Electroconvulsive Therapy (ECT)

What is electroconvulsive therapy (ECT)?

Electroconvulsive therapy is a medical procedure in which a mild electric current induces a brief seizure in the brain. The procedure is painless as it is performed under anaesthesia and is a viable option for those unresponsive to conventional therapies.
Read on to learn more about what electroconvulsive therapy (ECT) is, what ECT is used for, and what conditions are treated with ECT. The blog discusses what the advantages of ECT are and how electroconvulsive therapy works.

Is ECT painful? Is ECT safe?

No, ECT is not a painful procedure, as a patient is treated under general anaesthesia. Modern advancements have made ECTs safe, as the procedures can adjust patients’ requirements according to the circumstances. However, patients might experience headaches and nausea after the procedure, which can be easily managed with the guidance of a healthcare provider.

Does ECT cause brain damage or memory loss?

Research shows that ECT rarely causes side effects like brain damage or memory loss. Temporary memory loss may occur, but it usually resolves within a few months.

Why is ECT Used?

ECT is used when other treatments or medical interventions are insufficient or too slow for the patient to recover quickly. This usually happens when:

1. Medication fails to improve symptoms despite adequate trials.

2. In emergencies where an individual poses a threat to themselves and others.

Certain mental health issues like depression, acute suicidal thoughts, bipolar disorder, and so on are also treated by this method.

How does electroconvulsive therapy work?

• Pre-Treatment Procedure
  Healthcare providers explain the procedure before starting the therapy to ensure there are no health conditions that contraindicate. Blood tests, urine samples, metabolic and thyroid panels, and imaging tests like CT scans and X-rays are conducted to learn about the patient's health. Some professionals might also conduct an electrocardiogram (ECG) to detect issues with the heart.
• Electroconvulsive Therapy Procedure
  Anaesthesia and Muscle Relaxants: The ECT procedure starts with general anaesthesia to ensure a painless procedure. Doctors often prescribe muscle relaxants to prevent injury in case the patient jerks during the seizure. A bite guard is inserted to protect the teeth and an IV is used for administering anaesthesia and promptly managing side effects.
• Electrode Placement
  Electrodes are placed on either side of the head so that they suit the patient’s needs and minimise any prospective side effects of the treatment. The 3 possible placements are:
• Right Unilateral (Both electrodes are placed on the right side, one near the temple and another above the ear.) Bifrontal (Electrodes are placed on either side of the forehead.) Bitemporal (Electrodes are placed at the temples on either side of the head.) Electrodes are covered with a conductive gel that reduces any chances of skin irritation. Even though the current is low, the chances of irritation persist.
• Electricity Requirements
  ECT uses a small electric current, up to 0.4 amps, comparable to a 9-volt battery that delivers 0.6 amps for an hour. Health providers begin the procedure with low current levels, adjusting it as needed for effectiveness. The simulation lasts only a few seconds in each session.
• Induced Seizures
  ECT induces a brief seizure that triggers rapid electric activity in the brain. The aim is to cause chemical changes in the brain for improved functioning. These seizures last 30 seconds to 90 seconds and are stopped with injectable medications if needed.
• Post-Treatment Care
  Once the seizures stop, healthcare providers monitor the vitals as and when the patient wakes up from the anaesthesia. The aim is to keep a tab on any side effects or anaesthesia-related issues. Most people regain consciousness within 10-15 minutes and are on their feet within 30 minutes.

What Conditions Are Treated with ECT?

• ECT can treat severe depression, particularly when a patient is going through psychosis and is feeling suicidal.
• Electroconvulsive therapy has proven to be effective in treating drug-resistant depression and other psychological disorders, mania, or aggression.
• Electroconvulsive therapy is effective for patients suffering from catatonia featuring strange or no movements, slurred speech, or complete immobility.

What are the advantages of ECT?

• ECT has proven to be extremely effective for mood disorders. It is best suited for treating treatment-resistant depression in which patients do not respond to medication.
• Modern anaesthesia and advanced post-procedure care ensure ECT is safe. Under expert supervision, this procedure is also safe for heart patients.
• Electroconvulsive therapy can be administered to pregnant women as well since they cannot take medication for any disease or disorder.
• Patients feel better after three to five sittings, making it vital for severe conditions. Those who cannot take medication owing to other health conditions can opt for electroconvulsive therapy, as it does not interfere with other conditions.
• Relapse risk is greatly reduced as it is easily accessible. With advancements in technology, memory-related side effects have also lowered in number.
• The protocols associated with ECT can be customised according to a patient's needs. The intensity of the current, electrode placement and frequency of sessions are decided as per a patient’s demands.

Does ECT work?

Yes. ECT works on symptom improvement and is more effective than antidepressants. The therapy triggers brain chemistry, which changes during and after the seizures, reducing symptoms of mental illness.
However, electroconvulsive therapy works best when completed as a full course of several treatments. Relapse prevention treatment must be followed, which includes taking milder antidepressants and psychotherapy.