What is Electroconvulsive Therapy?
Electroconvulsive Therapy or ECT is a form of medical therapy for people with severe mental illness who do not respond to counselling, medication, or other forms of treatment. The therapy involves sending carefully controlled electric impulses to the brain to stimulate a brief epileptic fit with the goal of relieving extreme depression, mania, or catatonia. The electric stimuli seem to provoke changes in brain chemistry which help alleviate the patient’s mental symptoms.
When ECT is administered, the patient is given a muscle relaxant and put to sleep with anaesthesia. Electrodes are placed on the head after which a finely channelled electric current is sent to stimulate the brain. These impulses trigger slight seizure-like movements in the sleeping patient. The session is painless and lasts only several minutes after which the patient awakes with no memory of the treatment or the events leading up to it. He may also wake up disoriented but this will last only for a while.
Improvements in patients are noticed usually after the first three sessions and major improvements are palpable after six. These improvements could manifest as better sleeping patterns, less lethargy, or better appetites.
Is Electroconvulsive Therapy Dangerous?
ECT today is a generally safe method as it involves no pain or bad shocks. There is a side effect though which involves memory impairment lasting about several weeks after the treatment. Although memory is usually resolved in the short-term, there are rare cases in which patients do lose personal and skill memories and have difficulty processing new information.
In cases of extreme depression, the benefits however may outweigh the risks of a memory disadvantage especially in patients whose need for some symptom alleviation are urgent. For instance, a mother with severe postnatal depression may require the symptom alleviation ECT may provide, when other therapies have failed to, in order to for her to adequately nurture her infant.
ECT has gotten a bad reputation because of the errors done during its early developmental phase. ECT’s stigma stemmed from misuse of equipment, inadequate information and staff training, and improper treatment administration. These errors had proved to be injurious to some patients who were administered with high electric charges without anaesthesia causing memory loss, fractured bones, and other serious injuries. Electroconvulsive therapy has evolved to today’s relatively safe administration of finely controlled charges, anaesthesia, and strict supervision.
Who are Candidates for ECT?
Patients who merit a prescription for electroconvulsive therapy may be:
- suicidal because of severe depressive symptoms. About 80% of these cases report a mood improvement with ECT.
- unresponsive to drugs or talking therapies
- in a severe manic episode lasting for a long period of time
- catatonic
- those that have a history of responding well to ECT therapy in the past
- aggressive or extremely agitated because of dementia
- pregnant and cannot take medications
- intolerant of the side effects of drugs
- mothers with severe postnatal depression. As electroconvulsive therapy works more quickly than counselling or medication, it helps cut down the time that the mother spends away from infant nurture.
- nutritionally compromised because patient refuses food or sustenance owing to extreme depression
- severely psychotic or schizophrenic
Is ECT Effective?
There is a huge body of evidence now that ECT is an invaluable treatment tool for those with acute depression and psychosis. Although electroconvulsive therapy can go a long way in treating patients, this must be followed up with talking therapies and medication to avert recurrence of extreme symptoms.
Types of Electroconvulsive Therapies
There are two types of ECT administration which is differentiated by the location of electrode placement:
- Right Unilateral Treatment
Right unilateral treatment involves the placement of one electrode at the crown of the head and the other, at the right temple. The placement produces milder stimuli and therefore has lower risks of side effects concerning memory. The patient response rate, however, is also slower compared to bilateral ECT, the other type of treatment. If patients do not respond to right unilateral treatment, they may be switched to the stronger bilateral one.
- Bilateral Treatment
Bilateral treatment is a full-on type that requires electrodes to be placed on both the left and right temples of the patient’s head. In this case, the electric stimuli are much stronger, but still controlled, and therefore more effective in resistant patients. Bilateral ECT however carries more risk of some memory loss.
The patient and doctor should work out which treatment type is best. This usually involves taking into consideration the patient’s medical and psychiatric history, severity of symptoms, and personal concerns as well.
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