffered a terrible disruption to their memory and to their lives. Although the second group is in the minority (80 percent of people who have had ECT report that the procedure was no more frightening than going to the dentist), accounts of the suffering of those who perceive they have been harmed may add to the apprehension of many patients who consider ECT treatment.

Conclusion

ECT remains controversial despite its documented benefits. This controversy is perpetuated by the following factors: the nature of the treatment itself, its history of abuse, unfavorable media presentations, compelling testimony of former patients, special attention by the legal system, and uneven distribution of ECT use among practitioners and facilities.

Nonetheless, ECT is demonstrably effective for a narrow range of severe psychiatric disorders-delusional and severe endogenous depression, manic episodes, and certain schizophrenic syndromes. There are, however, significant side effects, especially confused states and persistent memory deficits for events during the weeks surrounding the ECT treatment. Proper administration of ECT can reduce potential side effects while still providing for adequate therapeutic effects.

Would you consider going for this form of treatment? 

Watch Rachael’s Experience with electroconvulsive therapy

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