Electroconvulsive therapy (ECT) today doesn’t resemble Dr. Frankenstein’s attempts to quicken his monster or Nurse Ratched’s Shock Shop. ECT is a legitimate treatment for several categories of psychiatric illnesses like major depressive disorder, schizophrenia and bipolar disorder. While there are many pharmaceutical treatments available for bipolar disorder, up to one-third of patients find themselves still struggling with symptoms. For those with treatment-resistant bipolar disorder, electroconvulsive therapy provides an effective alternative to pharmacotherapy.
The use of ECT as a treatment for mental illness began in 1938. At that time it was one of very few options for psychiatric illnesses. During the early periods of use, patients were fully conscious and experienced a significant shock. The shock produced convulsions that, at times, were intense enough to cause broken bones. Despite the effectiveness of the treatment, this brutality is what ultimately gave ECT its controversial reputation. With lithium becoming a popular treatment for bipolar disorder in the 1970’s, ECT fell out of favor.
Since then the practice has been changed to become safer and more effective. Here’s what electroconvulsive therapy looks like now:
Before the appointment:
Like the medications used to treat bipolar disorder, ECT is a serious endeavor. Patients work with their psychiatrists, therapists and medical doctors to establish whether or not they are considered a good candidate for the treatment. It is generally only sought after pharmacotherapy has failed to induce remission.
Potential patients are given physical and psychological examinations to determine whether they are fit for treatment and able to undergo anesthesia. Other tests may include blood tests, an echocardiogram (EKG), stress test, x-rays or an MRI and a dental exam to ensure the body will not be negatively impacted. Patients are psychologically evaluated for factors like general cognition and memory.
Before treatment begins, as well as over the course of treatment, patients are given detailed information on the procedure so they can give informed consent to move forward.
During the appointment:
Vital signs are monitored during the entire procedure and oxygen is provided. Anesthesia is administered to relax muscles and sedate the patient to reduce awareness. Anticholinergics and neuromuscular blockers are administered to maintain normal heart rate and decrease the likelihood of bone fractures. A mouth guard will also be put in place to protect the teeth and tongue.
The electrodes will be placed on the patient’s temples, forehead, the top of the head or a combination of the three, depending on which placement is deemed best by the treatment team.
The strength of the shock itself is either determined by the patient’s age or the lowest strength needed to induce a tonic-clonic seizure. Seizures typically last between 15-45 seconds. Once the seizure has ceased, the patient can be taken to recovery.
After the appointment:
ECT is typically administered two to three times a week for a total of 6-12 sessions. The frequency and length of the treatment period is determined by the patient’s psychiatrist, depending on the level of symptom improvement and the intensity of the side effects.
Physical risks of the procedure are similar to those of any outpatient procedure performed under anesthesia. Mortality rates are between 1 in 10,000 and 1 in 80,000. Patients may also experience headaches, body aches and nausea.
Psychologically, patients often experience disorientation, cognitive deficit and memory problems. The memory problems are usually centered around the time of treatment, but can be severe, with some patients losing months or years worth of memories.
Electroconvulsive therapy is effective for around 70% of bipolar disorder patients and has a rapid response rate, which is not always the case for pharmacotherapy. However, relapse rate is high so treatment will likely need to be repeated.
In addition to being effective for treatment-resistant patients, ECT is also considered safe for pregnant women and elderly patients. So, it has benefits for those who need treatment but may be unable or unwilling to add pharmacotherapy.
If electroconvulsive therapy seems to be a good fit, patients should speak with their psychiatrists, therapists and medical doctors extensively before beginning treatment.
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