Electroconvulsive Therapy
The most common treatment of depression is with antidepressants and psychotherapy but there are other forms of treatment. One of them is ECT, (an abbreviation for electroconvulsive therapy) or commonly called ‘shock therapy’.
ECT is an effective, quick and safe treatment for some forms of depression, especially if severe and non-responsive to medication. ECT requires specific preliminary assessments and preparation.
What is involved in ECT?
During the administration of ECT, a number of medical professionals are involved. This usually includes a psychiatrist, anesthesiologist, and other supportive medical personnel in a strictly controlled environment with appropriate monitoring of heart rate and other vital signs.
There have been major improvements in ECT with the use of anaesthetics, muscle relaxants and good anaesthetic monitoring. Newer ECT machines are computer controlled and can deliver an effective treatment stimulus at lower energy than used to be needed in the past, thereby reducing adverse effects on memory.
The ability to measure the electroencephalogram (EEG) after each stimulus can allow checks to be more certain that each treatment is effective. The EEG can also indicate the need for dose adjustment over the course of treatment. Right unilateral treatment can be almost as effective as bilateral treatment but causes fewer memory problems and less confusion.
Anaesthesia
Patients undergoing ECT are given a general anaesthetic (GA). This includes a muscle relaxant.
Doctors then induce a convulsion via a weak electric shock over both temporal regions or over the right temporal region and the crown.
Because you are anaesthetized, only small contractions in the muscles are noticeable.
No collective explanation to the question about how ECT works has yet been found but there are many hypotheses about the mechanism involved.
It takes place in hospital
In most places you receive ECT treatment three times a week. The number of treatments required often ranges between six and twelve but sometimes it is necessary to give more ECT treatments. It varies depending on the individual and the protocols in place in individual hospitals.
ECT treatments always takes place in a hospital. In some cases, you would be admitted for the procedure and in others it may occur as an out-patient .
Compulsory Treatment
In rare cases, doctors may impose a compulsory treatment order to allow them to administer ECT treatment even without a patients consent. This is only considered an option in severe, life threatening cases, which cannot be treated in any other way.
In Australia, the decision to administer involuntary ECT is made by the Medical Review Tribunal. This consists of a Psychiatrist, a lawyer and a community representative. You and your doctor will be invited to discuss your views and your family will be encouraged to attend and give their opinions if you wish
Effective
ECT is the fastest working and most effective treatment of depression. Around 70 to 90% of depressed patients improve following ECT. The corresponding figures for patients who are treated with medicines range between 50 and 70%.
Approximately 50% of those who have improved after the ECT treatment unfortunately have a relapse within 6 months. If we use both ECT and preventive antidepressants, the frequency of relapses is reduced.
ECT is therefore not a curative treatment. It needs to be followed up with preventive treatment and monitoring.
Adverse effects
As with any effective treatment, ECT is not without adverse effects. Some people are troubled by the confusion immediately following the anaesthetic. Others may be transient muscle aches and pains from the muscle relaxant and there may be a period of some minutes or hours of confusion following a specific treatment.
Regarding possible long term effects and safety, most of the presently available evidence suggests that ECT does not cause permanent ‘brain damage’.
There may be persisting problems in relation to memory, especially for the period before treatment began and during treatment. This may be contributed to by the poor attention, concentration and memory seen with severe depression, as well as any direct effect of ECT. There are no data to suggest that ECT results in continuing problems with new memories from about a month or so after the end of treatment.
Please discuss safety concerns with your doctor. You should always balance potential benefits and potential adverse events for you.
ECT works for most but not all patients. The advantages and disadvantages of ECT for you will need to be discussed with you to see if the possible advantages outweigh the disadvantages for you.
There is a lot of misinformation about ECT on the web so make sure you get the correct information from your psychiatrist.
If you want more local information there is a book on ECT written for Australia called “Electroconvulsive Therapy: An Australasian Guide” available at VMPF (Victorian Medical Postgraduate Foundation).