Electroconvulsive Therapy (ECT) is a treatment option for patients suffering from severe depression who have been unsuccessful with other forms of treatment, such as antidepressant medication and psychotherapy. A thorough psychiatric evaluation must be completed to determine whether or not a patient is a good candidate for ECT.
If a psychiatrist recommends ECT treatment and the patient agrees with the treatment course, general medical evaluation in the Pre-Anesthesia Assessment Clinic (PAC) is necessary before ECT treatment.
Other tests must be done prior to receiving such services including a physical, EKG, CT of the head, chest x-ray, and the patient must be medically cleared by a physician. Prior to the ECT procedure, the patient will be medically evaluated by multiple physicians, namely a psychiatrist and an anesthesiologist.
How Does Electroconvulsive Therapy (ECT) Work?
ECT induces seizure activity by releasing an electrical pulse through a portion of the brain while patient is under general anesthesia. Invented in 1937, ECT has been performed with anesthesia since 1952. In recent years, techniques for providing ECT have improved greatly.
ECT is used for people whose depression is severe or life-threatening or who cannot take antidepressant medication. ECT is often effective in cases where antidepressant medications do not provide sufficient relief of symptoms or in cases where the side effects, caused by antidepressant, are not tolerable.
ECT is done under brief general anesthesia in an operating room setting. After general anesthesia is induced, a muscle relaxant is given before ECT electric stimulus. Two electrodes are placed at precise locations on the head to deliver electrical impulses.
The stimulation causes a brief (about 30 seconds) seizure within the brain.The patient does not consciously experience the electrical stimulus. For full therapeutic benefit, at least six-nine sessions of ECT are typically given at the rate of three per week.
The ECT procedure lasts only 2 to 3 minutes and the patient wakes up from the effects of anesthesia within 5 to 10 minutes. It is a well-controlled and highly successful treatment option.
Wake Forest Baptist performs ECT as an outpatient and inpatient procedure.
Electroconvulsive Therapy Side Effects
Side effects may result from anesthesia, ECT treatment or both. Common ECT side effects include temporary short-term memory loss, such as recent events, dates or meals.
Other ECT side effects – which occur mostly on the day of the procedure – may include confusion, nausea, muscle aches and headache.
Due to epileptic, parasympathetic, and sympathetic responses, control of the patient's muscular sphincters can be altered. The patient can experience defecation (bowel incontinence) as a result of the ECT procedure. Being compliant with "Nothing Taken by Mouth" 8 hours prior to the procedure decreases the incidence of this potential ECT side effect. We will prompt patients to void before ECT so that bowel and bladder incontinence will be very unlikely.
Patients should NOT operate vehicles or heavy machinery during an ECT treatment series. We require a family member or friend to drive the patient to the ECT procedure and drive patient back home after the ECT procedure. We do not agree with patients using Uber, Lyft or taxi services without a friend/companion due to confusion/tiredness after ECT and general anesthesia.
Some people may have longer-lasting problems with memory after ECT, but this type of memory loss is rare. In most patients, the memory disturbances go away within a few hours.
What is the Success Rate of ECT?
ECT is an effective medical treatment option, helping as many as 80-85 percent of patients who receive it. Most patients remain well for many months afterwards. The tendency to relapse after a favorable ECT treatment outcome can often be countered by medication after a series of treatments.
Maintenance treatments of ECT may be given depending on individual patient needs. Maintenance ECT treatment will typically be performed once a month.