Electroconvulsive Therapy

Electroconvulsive therapy (ECT), sometimes referred to as “shock therapy” by the general public, is a treatment with a great deal of stigma attached to it because it was isn’t well understood. People have visions of One Flew Over the Cuckoo’s Nest in their heads, but modern-day ECT is nothing like the inhumane treatment portrayed in that movie.

ECT delivers electrical currents to the brain through electrodes placed on the head. The electricity causes a controlled seizure that makes changes in the brain. When the procedure was first developed, patients were awake, but that’s not the case today. ECT is done under general anesthesia and muscle relaxers are given to prevent the body from convulsing. People don’t feel any pain or experience discomfort during the procedure.

It is primarily used to treat severe depression that doesn’t respond to medication or psychotherapy, but is also used for bipolar disorder, schizophrenia and catatonia. People respond quicker to ECT than medication or therapy, so it’s a treatment that’s considered when a person is at high risk for suicide.

What to Expect
The procedure is performed by a specially trained team that includes a psychiatrist, anesthesiologist and nurse. When a patient arrives, they are hooked up to a heart monitor and the treatment team administers sedatives. Once the person is asleep, a controlled seizure, which usually lasts for one minute, is induced by electrical currents delivered through the electrodes on the scalp. Since patients are asleep and the muscles are relaxed, they do not feel any pain and they do not convulse during ECT. The actual procedure lasts for about 15 – 20 minutes and then about 30 minutes is spent in the recovery room.

Your doctor will determine whether unilateral or bilateral ECT is best. This refers to the placement of electrodes on the head.

• Unilateral – One electrode is placed on the right temple and the other is placed on the crown of the head. Patients may need a few more sessions than those receiving bilateral ECT to achieve the best results. The benefit of unilateral ECT is it’s associated with fewer memory problems than bilateral because electrodes are not placed on the side of the head that controls learning and memory. Doctors may try this first and switch to bilateral if there isn’t significant improvement.
• Bilateral – Electrodes are placed on both the left and right temple; this is considered the traditional form of ECT. Doctors use bilateral ECT in patients with severe symptoms including psychosis, extreme mania and those at a high risk for suicide.

People usually go two to three times a week for six to twelve sessions; the length of treatment varies for each person. Significant improvement is typically seen after four to six sessions. In fact, research has shown 70% to 90% of patients experience significant reduction in depression symptoms. Although ECT is effective, it doesn’t cure the mental illness. Medication and psychotherapy are typically continued and some people undergo maintenance ECT sessions to prevent relapses.

Is it Safe?
ECT is considered a safe procedure, but like anything, there are potential side effects. Immediately following the procedure, people may experience headaches, nausea, confusion, fatigue and sore muscles. Some people do experience memory loss that lasts for weeks or months. If this happens, people often have trouble remembering things that occurred right before or right after the ECT procedure. Typically, memory problems occur more frequently with bilateral ECT than unilateral and improve over time.

Resources
American Psychiatric Association
National Institute of Mental Health