Back to Electroconvulsive Therapy. All Topics. Electroconvulsive therapy ECT is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia. It is typically administered by a team of trained medical professionals that includes a psychiatrist, an anesthesiologist, and a nurse or physician assistant.
Extensive research has found ECT to be highly effective for the relief of major depression. Clinical evidence indicates that for individuals with uncomplicated, but severe major depression, ECT will produce substantial improvement in approximately 80 percent of patients.
It is also used for other severe mental illnesses, such as bipolar disorder and schizophrenia. ECT is sometimes used in treating individuals with catatonia, a condition in which a person can become increasingly agitated and unresponsive.
A person with catatonia can seriously injure themselves or develop severe dehydration from not eating or drinking.
ECT is also used for people who require a rapid treatment response because of the severity of their condition, such as being at risk for suicide. Although ECT can be very effective for many individuals with serious mental illness, it is not a cure. To prevent a return of the illness, most people treated with ECT need to continue with some type of maintenance treatment. Before beginning a series of ECT treatments, a patient should receive a thorough psychiatric assessment, including a medical examination and sometimes a basic blood test and an electrocardiogram ECG to check heart health.
Informed consent is another important part of the process. A patient must provide written informed consent before ECT is administered. In situations where a person is too ill to make decisions for him or herself, the consent process is governed by state law for example, a court-appointed guardian. If ECT is done on an outpatient basis, a family member or friend must drive the person home after the procedure driving is not allowed in the 24 hours following an ECT session and stay until he or she goes to sleep that night.
The person should be re-assessed after every session of ECT. Generally, symptoms start to improve after two sessions. It is not understood exactly how ECT works to treat depression and the outcomes may vary from person to person.
The greatest risk with ECT is associated with the anaesthetic, which has a very small risk of death often quoted as one in , Like any procedure involving an anaesthetic, ECT involves this small amount of risk, but overall, it is regarded as a very safe treatment.
Despite the myths about ECT causing brain damage, MRI studies have shown that it does not change the brain anatomy in any way, as the strength of the electrical current is too low to harm brain tissue. Some people who have undergone ECT recommend writing down passwords, PINs, phone numbers and special dates, and keeping them in a safe place in case they cannot be recalled in the period after the treatment.
A common and significant side-effect is difficulties with memory — this is reported by at least one in three people 1 who have ECT. It can be hard to work out which memory changes are caused by ECT and which by the mental health condition itself — but ECT may lead to both loss of memories or difficulty in creating new memories.
Most research demonstrates that memory loss is very restricted and usually temporary. However, memory changes may last for some weeks after treatment and a few people experience long-term or even permanent loss of memories.
People differ in the amount of memory loss they report from ECT and how they feel about it. While some people find ECT to be a beneficial and lifesaving treatment, others find their memory loss distressing and for them, this outweighs any benefit from ECT. National Institute for Clinical Excellence Guidance on the use of electroconvulsive therapy. Technology Appraisal 59 April Sign up below for regular emails filled with information, advice and support for you or your loved ones.
When is ECT used and why? How is the decision to use ECT made? Who administers ECT? But there have been plenty of trials. Bilateral ECT was more effective than unilateral that is, treatments given to the whole brain are more effective than those given to half of the brain. And, finally, six trials that compared higher electric charges with lower electric charges found that higher charges produced greater improvements.
Still, every few years the opponents of ECT demand more evidence. In response to such demands, a large study was conducted in the US the CORE report on patients and the results were published in The study set the bar for improvement very high: it required depressed patients to have almost no symptoms on two consecutive measurements at the end of the treatment period.
Three-quarters of patients reached those remission criteria. No other treatment in psychiatry has come even close to such effects. The real effect from ECT is even stronger than what has been claimed in trials.
This is because it produces its best effect in the most severely ill patients: those who stop talking, stop eating or become psychotic. In fact, if a patient with psychotic depression is not improving during an ECT course, as the ECT lead consultant in my hospital, I try to find out what we are doing wrong. These patients do not get included in randomised trials, as they are not capable of providing informed consent and most professionals would think it unethical to allow them to receive placebo or any weaker treatment that is compared to ECT in a randomised trial.
They would be even less likely to receive psychotherapy, as they would be deemed — correctly — as being incapable of engaging in psychological treatments. Perhaps such people might be persuaded if they go to an ECT clinic and witness one of the miraculous changes that can occur there. I do this with medical students who come to observe one session of ECT, as part of their education. Every few weeks, we have a patient who enters the treatment room mumbling incoherently, or telling us that they are a sinner deserving to be punished, or complaining that they have no intestines or some other vital body part or function.
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