What is Electroconvulsive Therapy (ECT)?


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The basics of Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which controlled electric currents are passed through the head, intentionally triggering a brief seizure. ECT is thought to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.
ECT is used and often works when other treatments are unsuccessful. Like any treatment, ECT may not work for everyone.
Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered, sometimes without anesthesia, leading to serious side effects. It is important not to confuse historical ECT with the medical procedure of today.
ECT is much safer today. Although ECT may still cause some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
According to International Society for ECT and Neurostimulation (ISEN):” Electroconvulsive therapy (ECT) is a medical procedure used to treat severe psychiatric and neurological illnesses. It is highly effective, with up to a 60-90% success rate in severely depressed patients. ECT has a long history which dates back to 1938, though early forms of the treatment bear little resemblance to modern ECT. With advances in both anesthesia and technology, ECT today is very safe; the risk of injury or death is extremely low (mortality less than 1 per 70,000 treatments), far below the risk of childbirth.”

When ECT is preferential:

According to the FDA’s 2011 executive summary, because ECT is a controversial treatment, it is generally reserved as a last-stitch treatment for select disorders, such as: major depressive disorder, mania, and catatonia. Beyond this scope, WebMD assesses ECT as suitable for patients who are: at severe risk of suicide, resistant to pharmacological treatments, in a catatonic stupor, schizophrenic, bipolar (either phase), and depressed. Although controversial, ECT was shown to relieve depression twice as well as TMS for treatment-resistant patients, using Hamilton’s depression scale.2 Moreover, the Mayo Clinic asserts ECT as a safe technique today, and attributes the lack of anesthesia in early ECT to the stigma it landed. There is speculation on the exact mechanisms behind ECT, and at this point the mechanisms of action remain unclear.
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of several mental health conditions. ECT is used to treat:

  • Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
  • Treatment-resistant depression, a severe depression that doesn’t improve with medications or other treatments.
  • Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision-making, impulsive or risky behavior, substance abuse, and psychosis.
  • Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
  • Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.

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:

  • During pregnancy, when medications can’t be taken because they might harm the developing fetus
  • In older adults who can’t tolerate drug side effects
  • In people who prefer ECT treatments over taking medications
  • When ECT has been successful in the past

Where can I get ECT Treatment?

The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you’re hospitalized or as an outpatient procedure. You can use this free tool below to find doctors and clinics who provide ECT treatment.

Side-effects of ECT:

Side-effects of ECT include: confusion, soreness, seizure, pain, and retrograde amnesia. The bout of retrograde amnesia that commonly comes with ECT is usually transient, and can be assessed with the autobiographical memory interview (AMI). A pulsating technique has been shown to incur less memory loss, and this is a common technique for current ECT practitioners.3
Although ECT is generally safe, according to Mayo Clinic, risks and side effects may include:4

  • Confusion: Immediately after treatment, you may experience confusion, which can last from a few minutes to several hours. You may not know where you are or why you’re there. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
  • Memory loss: Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. This condition is called retrograde amnesia. You may also have trouble recalling events that occurred during the weeks of your treatment. For most people, these memory problems usually improve within a couple of months after treatment ends.
  • Physical side effects: On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle ache. These generally can be treated with medications.
  • edical complications: As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.

What is Magnetic Seizure Therapy?

Magnetic seizure therapy (MST) is related to ECT but not the same inect how energy is delivered to the brain to produce a seizure. MST involves the induction of a seizure by applying magnetic stimulation to the brain. The first MST seizure was induced in 1998. MST is being investigated as an alternative to electroconvulsive therapy (ECT) in order to find a beneficial treatment for depression, psychosis and obsessive-compulsive disorder with fewer cognitive side effects.
In most countries, MST is only provided as part of a research study. Therefore, you must meet the study criteria in order to receive MST. The chance to be part of the clinical trial and receive MST is offered to those experiencing symptoms of depression, schizophrenia or obsessive-compulsive disorder.
Common effects after MST are headache, dizziness, nausea or vomiting, muscle aches and fatigue. These may be caused by the anesthetic, the MST or not having anything to eat or drink for a long time.

How much does ECT cost?

The cost of ECT varies depending on whether or not the patient has health insurance, if the insurance covers the procedure, and to what extent. According to psychologytoday.com, ECT costs around $2,500 per session, $25,000 for ten sessions, plus the cost of one week hospital stay in some cases.

The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.




References

1. Rudorfer, M. V., Henry, M. E., & Sackeim, H. A. (2003). Electroconvulsive therapy. Psychiatry, 2, 1865-1901.
2. Micallef-Trigona, B. (2014). Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression: a systematic review and meta-analysis. Depression research and treatment, 2014.
3. Benbow, S. M. (2004). Adverse effects of ECT” In AIF Scott (ed.) The ECT Handbook secod edition, The Royal College of Psychiatrist.
4. Mayo Clinic Staff. (2018, October 12). Electroconvulsive therapy (ECT). Retrieved February 5, 2019, from https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894

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