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For a short period following ECT, I may also experience difficulty in remembering new information. This difficulty in forming new memories should be temporary and typically disappears within several weeks following the ECT course.
The majority of patients state that the benefits of ECT outweigh the problems with memory. Furthermore, most patients report that their memory is actually improved after ECT. Nonetheless, a minority of patients report problems in memory that remain for months or even years. The reasons for these reported long-lasting impairments are not fully understood. As with any medical treatment, people who receive ECT differ considerably in the extent to which they experience side effects.
Because of the possible problems with confusion and memory, I should not make any important personal or business decisions during, or immediately following, the ECT course. During and shortly after the ECT course, and until discussed with my doctor, I should refrain from driving, transacting business, or other activities for which memory difficulties may be troublesome.
The conduct of ECT at this facility is under the direction of Dr.
_________________________________
I may contact him/her at _______________ if I have further questions.
I am free to ask my doctor or members of the ECT treatment team questions about ECT at this time or at any time during or following, the ECT course. My decision to agree to ECT is being made voluntarily, and I may withdraw my consent for further treatment at any time.
I have been given a copy of this consent form to keep.
Date ------------------------------ Signature
_________ --- _________________________
Person Obtaining Consent:
Date ------------------------------ Signature
_________ --- _________________________
Electroconvulsive Therapy (ECT) Consent Form:
Continuation/Maintenance Treatment
Name of Patient: _________________________________
My doctor, ____________________________ has recommended that I receive continuation or maintenance treatment with electroconvulsive therapy (ECT). This treatment, including, the risks and benefits that I may experience, has been fully described to me. I give my consent to be treated with continuation ECT.
I will receive ECT to prevent relapse of my illness. Whether ECT or an alternative treatment, like medication or psychotherapy, is most appropriate for me at this time depends on my prior experience with these treatments in preventing, the return of symptoms, the features of my illness, and other considerations. Why continuation/maintenance ECT has been recommended for me has been explained.
Continuation/maintenance ECT involves a series of treatments with each usually separated in time by one or more weeks. Continuation /maintenance ECT is usually given for a period of several months or longer. These treatments may be given on an inpatient or outpatient basis.
To receive each continuation/maintenance treatment I will come to a specially equipped area in this facility. The treatments are usually given in the morning. Because the treatments involve general anesthesia, I will have had nothing to eat or drink for several hours before each treatment. Before the treatment, a small needle will be placed in my vein so that I can be given medications. An anesthetic medication will be injected that will quickly put me to sleep. I will then be given another medication that will relax my muscles. Because I will be asleep, I will not experience pain or discomfort or remember the procedure. Other medications may also be given depending on my needs.
To prepare for the treatment, monitoring sensors will be placed on my head and body. Blood pressure cuffs will be placed on an arm and leg. This monitoring involves no pain or discomfort. After I am asleep, a carefully controlled amount of electricity will be passed between two electrodes that have been placed on my head.
I may receive bilateral ECT or unilateral ECT. In bilateral ECT, one electrode is placed on the left side of the head, the other on the right side. In unilateral ECT, both electrodes are placed on the same side of the head, usually the right side. Right unilateral ECT (electrodes on the right side) is likely to produce less memory difficulty than bilateral ECT. However, for some patients bilateral ECT may be a more effective treatment. My doctor will carefully consider the choice of unilateral or bilateral ECT.
The electrical current produces a seizure in the brain. The amount of electricity used to produce the seizure will be adjusted to my individual needs, based on the judgment of the ECT physician. The medication used to relax my muscles will greatly soften the contractions in my body that would ordinarily accompany the seizure. I will be given oxygen to breathe. The seizure will last for approximately one minute. During, the procedure, my heart, blood pressure, and brain waves will be monitored. Within a few minutes, the anesthetic medications will wear off and I will awaken. I will then be observed until it is time to leave the ECT area.
The number of continuation/maintenance treatments that I will receive will depend on my clinical course. Continuation ECT is usually given for at least six months. If it is felt that continuation ECT is helpful and should be used for a longer period (maintenance ECT), I will be asked to consent to the procedure again.
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