Electroconvulsive therapy (ECT) – What is it, Why is it Needed, Risks and Benefits

Overview

Electroconvulsive therapy (ECT) is a procedure conducted by doctors under general anaesthesia where the patient receives electric currents to the brain. This intentionally triggers a brief seizure. ECT may cause changes in the brain chemistry that can quickly reverse symptoms of certain mental health conditions. 

This procedure is shown to have positive effects in treating severe, treatment-resist mental health issues. Its history dates back to more than 80 years, and after series of extensive research it has proven that it is an effective and safe treatment technique. If you are planning to undergo this treatment, note that it is painless as you will be under anaesthesia. 

Often, people have negative thoughts when it comes to ECT treatment. This is because most movies, television shows, and other media inaccurately portray how the procedure is conducted, incite fear about the painfulness of the procedure, and showcase it as ineffective. These representations are not true and do not show how the procedure is conducted safely and humanely by the doctors and their team.

What conditions are treated with ECT?

The following are the several conditions that ECT can possibly treat.

• Depression: for people who are above the age of 60 years.
• Schizophrenia: This includes other schizophrenia-spectrum conditions and psychotic disorders.
• Bipolar disorder and other conditions that may involve mania

Why is ECT performed?

ECT has been shown to provide immediate and significant improvements in your mental health conditions. This procedure has been employed when most other treatments have failed. ECT is currently being used to treat:

1. Treatment-resistant depression: A condition of severe depression that has not shown any improvements with medication.
2. Severe depression: This is characterized by a detachment from reality, refusal to eat, and wanting to commit suicide.
3. Severe mania: It is characterized by a mental state of agitation and hyperactivity. This is also considered a subset of bipolar disorder.
4. Catatonia: This is characterized by a lack of movement and speech aside from other symptoms. This is also sometimes associated with schizophrenia and other psychiatric disorders.
5. Agitation and aggression in patients with dementia are challenging to manage and treat and adversely affect life quality.

ECT is also considered a good treatment option for

• Pregnancy,  when administering drugs can harm the fetus inside.
• For people who prefer ECT over other treatment methodologies.
• Adults who cannot tolerate the side effects of drugs.

Book An Appointment

How common is ECT?

As mentioned earlier, it is an effective and safe procedure but it is an uncommon procedure. However, this treatment is recommended for several reasons including:

• It is rarely a first-line of treatment for depression
• Many several newer medications that are available to treat many mental health conditions.
• There are fewer hospitals that offer ECT

What are the risks associated with ECT?

ECT is usually considered safe, but some of the common risks associated with the procedure are:

1. Memory loss: You may develop retrograde amnesia wherein you would find trouble remembering moments just before the treatment or events occurred a few months or years before. You may also have difficulty remembering  the treatment. But despite these, memory loss has been seen to improve within a few weeks to a few months post-treatment.
2. Confusion: Confusion is a common risk associated if you are older. You may be confused about your surroundings just after the treatment. This usually lasts for a few minutes to a few hours after the treatment. In rare instances, it has been reported that the state of confusion has extended for days.
3. Medical complications: Certain other medical complications can be observed, such as an increase in heart rate and blood pressure. In rare cases, serious heart problems are also observed.

What to Expect?

Before you start the ECT procedure, your healthcare provider will explain in detail all about the procedure, its risks, and how it works. They will ensure that you don’t have any underlying health conditions or any reasons for not receiving this procedure. 

What happens before the procedure?

Before starting the procedure, your doctor may recommend several tests including

• Blood and urine tests: You may be required to give blood and urine samples for some tests including complete blood count, a basic or comprehensive metabolic panel, thyroid function, kidney function, and others
• Imaging tests on skull, brain, and spine: These tests can include x-rays and computerized tomography (CT) scans.
• Electrocardiogram (ECG or EKG): These tests are conducted to check your heart function and may spot any abnormalities or problems in your heart’s electrical system.

Reasons why you shouldn’t receive ECT

Sometimes your doctor may not proceed with the procedure due to certain conditions and reasons, known as contraindications. These are considered by doctors on every case basis. However, if you have contraindications your healthcare providers can adjust the procedure so that you can receive ECT. The contraindications include:

• If you had a recent heart attack or other unstable heart condition
• Certain conditions such as intracranial hypertension or brain tumours that can increase the pressure inside your skull
• A recent stroke, aneurysm, or other causes of brain bleed
• Severe lung diseases such as chronic obstructive pulmonary disease (COPD)
• Other life-threatening conditions 

Stoppage of food and liquids

As this procedure is conducted under a general anaesthesia, your doctor can ask you to fast before the procedure. This means you are supposed to stopping eating solid food eight hours and not drink for two hours before the procedure.

What you should take off or remove

Your doctor may ask you to remove your jewellery, medical devices, accessories, or prosthetics before the procedure. Common examples include removing your glasses, contact lenses, hearing aids, dentures, or dental plates, and others. When you remove these objects from your body, you avoid the risk of injury or choking. 

Medication stoppage

There are certain medications that can affect how ECT affects you, such as the effectiveness of the treatment. Your doctor may ask you to stop certain medications or reduce your dosage. However, it is best to stop or change medication only after a doctor’s directives.

What happens during the procedure?

This procedure is conducted with multiple healthcare providers such as psychiatrists, anaesthesiology, and other specialised trained personnel.

• Anaesthesia and other preparations: As this procedure is conducted general anaesthesia, puts you into a deep sleep and minimizes any feeling of pain, discomfort, or anxiety during the procedure. The doctors can also give you a muscle relaxant to avoid any injuries or strain that may occur during a seizure. The doctor may also insert a bite guard into your mouth to protect your teeth and an intravenous needle allows quick injection access for anaesthesia. 
• Electrode placement: Your doctor can place electrodes – these are contact points for electric currents to travel through – against the skin of your head. The placement depends on the requirements and doctors will choose to place an electrode that has the lowest chance of causing a side effect.
• Electricity requirements: Doctors may start with lose dose of electric current and slowly increase it until it has a desired effect. The duration is also brief and may last only for a few seconds. This involves a very small electrical current, up to about 0.4 amps.
• Induced seizure: This procedure uses an electrical current that causes seizures. Seizures occur when a burst of electrical activity happens in your brain and causes the affected brain to fire rapidly. This causes electrical and chemical changes in the affected brain leading to improvements in how those areas of the brain work. Typically, seizures last anywhere between 30 to 90 seconds. If it lasts longer, the doctors can stop the seizure with an injectable medication.

What happens after this procedure?

Once the seizure stops and the anaesthesia wears off, the doctors monitor your vital and check for signs of any side effects or other anaesthesia-related issues that may occur. Most people are fully conscious within 10 to 15 minutes after the procedure and they can be on their feet within 30 minutes.

Results

Many patients start to notice considerable improvement after about six treatments with ECT. Full improvement may take longer, however ECT may not work for everyone. This therapy yields quicker results as compared to the response to antidepressant medications takes several weeks or more.

It is unsure how ECT helps treat severe depression and other mental illnesses. Although, it is known that many chemical aspects of the brain are changed during and after the seizure. These chemical changes may gather upon one another and may reduce symptoms of severe depression or other mental illnesses. Therefore, ECT is considered the most effective in people who receive a full course of multiple treatments. If your symptoms improve, you will still need ongoing depression treatment to prevent a recurrence.

What are the advantages of ECT?

Due to its several advantages, it makes a critical tool for treating mental health conditions:

•  It is tremendously effective: Several experts are of the opinion that ECT is one of the most treatments for mood disorders such as depression. It is also most effective at assisting people with depression-resistant forms of treatments like medications or therapy.
• It is safe: As the doctors use anaesthesia this therapy is generally safe. The other modern care practices have tremendously improved this procedure’s overall safety. People suffering from heart problems can often receive ECT with medication adjustments and close monitoring of their vital signs.
• It is safe during pregnancy: It is safe during all three trimesters of pregnancy.
• It works fast: After three to five treatments, people notice an improvement in their symptoms, especially for conditions such as major depressive disorder and severe mental health conditions that may put the patients at harm.
• It helps patients when other treatments are unavailable: in certain cases, when people cannot take medications, numerous reasons, for mental health conditions can still receive ECT. The procedure can make a big difference for patients with organ function issues
• It is most effective when combined with the medication: People who receiving ECT also take medications for treating. Thus, further improving their mental health condition.

What is the recovery time?

People who receive ECT recover quickly and wake up within 15 minutes of the procedure. They can be on their feet within 30 minutes of the procedure. The procedure involves multiple treatments per week and for several weeks. Generally, people receive 3 treatments per week.

Other Brain Stimulation Treatments

Apart from ECT, there are other brain stimulation treatments. They are as follows:

• Transcranial magnetic stimulation (TMS): This is a non-invasive process that treats depression that is resistant to other therapies. It uses rapidly alternating magnetic fields to stimulate certain areas of the brain. This does not cause a seizure and the patient remains awake throughout the procedure. This procedure may have mild side effects such as headaches, muscle twitches, and pain at the stimulation site. It is administered 4 to 5 times a week for four to six weeks.
• Vagus Nerve Stimulation (VNS): It was mainly developed as a treatment for seizure disorder but can also be used to treat depression that is resistant to other therapies. In this, a patient is implanted with an electrical pulse generator in the chest that sends intermittent electrical stimulation the vagus nerve in the neck.

Conclusion

Many patients observe marked improvement after the fourth or the sixth ECT procedure. Complete improvement would take a lot longer. While no one is still sure of how ECT works and how it is useful in treating various mental health conditions such as severe depression, reports have shown that the brain chemistry seems to have changed after the induction of seizure. Moreover, each seizure builds upon the change in brain chemistry achieved in the previous session, ultimately resulting in an improved position towards the end of the full course of treatment.

As the treatment does not end here, you would have to continue with the medications and maybe even milder ECT procedures in the future.

Frequently Asked Questions

Is ECT painful?

ECT is not painful as the doctors sedate the patients with anaesthesia.  

Is ECT safe?

Yes, the procedure is very safe due to advances in modern medicines. If you have any concerns about the procedure, it is best advised to talk to your doctor. And your doctor can take your other health conditions or circumstance into consideration and accordingly adjust the procedure.

What is the success rate of electroconvulsive therapy? 

These improve depression close to 70 to 90 per cent of the patients and the response rate is greater than that of antidepressant medications. However, ECT is effective, its benefits are short-lived.

What mental illness does ECT treat?

ECT is currently being used to treat:

• Treatment-resistant depression: A condition of severe depression that has not shown any improvements with medication.
• Severe depression: This is characterized by a detachment from reality, refusal to eat, and wanting to commit suicide.
• Severe mania: It is characterized by a mental state of agitation and hyperactivity. This is also considered a subset of bipolar disorder.

Also Read About: Attention Deficit Hyperactivity Disorder

• Catatonia: This is characterized by a lack of movement and speech aside from other symptoms. This is also sometimes associated with schizophrenia and other psychiatric disorders.
• Agitation and aggression in patients with dementia are challenging to manage and treat and adversely affect life quality.

Do they shave your head for ECT?

Electroconvulsive therapy (ECT) is a procedure conducted by doctors under general anaesthesia where the patient receives electric currents to the brain.

Can ECT make you worse?

No, the ECT procedure helps alleviate the symptoms of depression and other mental health conditions.

Does ECT worsen anxiety?

There are some psychiatrists are of concerns that while ECT may help in alleviate depressive symptoms, it could worsen anxiety symptoms, including obsessive thoughts or panic attacks.

Does memory come back after ECT?

Some people experience memory loss. In certain cases, the memory return after a short period of time and sometime the patient may have long term memory loss.