ECT, Shock Therapy - How Electroconvulsive Therapy Works

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ECT, Shock Therapy
How it Works

An electric shock used to induce a controlled seizure intended as a treatment for chemical imbalances in the brain.

The brain is still not well understood, nor is the reason for the curative effects electroconvulsive therapy (ECT) on some individuals. ECT was overused in the past and since has come to have a mixed reputation. Great care is now taken to ensure that ECT is warranted before its use, and you must give your signed consent before its implementation.

How ECT is performed:

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The procedure will most likely be performed in the recovery room of a hospital, in the operating room itself, or possibly in your hospital room. An intravenous (IV) is inserted to provide anaesthetic medication. Your vital signs are taken initially and continuously throughout the procedure.

An anesthesiologist administers anesthesia and after you are asleep, places a tube in your throat to help you breath. A paralyzing agent called succinylcholine is then administered to prevent the seizure from spreading to your body. The electrodes are then applied to your head with conducting jelly and a brief shock (less than 2 seconds) is administered.

When you awaken, you will be mildly disoriented and will probably experience a brief memory loss, but this should pass.

How to prepare for ECT:

Because a general anesthesia will be administered, do not eat or drink after the midnight before the ECT. This helps to prevent aspiration of vomitus during the procedure. You will empty your bladder right before the procedure to prevent incontinence.

How ECT will feel:

If the procedure is to take place outside your room, you will be wheeled to that location in the gurney. The general anesthesia is then administered as you count backward from a 100. When you awake from the anesthesia, you may be confused and tired. Your vital signs will be monitored closely after the ECT to assure proper recovery. There may be complaints of headache, muscle pain, or back pain. Such discomfort is quickly relieved by mild medications such as aspirin.

Why ECT is performed:

The procedure is performed to improve the condition of the following disorders:

severe depression
acute mania
catatonia
occasionally with types of schizophrenia

The purpose of electroconvulsive therapy is to provide relief from the signs and symptoms of mental illnesses such as severe depression, mania, and schizophrenia. ECT is indicated when patients need rapid improvement because they are suicidal, self-injurious, refuse to eat or drink, cannot or will not take medication as prescribed, or present some other danger to themselves. Antidepressant medications, while effective in many cases, may take 2–6 weeks to produce a therapeutic effect. Antipsychotic medications used to treat mania and schizophrenia have many uncomfortable and sometimes dangerous side effects, limiting their use. In addition, some patients develop allergies and therefore are unable to take their medicine.

Risks associated with ECT

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Advanced medical technology has substantially reduced the complications associated with ECT. These include slow heart beat (bradycardia), rapid heart beat (tachycardia), memory loss, and confusion. Persons at high risk for ECT include those with recent heart attack, uncontrolled blood pressure, brain tumors, and previous spinal injuries.

Normal Results

ECT often produces dramatic improvement in the signs and symptoms of major depression, especially in elderly individuals, sometimes during the first week of treatment. While it is estimated that 50% of these patients will experience a future return of symptoms, the prognosis for each episode of illness is good. Mania also often responds well to treatment. The picture is not as bright for schizophrenia, which is more difficult to treat and is characterized by frequent relapses.

A few patients are placed on maintenance ECT. This means they return to the hospital every 1–2 months, as needed, for an additional treatment. These individuals are thus able to keep their illness under control and lead a normal and productive life.

ECT, Shock Therapy How it Works