What is Electroconvulsive Therapy?
Electroconvulsive Therapy (ECT) is a physical treatment used for a range of mental illnesses. ECT was introduced in 1938 and has since undergone dramatic changes so that modern ECT no longer resembles the early treatment often portrayed in the media. Historically, ECT was given without anaesthesia and for conditions that would not be suitable for ECT treatment today. Modern ECT treatment involves stimulating the brain, using a carefully controlled current to induce a seizure while the patient is unconscious, under a short acting general anaesthetic and muscle relaxant.
When is ECT used?
ECT has been shown to be the most effective antidepressant treatment available for severe depression. Both the likelihood of recovery from depression, and the speed of improvement in depressive symptoms are higher following ECT than antidepressant medications.
ECT is often prescribed as a treatment for depression when other treatments (antidepressant medication and psychological therapy) have failed to produce an improvement in symptoms, when patients have experienced serious side effects from medications, or are unable to safely take particular medications due to a medical condition. Due to the fast acting antidepressant effects of ECT it may also be prescribed when the risk of suicide is high or when a patient is too unwell to eat, drink or take medications. ECT is also used in the treatment of acute mania, catatonia and schizophrenia.In my experience I was medicated but was still nearly catatonic and severely suicidal. ECT was the last resort in my treatment, even my husband was giving up hope that we would find a treatment to pull me out of my depression before I had a successful suicide attempt.
What are the side effects of ECT?
ECT is generally a very safe treatment. Before commencing a course of ECT, patients will undergo a thorough psychiatric evaluation and general health screening process. This may include having blood tests, a chest X ray and an electrocardiogram (ECG). Overall the medical complication rate with ECT is very low and is comparable to other minor medical procedures involving anaesthesia (1:200, 000 mortality rate). A brief period of confusion following ECT is relatively common. Some people may experience a headache or nausea and these side effects can be treated with medication if necessary. Muscle soreness or aching can also occur after ECT as a result of the medications given to relax muscles during ECT. These effects are transient, usually lasting only a few hours after the ECT.I was very confused after each treatment, more so than most people. But within 4-6 hours I was usually pretty good. The headache would stay around for about 24hours for me. I didn’t suffer nausea very often. I described how I felt for the first 24hours as being as if I had been hit by a truck but really I was just sore all over, with a major headache and fuzzy thinking.
ECT can cause temporary memory loss. Specifically, some patients experience difficulties laying down new memories during the course of ECT and may be unable to remember events which occurred during this period. Evidence from research (Semkovska and McLoughlin, 2010) suggests that if memory and thinking are affected by ECT, the period of memory problems is relatively brief and test scores have usually returned to pre-ECT levels one month after treatment.Sometimes occasional memories from the past may be forgotten. It is also important to note that many patients suffering from depression already have problems with attention, concentration, thinking and memory prior to commencing ECT. It is not uncommon for patients to report that their memory is better following ECT. I had temporary memory loss of the time just before each treatment and also longer term memory loss. It is hard to say whether the memory loss was due to the depression or the ECT. But I have lost large patches of my life and this is the most distressing part of my mental illness. If it was from the ECT though it was still worth it, you have to be alive to appreciate memories and I wouldn’t be alive if I hadn’t had ECT.
The safety of ECT has also been examined with detailed brain scans done before and after ECT. There is no evidence that ECT causes brain damage.
How is ECT done?
ECT is usually performed in an operating suite, so that there is easy access to specialist anaesthetic services. The anaesthetist and ECT nurses will connect monitoring equipment to check a patient’s heart rate, blood pressure, oxygen levels, and brain waves. The anaesthetist will then insert a small needle into a vein in the hand, to provide anaesthetic. While going off to sleep, the anaesthetist will also provide oxygen to breathe.
Once fully asleep and relaxed, a doctor will give the ECT stimulus (which usually lasts about five seconds). This will induce a seizure that lasts about a minute, with minimal muscle movement. After this, patients gradually regain consciousness and are taken to the recovery area where a nurse will monitor heart rate, blood pressure, etc. until the patient is fully awake. The whole process takes around half an hour, and the patient may feel groggy for a while due to the seizure and the anaesthetic.My ECT was done in a small private hospital. I would wake in the morning and be told how long until I was ‘up’. I didn’t eat or drink anything from memory before each treatment. I would then be taken down to the operating suite where I would lay down on the operating table. They would put all sorts of things on me – electro pads of course, plus heart rate monitors, putting a needle in my hand for the anaesthetic etc etc. It felt like I was a lab rat. Then the anaesthetist would tell me to count back from 10 and I’d go off to sleep. I love the feeling of going off to sleep and in my depression I just wished they’d let me stay that way. I would then wake up in the recovery room and when I was ready would be asked to eat and drink something before I could go back to my room in the hospital and sleep most of the day. Which was a miraculous thing for me because I was suffering severe insomnia as part of my depression. By the next morning I would be feeling much better physically and mentally as a combination of recovering from the treatment, getting the benefits of the treatment and having had some quality sleep the day before.
Giving consent to ECT
As with any other significant medical procedure, before the ECT can be done, patients will be asked to give consent or permission for it to go ahead. Consent needs to be ‘informed’ – that is, the reasons for doing it, and the possible risks and benefits should be explained fully in a way that is understood. Patients have the right to ask questions regarding the procedure, and to discuss their views with their psychiatrist. After this is done, patients are asked to sign a consent form that states that ECT has been explained to them, that they understand what is going to happen, and that they consent to it. Patients can, however, withdraw their consent at any point if they wish – even before the first treatment.
There may be cases sometimes where people are too unwell to make a decision about having ECT. For example, they may be so severely withdrawn or have ideas about themselves that stop them taking on board all the issues surrounding ECT (e.g. they may wrongly believe that their depression is a punishment they deserve for something they have done). If this happens, it may be impossible for them to give informed consent. In this case, ECT can still be given under the Mental Health Act – this is a strictly controlled process regulated by law, with input from independent clinical and legal experts, and takes into account the view of the patient and their family.I gave consent for my treatment, but really I just did what my husband suggested I should do. I wasn’t in a fit state to make major decisions but I trusted my husband. From memory it was twelve treatments in a row, every second day for 24 days. If I felt significant improvement before I got to 12 treatments I was allowed to say no to having more – which I did once. But when I did that I relapsed fairly quickly afterwards, so it would be my advice to finish the full treatment.