Electroconvulsive therapy (ECT) is a procedure, performed under general anesthesia, where, small electric currents are passed through your brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. This procedure is often performed when all other treatments have failed towards curing a mental condition. Over the past many years, the procedure has become safer and less traumatic, as the electric current is passed in controlled settings with minimum risks.
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:
- 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.
- 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.
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.
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What are the risks associated with ECT?
ECT is usually considered safe, but some of the common risks associated with the procedure are:
- 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.
- 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.
- 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.
How to prepare for ECT?
Your doctor would evaluate you fully if you are undergoing this procedure for the first time. Your full evaluation includes:
- Medical history
- Psychiatric evaluation
- Physical examination
- Blood tests
- Electrocardiogram (ECG)
- Discussion of anesthesia and the risks associated with it
ECT- The Procedure
The ECT procedure in itself would take approximately 5-10 minutes. To this, you can add some time for preparation and recovery. This procedure can be performed either when you are hospitalized or as an out-patient procedure.
Before the procedure
To get ready for the ECT, you would have to go through the following;
- General anesthesia: Your doctor may provide you a list of foods you can and cannot eat a few days before the procedure. They would also advise you to avoid any food or water after midnight on the procedure day.
- Physical Examination: You would also undergo a brief physical examination to assess your vital organs’ health, especially the heart and lungs.
- An intravenous line (IV): An intravenous tube would be inserted into your arm to administer drugs and fluids.
- Electrode pads on the head: Electrode pads would be placed on the head to pass the electric current.
- Medications and anesthesia
You would receive the anesthetic and a muscle relaxant through the IV line to make you unconscious and minimize seizure and injury, respectively. Additionally, you may receive other medications depending on your health condition.
During the procedure
- A blood pressure cuff would be placed around one ankle to prevent the muscle relaxant from reaching that foot. Your doctor would monitor seizure activity from that foot and assess the electric current dose that would be administered.
- Your vitals, such as brain activity, heart, blood pressure, and lungs, would be closely and continuously monitored.
- You would be provided oxygen through the oxygen mask.
- You would also be provided a mouth guard to protect the tongue and teeth from injury.
- Seizure induction
Once under anesthesia, your doctor would allow a small electric current to pass through the electrodes to your brain that would cause a seizure lasting approximately sixty seconds. Owing to the anesthetic and the muscle relaxant, you may not even realize the oncoming seizure except for the one foot, which is monitored. An electroencephalogram (EEG) would record your brain activity. The brain activity would sharply increase upon induction with the electric current and would die down, showing that the seizure is over.
After a few minutes, the anesthetic and the muscle relaxant wears off, and you will be taken to a recovery room, where you will be continuously monitored until complete recovery is attained.
As you wake up, you may experience a brief moment of confusion that vanishes with time.
ECT can be given two to three times weekly for three to four weeks. The number of ECT procedures that need to be performed primarily depends on the severity of the condition.
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 (FAQs)
How does ECT work?
While it is not clear how ECT works, some reports suggest that ECT floods the brain with neurotransmitters such as serotonin and dopamine, helping the brain recover from mental health conditions such as depression and schizophrenia.
How do I go home after the ECT procedure?
Your family would be asked to take you home and assist you with daily activities till the confusion and haziness disappears.
How long does it take to recover from an ECT procedure?
The procedure itself takes approximately five to ten minutes, and you would immediately wake up after the anesthesia wears off. However, since you are administered anesthesia, a lot of time is spent preparing you for the procedure and the recovery. You may feel groggy and hazy initially after regaining consciousness, but you can resume normal activities after a couple of hours.