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Electroconvulsive Therapy
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Electroconvulsive Therapy

(Therapy, Electroconvulsive; ECT)

En Español (Spanish Version)

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 with severe depression and other mental health conditions.

The Brain

Color coded brain

During ECT, an electronic current is delivered to the brain.

© 2011 Nucleus Medical Media, Inc.

Reasons for Procedure

ECT is commonly used to treat:

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

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

Possible Complications

Common complications include:

  • Short-term changes in blood pressure and heart rate
  • Short-term abnormal heart rate
  • Headache
  • Nausea
  • Muscle aches or soreness
  • Cognitive impairment (eg, problems with thinking and memory)—These usually go away after a couple of weeks. In some cases, memory problems may last for several months.

Rare complications may also occur, such as:

Factors that may increase the risk of complications include:

  • Having a history of heart problems, stroke, or high blood pressure
  • Being pregnant—While ECT is used in pregnant women with severe depression, this form of therapy may increase the risk of complications in the fetus.
  • Not responding well to medicine or being elderly—These factors may increase the chance of relapse.

Discuss these risks with your doctor before the procedure.

What to Expect

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 medicines (prescription and over-the-counter products) you are taking
  • Have tests done, which may include blood tests and an electrocardiogram
  • Have you meet with an anesthesiologist
  • Give you instructions about not eating or drinking before the procedure

Since 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

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

Once 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, the doctor will position electrodes 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. Once the shock is given, the muscles that have not been affected by the medicine will contract for a few seconds. Next, your body will twitch, which can last up to a minute.

Immediately After Procedure

You will be taken to a recovery room where the nurses will monitor your vital signs. 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?

About 30 minutes (plus time to recover after the procedure)

How Much Will It Hurt?

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

Post-procedure Care

At the Care Center

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

At Home

You will need to schedule an appointment for another ECT treatment. In most cases, you will need to have three treatments per week for one month. You will need to take medicine (eg, 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.

Follow any instructions your doctor gives you.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

  • Worsening of symptoms (eg, feelings of hopelessness or helplessness, 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

In case of an emergency, CALL 911.

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: treatment with electroconvulsive therapy. Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/common/mentalhealth/treatment/058.html. Updated May 2010. Accessed December 27, 2010.

Electroconvulsive therapy. Mental Health America website. Available at: http://www.nmha.org/go/information/get-info/treatment/electroconvulsive-therapy-ect. Accessed December 27, 2010.

Electroconvulsive therapy. UMASS Memorial Medical Center website. Available at: http://www.umassmemorial.org/MedicalCenterIP.cfm?id=4506. Accessed December 27, 2010.

Electroconvulsive therapy (ECT). El Camino Hospital website. Available at: http://www.elcaminohospital.org/Programs_and_Services/Behavioral_Health/Electroconvulsive_Therapy. Accessed December 27, 2010.

Electroconvulsive therapy (ECT). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129. Updated July 9, 2010. Accessed December 27, 2010.

Electroconvulsive therapy (ECT) for depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 5, 2010. Accessed December 27, 2010.

5/13/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 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 January 2011 by Theodor B. Rais, MD


Last updated Updated: 5/13/2011

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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