Electroconvulsive Therapy (ECT)
What you need to know about Electroconvulsive Therapy
The validity of Electroconvulsive Therapy (ECT) as a therapeutic, and often lifesaving, intervention has been marred by misconceptions. Much of the stigma is based on depictions from movies (One Flew Over the Cuckoo’s Nest & The Snake Pit), where early treatments were performed without anesthesia or muscle relaxants. Modern ECT bears no resemblance to the dramatization depicted in movies. It’s performed in a controlled setting, under anesthesia, to achieve the most therapeutic benefit with the fewest possible risks.
Electroconvulsive Therapy is endorsed by the American Psychiatric Association and approximately 100,000 patients annually receive ECT in the US. Recently, ECT has gained some national attention as a more accepted form of treatment for those with severe depression, mania or other psychiatric disorders. In 2011, actress/author Carrie Fisher went on the Oprah Winfrey Show to discuss how she has struggled with her own severe depression, since her 20’s. She now receives ECT every six weeks to help successfully manage her manic depression. In 2012, Dr. Oz dedicated a whole show to ECT and it’s effectiveness, entitled “The Shock That Could Save Your Life”.
ECT may be a good treatment option to be considered when medications aren’t tolerated or other forms of therapy haven’t worked. However, it is far more valuable than to be considered just an intervention of last resort (for example, ECT can be a beneficial alternative for women who don’t want to expose their infants to antidepressants while breastfeeding). It is the most effective and rapidly acting treatment that we have today. Remission, which is the likelihood of having complete resolution of symptoms, is reported to range from 70-90% with ECT (much more effective than any medication we have at present, which typically have remission rates around 20-30%). *
*(Sarah Hollingsworth Lisanby, MD, Professor and Chair, Department of Psychiatry and Behavioral Sciences, Director, Brain Stimulation and Neurophysiology Center, Duke University School of Medicine)
Electroconvulsive Therapy (ECT) is a modern medical treatment for certain illnesses that have mental or emotional symptoms. In this treatment, a patient goes to sleep under anesthesia, receives muscle relaxants and oxygen, and then receives a brief electrical stimulation to the scalp. The resultant nerve-cell activity releases chemicals in the brain and helps to restore normal functioning. ECT resembles cardioversion, a common medical procedure in which the heart is stimulated electrically to restore its normal functioning but ECT uses a much smaller amount of electricity.
ECT has been used for over 50 years. The American Psychiatric Association concluded in 1978 that ECT was both safe and effective for cases of severe depression and several other severe mental illnesses. More recently, a blue ribbon panel convened in 1985 by the U.S. Governments National Institutes of Mental Health found that ECT was demonstrably effective for a narrow range of severe psychiatric disorders, including depression, mania and schizophrenia.
Medication helps many people suffering from the aforementioned psychiatric disorders but for over 100,000 U.S. patients each year, ECT is the most effective treatment. Some patients do not respond to medications, others cannot tolerate the side effects, and still others – those whose illness has made them seriously suicidal, for example – urgently require the reliable symptom relief that ECT can provide.
How is ECT Given?
ECT is given by a treatment team of doctors, nurses, and nursing assistants, often with an anesthesia specialist. ECT is usually given two or three times a week, typically Monday, Wednesday and Friday mornings, for a total of 6-12 treatments. A few patients may require more than 12 treatment for maximum benefit.
Is ECT Curative?
ECT is an exceptionally effective medical treatment, helping 90% of the patients who use it. Most patients remain well for many months afterwards. The tendency to relapse after a favorable treatment outcome can often be countered by medication taken for about half a year after ECT. Permanent cures for psychiatric illnesses are rare, however, regardless of the treatment given.
How Safe Is ECT?
ECT is a very safe medical treatment. A recent study in California found about one death per 50,000 ECT treatments, a risk far below the risk of child birth. Another study observed the death from heart attacks and suicide were less frequent among depressed patients who received ECT than among those who had not. With modern anesthesia, fractures and oxygen deprivation virtually never occur, and many patients with high blood pressure or heart conditions can safely be treated. Most patients surveyed after ECT said it was no worse than going to the dentist, and many found ECT less stressful.
Although it is necessary for the brain cells to interact with each other chemically and electrically for ECT to work, exactly how this integration is therapeutic needs further investigation. We believe that patients with melancholia have a severe biochemical disorder of the nervous system that ECT corrects. A number of rigorously designed research projects are under way to study this question.
What are the Main Side-Effects of ECT?
On awakening from ECT, it is customary for patients to experience some confusion, which generally clears within an hour. Memory for recent events, addresses, and telephone numbers may not be as good. In most patients, the memory disturbances goes away within a few days or weeks, but it can continue in a mild form for a period of months. Many patients will find that their memories are somewhat hazy for the time they were ill; the same period is frequently experienced by depressed patients who do not receive ECT. Memory disturbances are not needed for ECT to work and doctors use special techniques (such as brief pulse ECT) to minimize or avoid any side effects on memory.
Can ECT Cause Brain Damage?
The available evidence speaks against this possibility. Patients receiving ECT show no evidence of brain enzymes that are released into the bloodstream when normal brain damage occurs. Such as after a stroke. Animal studies have shown that oxygen administration is essential during ECT, as it is in surgery. Even after experimental seizures lasting for hours, with plentiful oxygen, there is no evidence of brain damage. This is why ECT is always given under oxygen and with muscle relaxants to aid oxygen delivery.
Does ECT Cause Permanent Memory Loss?
Not in most people. Most importantly, ECT does not interfere with the ability to learn, and many studies have shown better learning after ECT than before it, probably because of improved concentration from relief of depression. A few patients, however, still have not regained some specific personal memories when tested six months after receiving a form of treatment called bilateral ECT. Generally, these memories are for events in the months immediately preceding. No long term or persistent effects of ECT on intellectual abilities or memory problems in patients with psychiatric illness result more often from medication and incompletely treated illness.
Why Does ECT’s Public Image Suffer?
Just as with other medical treatments, ECT was used excessively in the past, mostly in large understaffed mental hospitals in the 1940’s. The drama of mental illness has also been exploited by fictional movies such as “The Snake Pit” that indicates stark and more exaggerated portrayals of ECT to emphasize a story. More recently, quasi-religious groups have received media attention for unsubstantiated claims that all medical approaches to psychiatric illnesses are undesirable.
This information is intended to provide the facts about ECT in order to further the understanding of its value.
For more information, please call the ECT Department at 716-886-8200 ext. 2219