Electroconvulsive therapy (ECT)
The most common forms of treatment for depression are antidepressants and psychotherapy. But there are other forms of treatment too, which you can read about here:
- Electroconvulsive therapy (ECT)
ECT:
ECT is often associated with frightening movies about psychiatric care. Today it is occasionally used for very severe cases of depression and sometimes when medication is not effective. Its effects are rapid and it is done with a general anaesthetic and a muscle relaxant in the presence of two doctors and a nursing staff.
If you undergo ECT treatment:
- First you are assessed by a psychiatrist and an anaesthetist
- You are given a general anaesthetic.
- Next you are given an injection to relax your muscles.
Now a seizure is induced by passing a weak electric current between:
- Your temples or
- Your right temple and the top of your head
The seizure consists of rhythmic electrical activity in the nerve cells. As you are under anaesthesia and completely relaxed, only minor muscle spasms will be seen in your body.
After the treatment you will be required to rest briefly while the medical staff monitor your recovery.
A few hours later you will be up and about again, and you may already notice that your treatment has begun to help.
What is an EEG?
An EEG (electroencephalogram) is:
A way of measuring electrical activity in the brain
It is used mainly when investigating epilepsy but is also used during ECT treatment for depression.
We can use EEG to see whether a seizure of sufficiently high quality has been induced. The quality and strength of the seizure are the key to how well the treatment works.
Each treatment lasts between ten and fifteen minutes. The actual seizure will last for just 25-60 seconds.
How often do you have to have ECT?
Most places will treat you with ECT three times a week. The total number of treatments required is generally between six and twelve but some people need more treatments - it varies from person to person.
Where does it happen?
ECT treatment is always given at a hospital, often on a psychiatric ward or in operating theatre.
In most cases you will be admitted to hospital for 24 hours but you may be treated as an outpatient and go home the same day.
Who administers the treatment?
A doctor working on the psychiatric ward will administer the treatment. A doctor and nurse from the anaesthesia department will be responsible for the anaesthetic.
Who gets treated with ECT?
ECT treatment is often recommended if you're suffering from severe depression, which may be life-threatening.
Most people who have ECT are keen to have it again if they relapse because it is rapid and effective.
You will be offered ECT if you:
- Eat and drink so little that your situation is life-threatening
- Are feeling seriously suicidal
- Have psychotic symptoms
Treatment with ECT may save your life.
You may also be offered treatment with ECT if other forms of treatment, such as medications, are not successful.
Can someone be forced to have ECT?
In rare cases someone may be given ECT against their will. However, this will happen only if the person is suffering from severe depression with psychotic symptoms and:
- Is in a life-threatening condition due to his/her depression
- Cannot be treated in other ways
- Is unable to make a rational decision about his/her treatment
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How effective is ECT in the treatment of depression?
ECT is the fastest-acting and most effective form of treatment for depression. Studies of the effects of ECT show that:
- 70-90% of patients will recover from their current depressive episode
- The effects of ECT can be seen within one to two weeks.
How long do the effects last?
Unfortunately around 50% of those who get better after treatment with ECT suffer a relapse within six months.
However, if we combine ECT with antidepressant medication, we can reduce the frequency of relapses.
This means that ECT is not a cure - we must always follow it up with appropriate medication and/or psychotherapy.
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Is ECT dangerous - does it have side effects?
Some patients do suffer a loss of short-term memory following treatment. Some do not experience any difficulties at all while others find it difficult to remember small things for a couple of weeks. In rare cases this problem can persist for a few months.
Nobody suffers permanent memory loss or brain damage as a result of ECT.
Some patients may feel confused immediately following treatment. This confusion is temporary and will typically disappear within a few hours.
The only risks are the same for those as general anaesthetic.
How does ECT work?
There are many theories and research results that give us a certain understanding of the mechanisms of its action, but we have yet to find a simple explanation of how ECT works.
The key to its effect is that it triggers a convulsion in your nervous system. So we know that it is related to the actual convulsion that has the antidepressant effect.
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