Generic Patient Information on ECT

What is ECT? Electroconvulsive therapy (ECT) is a treatment for severe episodes of psychiatric disorders, especially major depression, mania, and some types of schizophrenia. It involves use of a brief, controlled electrical current to produce a seizure within the brain. This seizure activity is believed to bring about certain biochemical changes which may cause your symptoms to diminish or to even disappear. A series of ECT treatments, generally 6 to 12, given at a rate of 3 per week, is required to produce such a therapeutic effect; although sometimes a smaller or larger number may be necessary.

How is ECT administered? ECT is usually given three times a week, on Monday, Wednesday, and Friday mornings. It can be provided on either an inpatient or outpatient basis. You will not eat or drink after midnight the night before each treatment. Your ECT doctor will tell you what medications to take that morning. Before the treatment, a small needle is placed in a vein so that medications to put you to sleep and relax your muscles can later be given. The treatment itself is given in a special ECT Treatment Suite, where it is administered by a team of doctors and nurses with specialized training and experience. You will be brought into the Treatment Room and asked to lie down on a comfortable stretcher, after which blood pressure cuffs will be placed on your arm and ankle and a number of electrodes will be placed on your scalp, chest, and finger, so that brain waves (EEG), heart waves (ECG), and body oxygen levels can be monitored and so that the electrical stimulus can later be given after you are asleep. You will also be provided oxygen to breath by mask, and any pre-ECT medications, if indicated, will be given, followed by the anesthetic medication itself, which will put you to sleep.

Within a minute after the injection of the anesthetic medication, you will be asleep, and the medication to relax your muscles will be given. Within one to three minutes, your muscles will be relaxed. A controlled electrical stimulus, lasting a fraction of a second to eight seconds, will then be applied across the two stimulus electrodes, which will typically be placed either on both temples (bilateral ECT) or on the right temple and top of the head (unilateral ECT). As will be described later, unilateral ECT has less effect on memory than bilateral ECT. However, some reports suggest that it may not be as effective or rapid in all patients. The electrical stimulus triggers a seizure within the brain, which typically lasts around a minute. Because of the muscle relaxant drug given prior to the stimulation, very little body movement usually occurs.

Within a few minutes after the seizure, when you are breathing well on your own, you will be moved to a nearby room, where you will wake up within 5 to 10 minutes. Because of the anesthetic drug and the effects of having had the seizure, you will temporarily feel somewhat groggy. Usually within 20-30 minutes after leaving the treatment room, you will be brought back to your room (if you are an inpatient), or, if you are an outpatient, you will go to another area of the Treatment Suite, where you will wait till you are ready to leave the hospital (typically about an hour or more).

Is ECT effective? Although there have been many advances in the treatment of mental disorders in recent years, ECT remains the most effective, fastest and/or safest treatment for some individuals, particularly when alternative treatments, usually medications, are either not effective or not safe. Your doctor will discuss with you why ECT is being recommended in your case and what alternative treatments may be available. ECT is most effective in severe clinical depression (major depressive disorder), where it has a strong beneficial effect in 50-90% of patients, depending on the case. Still, there is no guarantee that ECT, or, for that matter, any treatment will be effective. In addition, while a series of ECT (or an alternative treatment) may bring an episode of illness to an end, it will not in itself prevent another episode from occurring weeks, months, or years later. Because of this situation, you and your doctor will need to consider additional treatment to follow any ECT that your receive. Such treatment generally consists of medication, psychotherapy, and/or additional ECT (given as an outpatient at a much less frequent rate and called “maintenance ECT”).

Is ECT safe? All treatments have risks and side effects, even no treatment at all. Prior to ECT you will undergo a medical, psychiatric, and laboratory evaluation to make sure that the treatments can be administered in the safest, most effective manner possible. Your medications may also be adjusted to minimize the risk and maximize the effectiveness of the treatments. For most patients, the side effects of ECT are relatively minor. The risk of death is very rare, about 1 per 10,000 patients for typical cases, but higher in those with some types of major pre-existing medical problems. Serious complications, which are also quite rare, include temporary or permanent heart abnormalities, reactions to the medication used at the times of the treatment, injuries to muscle, bones, or other parts of the body, and greatly prolonged seizures or seizures occurring after the treatment. More common side effects involve headache, muscle soreness, nausea, confusion, and memory difficulties. Headache, muscle soreness, and nausea are usually mild and can be prevented or at least diminished by medications.

Memory problems often build up over a course of ECT, but diminish as soon as the treatments have stopped. However, because of the harmful effects that mental disorders themselves often have on memory function, some patients successfully treated with ECT actually report an improvement in memory. When memory problems occur, they vary considerably from patient to patient, but are usually greater for larger numbers of treatments or when both sides of the head are stimulated (bilateral ECT). Because of the possibility of memory loss, it is recommended that important life decisions be postponed until any major negative effects of ECT on memory have worn off (usually within a week or two following completion of the treatment course).

ECT-related memory problems can be of two types: a difficulty remembering new information, and a loss of some memories from the past, particularly the recent past, e.g., during and just prior to receiving ECT. In this regard, the ability to learn and remember new information returns to one’s usual level over a period of days to weeks after ECT. The ability to remember material from the past, i.e. prior to ECT, likewise tends to return to normal over a similar time period, except that in this case, some memories from the recent past, mainly days to months prior to the treatments, may be delayed in recovery or even permanently lost. Some patients have reported longer gaps in memory. However, patient surveys have indicated that most patients receiving ECT are not greatly disturbed by memory effects and would have ECT again if it was felt to be indicated.

Other information on ECT: Please feel free to ask your doctors or nursing staff any questions you have about ECT. A variety of types of information are available concerning this type of treatment, including videotape material. You should understand that ECT is a treatment for which you (or your representative, if applicable) must consent on a voluntary basis, and that consent for future treatments can be withdrawn at your (or your representative’s) request at any time.

13 thoughts on “Generic Patient Information on ECT

    • thanks for asking carl. this is “the question” w ECT and an important one. although i have studied ECT at length, i again went into the research avail re: ECT to see if i could better answer for u and us. the truth is that it isn’t definitively answered. The body of information we have demonstrates that it most often does not cause permanent brain damage. When there is long term memory loss, it is considered atypical and it is not demonstrated yet at a cellular level.
      Furthermore, we have much that demonstrates neurogenesis from ECT therapy – the restoration of neuronal connections and brain healing.
      i could reference all the studies i went through but most of them are available to the curious information voyager online at PubMed.
      this is not, i understand what culture, popular belief and even personal account on comments on this blog and others have said. This is only to say that well designed studies on real people, real patients, tell us this much.

  1. I would never recommend ECT to anyone. I have seen the negative affects of treatment in too many friends without any significant benefits. I have sat with a friend while waiting for her treatment and its cold and impersonal and its an assembly line process without an personal privacy. Afterward she was a completely gorked out zombie. The nurses are either rude or sickenly sweet and condescending. I guess they think the patients are too messed up to notice this poor treatment. And even if they did and complained, who would believe them? One friend was mistakenly given the paralyzing agent before being put to sleep. He was unable to breathe, move, or in any way alert the medical personnel in the room of the situation-total Robin Cook horror story. When he confronted the doctor about it, the doctor was hardly concerned and never really apologized. (…) The friend I accompanied and other friends who have had ECT have had these treatments over a year ago and still have memory problems-a few weeks my eye! Every person I know that has undergone ECT has said they would NEVER do it again and that they DO NOT recommend it. Just my opinion.

  2. This was exactly what I was looking for. A step by step explanation. I want so badly to give this a shot. Medicines haven’t worked for me, and I am only getting worse.

    Hopefully one day I can participate in this.

    Thank you for the post. 🙂

  3. Pingback: Electroconvulsive Therapy

  4. IIf n 1980 David Burns wrote the book “Feeling Good, The new mood therapy”. I would be surprised if you have not read it.
    It sold millions of copies. It was very effective in helping me feel better. It starts out with the fact,
    as tested with patients, by dealing with cognitive distortions and changing from being inactive to active we can rapidly start to feel better. It shows this program is actualy more effective than medication. I can see where for some people that ECT or medication may be a good choice, but I think simply following what Dr. Burns suggests may also be a good starting point for a large number of people. If ECT or medication might be a good short term solution but I think what Dr. Burns recommends may be a life long solution and may also be a good place to start as well.
    Tom

    • Tom thank u for commenting.
      I haven’t read the mood. I have read the data/research though.
      Your comments r in many ways influenced by books like this perhaps. I don’t know. I haven’t read it.
      Keep on, friend Tom.

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