When is ECT used and why? How is the decision to use ECT made? Who administers ECT? What happens during ECT? What are the risks and side-effects of ECT?
Risks The greatest risk with ECT is associated with the anaesthetic, which has a very small risk of death often quoted as one in , Side-effects Immediate effects of ECT may include: loss of memory about the events immediately before and after ECT heart rhythm disturbances low blood pressure headaches nausea sore muscles, aching jaw confusion. Generally, these resolve within a few hours, although some memory loss may persist. What is the evidence for the use of ECT?
There is strong evidence that ECT is effective in treating severe depression in the short term. Repeated courses of ECT may be considered for individuals with severe depressive illness who have previously responded well to ECT. ECT is not effective in all cases.
Key points. ECT involves passing a carefully controlled electric current through the brain. ECT attracts very mixed responses — its supporters say that it is beneficial and lifesaving, while its critics say that it is invasive and unnecessary.
Modern ECT is a safe procedure, which is used to treat the most severe forms of depression including psychotic depression and severe manic symptoms, when the situation is thought to be life-threatening or after all other treatment options have failed.
ECT can reduce severe depressive symptoms more effectively than other treatments. ECT is not a 'cure', but can be useful in the short term because it works more quickly than antidepressants or other medications. The main side-effect of ECT is memory loss, which usually resolves after a few weeks, but can last longer. People have varying degrees of memory problems after ECT, and different reactions to it.
No one is sure how ECT helps certain psychiatric disorders. It may promote changes in how brain cells communicate with each other at synapses and it may stimulate the development of new brain cells. ECT may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in conditions like depression and schizophrenia. People with major depression typically first receive antidepressant medication and psychotherapy. These treatments, though often effective, take time to work.
This delay can be dangerous for patients whose depression is accompanied by delusions false beliefs or intense suicidal thoughts. ECT can work much more quickly than antidepressants and is useful when patients are at immediate risk for self-injury or suicide. ECT may also be prescribed when antidepressant medications have not worked.
It can be useful for older patients who are unable to tolerate antidepressants and for pregnant women in whom medication might damage the fetus.
People suffering from bipolar disorder and schizophrenia may also benefit from ECT. Before ECT, patients are asked not to eat or drink from midnight the night before treatment. During the procedure, the patient receives a short acting anesthetic agent which puts the patient to sleep for approximately minutes. A patient typically receives ECT two or three times a week for a total of six to 12 treatments, depending on the severity of symptoms and how quickly the symptoms respond to the treatment.
At the time of each treatment a patient is given general anesthesia and a muscle relaxant and electrodes are attached to the scalp at precise locations. The patient's brain is stimulated with a brief controlled series of electrical pulses. This causes a seizure within the brain that lasts for approximately a minute. The patient is asleep for the procedure and awakens after minutes, much as from minor surgery.
Most insurance plans offering coverage for psychiatric disorders at least partially reimburse the cost of ECT. Like any medical procedure, ECT is has some risks. ECT treatment has been associated with short-term memory loss and difficulty learning.
Some people have trouble remembering events that occurred in the weeks before the treatment or earlier. In most cases, memory problems improve within a couple of months. Some patients may experience longer lasting problems, including permanent gaps in memory. The risks of general anesthesia, which is needed for ECT, are similar to the risks when anesthesia is used for other procedures such as minor surgeries. The most common side effects of ECT on the day of treatment include nausea, headache, fatigue, confusion, and slight memory loss, which may last minutes to hours.
These risks must be balanced with the consequences of ineffectively treated severe psychiatric disorders. For some patients, the risks of ECT may be less than those of ongoing treatment with medications. ECT can work more quickly than medications. It can be especially useful if a patient is suicidal, is not responding to medications or cannot tolerate the side effects of medication.
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