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So, What is Electroconvulsive Therapy? When do we use it? How effective is it and what are the risks and side effects?
ECT is a medical procedure used to treat symptoms of severe psychiatric illness including Depression, Bipolar Disorder, and sometimes Schizoaffective Disorder/Schizophrenia. It is used as a first line treatment for severe Catatonia. Most often, it is implemented in patients who are suffering and simply not getting the desired benefits from other treatments, such as medication or therapy. Alas, about 35% of patients with Mood Disorders are considered "treatment resistant" and thus may may require this "Gold Standard" treatment to finally provide them some relief.
The procedure involves a short-acting general anesthesia followed by administration of a small, brief electrical stimulus that induces a generalized seizure. The stimulus and the seizure are what induce biochemical and ultimately structural changes to the brain that are associated with its powerful, quick acting anti-depressant and mood stabilizing effects. Each treatment involves the participation of an anesthesiologist, the ECT psychiatrist, and an ECT RN. The individual treatments last about 20 minutes, with the anesthesia and seizure activity lasting a mere few minutes of that time.
The clinical response is substantially more robust and expedient in their onset compared to medication. For instance, in a treatment resistant cohort of patients with depression, a further medication trial might prove to have a 10% remission rate. Whereas with ECT, that remission rate approaches 60%.
The onset of response is usually rapid; life-threatening suicidality, for instance, in the majority of ECT patients, is absent after just two weeks of treatment.
A full "acute" course of ECT involves three treatments per week for two to five weeks. If successful, this is followed by a "maintenance" phase of 3-6 months in which periodic ECT treatments along with medication management are implemented to enhance the likelihood of sustained remission.
The safety of ECT is well established. It carries a mortality rate of less than one in ten thousand. Patients are carefully assessed medically prior to starting to ensure the risk is minimal. Our practice - in which over 80,000 treatments have been performed - has had NO catastrophic results or death. Our safety record is excellent.
Nuisance side effects mostly include headache and nausea, often preventable with IV agents during the treatment, or with oral medications afterward.
Cognitive side effects are inevitable to some degree and usually involves short term memory capacity (forgetting events of the very recent past). This phenomenon, with equal inevitability, improves over the course of the weeks following the completion of the acute phase. Sometimes, patients will experience some "retrograde amnesia", loss of the memory of autobiographical episodes prior to ECT. Often, when this does occur, the memories can be retrieved with time.
Also for a couple of hours after each treatment, one can experience a short lived confusional state.
(Interestingly, despite the cognitive side effect just mentioned, ECT treatment has been shown to reverse the brain atrophy seen in many chronically, depressed patient in regions responsible for learning and memory!)
This website is intended to provide an introduction to information as it relates to the practice of Electroconvulsive Therapy and is not intended to be construed as medical advice for your or any other particular situation. For additional information please Click Here.