Electroconvulsive Therapy

Electroconvulsive therapy (ECT) was first introduced in the 1940’s and is arguably one of the most misunderstood treatments in psychiatry. This is likely secondary to the stigma associated with it. ECT is still suspect to many based on its dark history. In the 1940’s electric shock was administered without any type of anesthesia which led to serious and painful side effects. However, ECT today is significantly safer and the practice is much more humane.

What is ECT?

The premise of ECT involves a small electric current transferring through electrodes placed on the head. The electricity applied induces a controlled seizure that usually lasts around 1 minute. Electrodes can be placed one of three places on the head: unilaterally on either the left or right temple, or bilaterally (on both sides) of the temple.

ECT is done after general anesthesia is administered so the patient does not experience any pain. A bite block is placed in the mouth when the patient is asleep to protect the teeth and jaw, and a muscle relaxer is also given so the body is loose when the seizure is induced. This is meant to help mitigate physical side effects after treatment is completed. During ECT the patient is monitored for the entirety of treatment and also during recovery. The ECT administration team usually consists of an anesthesiologist, nursing staff, and a psychiatrist.

Having seen ECT in several patients for multiple sessions over the years, it is safe to say that the process itself is quite underwhelming. Prior to the first time observing ECT I was expecting a violent seizure with a thrashing body as it has been depicted on TV. Instead the procedure was frankly boring. It takes more time to setup the equipment for treatment than it does to administer the treatment itself. The actual application of electricity takes about 30 seconds. The patient’s movements are very minimal secondary to the muscle relaxer given prior to treatment. At most a patient makes a grimacing facial expression, an arm or leg may contract or tremble slightly, and then it’s over. They are taken to the recovery room and monitored, and in about an hour or two, once the anesthesia wears off they can resume regular activity.

Risks

Although ECT is quite safe, it is not without risks. The most common side effects include:

  • Usually lasts for a short period of time, but can last for several days.
  • Memory loss. Retrograde amnesia, or trouble remembering events that occurred before treatment is possible. Most of the memory loss comes from recent memory, but can rarely come from previous years. Memory usually improves after treatment is concluded.
  • Physical side effects.Nausea, headache, muscle ache that can be easily treated
  • Medical complications.There are always risks associated with any type of medical procedure particularly with procedures that involve anesthesia. This is why a full medical evaluation should take place before ECT treatment begins.

What conditions does ECT treat?

ECT is used to primarily treat the following conditions:

  • Treatment-resistant depression
  • Severe mania, a state of intense euphoria that is a symptom of bipolar disorder
  • Catatonia,which includes symptoms like: lack of movement despite the physical ability to do se, fast or strange movements, lack of speech, refusal/inability to eat, and stupor. Catatonia is associated with both psychiatric disorders and some medical illnesses.
  • Agitation and aggression associated with psychiatric disorders and medical disorders like dementia
  • Psychosis

When is ECT used?

ECT is typically the treatment of choice when less invasive treatments like medication or therapy have not worked, or when the need for treatment response is dire due to the severity of the patient’s condition. ECT can also be used when medication is not a viable option ie. during pregnancy where medications could put the fetus at risk, or in people who prefer not to use medication to treat mental health conditions.

The effectiveness of ECT is acknowledged by reputable organizations like the American Psychiatric Association, the American Medical Association, and the National Institute of Mental Health. More information can be found on these organization’s websites.

Resources

American Medical Association
https://www.ama-assn.org/

American Psychiatric Association
https://www.psychiatry.org/

National Alliance on Mental Illness
https://www.nami.org/

National Institute of Mental Health
https://www.nimh.nih.gov/index.shtml

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