Electroconvulsive Therapy

Electroconvulsive therapy (ECT) has been a treatment since the late 1930s. It was available years before there were antidepressant medications, mood stabilizers, or antipsychotic medications. ECT came to be looked upon with some suspicion because it was over-used or sometimes inappropriately used. This happened because it was the only treatment available at the time, and there was less emphasis on informed consent (the process by which medical procedures are fully explained to patients, along with all the possible risks and benefits, before permission to perform the procedure is sought). Today, ECT has been revolutionized by the advancement in anesthetic and muscle relaxant medications, better knowledge about disorders in which it can be useful, and the standard of informed consent. Unfortunately, a small fraction of patients do not respond to medications. ECT can be very beneficial for them. It is a safe and effective treatment for major depression, especially with psychotic features. It can also be used to treat mania.

ECT is typically performed in the hospital. Vital signs like blood pressure, pulse, oxygenation, and electrocardiogram (EKG) are carefully monitored. The patient is given an anesthetic medication to induce sleep, followed by a medication to relax the muscles. Anesthesiologists ensure adequate oxygenation. A small amount of electricity is administered to the scalp to stimulate areas of the brain. The electrical stimulation causes a seizure, but jerking movements of the muscles are prevented by the muscle relaxants. Patients are typically treated three times a week until their symptoms improve and resolve, usually around 6 to 12 treatments. Some short-term side effects include headache, muscle soreness, and problems with memory. Patients with hypertension, heart disease, and some other medical conditions may require additional medications and monitoring during the treatment. Some patients choose to continue less frequent, outpatient ECT treatments to maintain their response and to keep their illnesses from returning.