What is ECT?
Electroconvulsive therapy (ECT) is a procedure in which a brief application of electric stimulus is used to produce a generalized seizure. It is not known how or why ECT works or what the electrically stimulated seizure does to the brain. In the U.S. during the 1940s and 50s, the treatment was administered mostly to people with severe mental illnesses. During the last few decades, researchers have attempted to identify the effectiveness of ECT, to learn how and why it works, to understand its risks and adverse side effects, and to determine the best treatment technique. Today, ECT is administered to an estimated 100,000 people a year, primarily in general hospital psychiatric units and in psychiatric hospitals. ECT is generally used in treating patients with severe depression, acute mania, and certain schizophrenic syndromes. ECT is also used with some suicidal patients who cannot wait for antidepressant medication to take effect. Some individuals turn to ECT as a treatment when other options (such as medications alone) did not relieve suffering. Given the new research and interests in alternative forms of treatment and some success seen in ECT, other brain stimulation treatments like transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) are now available.
How is it administered?
ECT treatment is generally administered in the morning, before breakfast. Prior to the actual treatment, the patient is given general anesthesia and a muscle relaxant. Electrodes are then attached to the patient's scalp and an electric current is applied which causes a brief convulsion. Minutes later, the patient awakens without memory of events surrounding the treatment. This treatment is usually repeated two to three times a week for approximately one month, with the number of treatments varying from six to 12. It is often recommended that the patient maintain a regimen of medication after the ECT treatments to reduce the chance of relapse.
To maximize the benefits of ECT, it is crucial that the patient’s illness be accurately diagnosed and that the risks and adverse side effects be weighed against those of alternative treatments. The risks and side effects involved with ECT are related to the misuse of equipment, ill-trained staff, incorrect methods of administration, persistent memory loss, and transient post-treatment confusion.
Why is ECT so controversial?
After 60 years of use, ECT is still the most controversial psychiatric treatment. Much of the controversy surrounding ECT is around its effectiveness versus the side effects, the objectivity of ECT experts, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization.
Because of the concern about permanent memory loss and confusion related to ECT treatment, researchers recommend that the treatment only be used as a last resort. In some cases, the numbers are extremely favorable, citing nearly 80% improvement after ECT in severely depressed patients. It is important to understand risks and expectations related to ECT. Studies indicate that ECT results in improvement, but that relapse of symptoms can be high. Many individuals experience their symptoms returning within the first six months from treatment. There is a better chance for continued positive results if an individual is also on medication.
During the last decade, the “typical” ECT patient has changed from low-income males under age 40 to middle-income women over 65. This coincides with changing demographics. Medicare and many insurance companies cover the treatment to provide fast treatment rather than talk therapy. Unfortunately, concerns have been raised concerning inappropriate and even dangerous treatment of elderly patients with heart conditions, and the administration of ECT without proper consent.
Is ECT an option?
A person and their physician should discuss all options available before deciding on any treatment. If ECT is recommended, the person should be given a complete physical and neurological medical examination, in addition to EKG and laboratory tests. Medications need to be noted and monitored closely, as should cardiac conditions and hypertension. The individual and family should be educated and informed about the procedure via videos, written material, discussion, and any other means available before a written consent is signed.
The procedure should be administered by trained health professionals with experience in ECT administration as well as a specifically trained and certified anesthesiologist to administer the anesthesia. The seizure initiated by the electrical stimulus varies from person to person and should be monitored carefully by the administration team. Monitoring should be done by an EEG or “cuff” technique.
The nature of ECT, its history of abuse, unfavorable medical and media reports, and testimony from former patients about the challenges and benefits of this treatment all contribute to the debate surrounding its use. Research should continue, and techniques should be refined to maximize the efficacy and minimize the risks and side effects resulting from ECT.