Electroconvulsive Therapy

(Therapy, Electroconvulsive; ECT)

Definition

Electroconvulsive therapy (ECT) sends an electronic current through the brain. This current causes brief seizure activity. This causes changes in brain chemistry. ECT can reduce symptoms associated several mental health conditions.

The Brain

Color coded brain
During ECT, an electronic current is delivered to the brain.
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

ECT is commonly used to treat:

  • Severe depression that does not respond to medication or that causes serious symptoms, like psychosis and suicidal thoughts
  • Schizophrenia
  • Severe mania that does not respond to medication

In some cases, ECT may also be used for other mental or neurological conditions.

Possible Complications    TOP

Your doctor will review potential problems like:

  • Cognitive impairment, such as problems with thinking and memory:
    • They usually go away after a couple of weeks
    • In some cases memory problems may last for several months
    • Occasionally thinking and memory problems will persist
  • Short-term changes in blood pressure and heart rate
  • Short-term abnormal heart rate
  • Headache
  • Nausea
  • Muscle aches or soreness

Rare complications include:

Factors that may increase the risk of complications include:

  • Having a history of heart problems, stroke, or high blood pressure
  • Pregnancy—this form of therapy may increase the risk of complications in the fetus
  • Not responding well to medication
  • Increased age

What to Expect    TOP

Prior to Procedure

Prior to the procedure, your doctor will:

  • Do a physical exam
  • Do a complete medical and psychological history
  • Ask you about any medications you are taking, including prescription and over-the-counter medications
  • Have tests done, which may include blood tests, an electrocardiogram (EKG) , and imaging of the brain
  • Have you meet with an anesthesiologist
  • Give you instructions about not eating or drinking before the procedure

You may feel confused after ECT. Arrange for someone to drive you home from the hospital. Also, arrange for someone to help you at home.

Anesthesia

General anesthesia will be used. You will be asleep during the treatment and will not feel any pain.

Description of Procedure    TOP

You will be connected to a machine that will monitor your vital signs and brain activity. Next, you will receive general anesthesia and a medication to keep your muscles relaxed during the procedure.

After you are asleep, you will receive oxygen through a mask on your face. A mouth guard may also be placed to protect your tongue and teeth from injury. Next, electrodes will be positioned on your head. These electrodes will be connected to a machine that will deliver an electric current to your brain. This will cause seizure activity. After the shock is given, the muscles that have not been affected by the medication will contract for a few seconds. Next, your body will twitch, which can last up to a minute.

Immediately After Procedure    TOP

You will be taken to a recovery room where your vital signs will be monitored. You will wake up in 10-15 minutes. You may feel confused. This confusion can last minutes, hours, or sometimes longer.

How Long Will It Take?    TOP

About 30 minutes, including time to recover after the procedure

How Much Will It Hurt?    TOP

You will not feel any pain during the procedure. After ECT, you may have a headache and muscle aches or soreness.

Post-procedure Care    TOP

At the Care Center

When you are fully awake, you will be given something to eat and drink. In most cases, you will be able to go home the day of the procedure.

At Home

You should arrange for help at home in case thinking and memory problems persist.

You will need to schedule an appointment for another ECT treatment. In most cases, you will need to have 2-3 treatments per week, for many weeks. You will need to take medication, such as antidepressants, and continue with therapy to prevent a relapse.

You may also need maintenance ECT to further prevent a relapse. Your doctor will help determine the right plan for you. This will depend on how you are progressing.

Call Your Doctor    TOP

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

  • Worsening of symptoms, including feelings of hopelessness or helplessness and thoughts of suicide—If you have thoughts of suicide, call your doctor or therapist right away.
  • Confusion and memory loss that lasts longer than expected
  • Headache, muscle aches, or soreness that lasts longer than expected
  • Any new symptoms or concerns

If you think you have an emergency, call for medical help right away.

RESOURCES:

Depression and Bipolar Support Alliance
http://www.dbsalliance.org
Mental Health America
http://www.nmha.org

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.ontario.cmha.ca
Canadian Psychiatric Association
http://www.cpa-apc.org

References:

Depression: How electroconvulsive therapy works. American Academy of Family Physicians Family Doctor website. Available at:
...(Click grey area to select URL)
Updated September 2012. Accessed May 6, 2016.
Electroconvulsive therapy. Mental Health America website. Available at:
...(Click grey area to select URL)
Accessed May 6, 2016.
Electroconvulsive therapy (ECT). El Camino Hospital website. Available at:
...(Click grey area to select URL)
Accessed May 6, 2016.
Electroconvulsive therapy (ECT) for depression. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated April 21, 2016. Accessed May 6, 2016.
Kellner CH, Greenberg RM, Murrough JW, et al. ECT in treatment-resistant depression. Am J Psychiatry. 2012;169(12):1238-1244.
5/13/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010;68(6):568-577.
Last reviewed June 2016 by Michael Woods, MD
Last Updated: 5/23/2014

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