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Restrictions
The idea of ECT is frightening to many people, thanks in part to its depiction in the film "One Flew Over the Cuckoo's Nest." Some may not know that muscle relaxants and anesthesia make it a safe, practically painless procedure.
Some people who advocate legislative bans against ECT are former psychiatric patients who have undergone the procedure and believe they have been harmed by it and that the treatment is used to punish patients' misbehavior and make them more docile. This is untrue.
It is true that many years ago, when psychiatric knowledge was less advanced, ECT was used for a wide range of psychiatric problems, sometimes even to control troublesome patients. The procedure was frightening for patients because it was then administered without anesthesia or muscle relaxants, and the uncontrolled seizures sometimes broke bones.
Today, the American Psychiatric Association has very strict guidelines for ECT administration. This organization supports use of ECT only to treat severe, disabling mental disorders; never to control behavior.
Patient Rights
No psychiatrist simply "decides" to treat a patient with ECT. Before he or she can administer ECT, he or she must first obtain written consent from the patient or (in most states), if the patient is too ill to make decisions for him or herself, from a court appointed guardian (usually one of the patient's family members).
Under the APA's recommended "informed consent" protocol, permission to administer ECT comes after a careful review of the treatment. This review is not a simple recitation of dry, confusing facts; the psychiatrist explains in clear language what ECT involves, what other treatments might be available, and the benefits and risks these procedures may entail. The patient or family member is informed of when, where, and by whom the treatment will be administered and the number of treatments expected. Questions are encouraged. The person consenting to the procedure is kept informed of progress as the treatment continues, and may withdraw consent at any time.
Costs
The costs for any psychiatric treatment vary widely, depending on the state and the facility administering it. Usually, however, ECT costs between $300 and $800 per treatment, an amount which covers the psychiatrist, anesthetist, and a variety of hospital charges. With eight as the average number of treatments, this means a course of ECT treatment will usually cost between $2,400 and $6,400. The cost of ECT is at least partially reimbursed by most insurance plans offering coverage for mental disorders. In cases where the use of ECT shortens the duration of a hospital stay, its net cost may be substantially less.
Bibliography
1. Weiner RD, Coffey CE: Indications for use of electroconvulsive therapy, in Review of Psychiatry, Vol 7. Edited by Frances AJ, Hales RE. Washington, DC: American Psychiatric Press Inc., pp 45881, 1988
2. Sackheim, HA, Prudic J, Devanand DP: Treatment of medication resistant depression with electroconvulsive therapy, in Review of Psychiatry, Vol. 9. Edited by Tasman A, Goldfinger SM, Kaufman CA, Washington, DC: American Psychiatric Press, Inc., pp 91115, 1990
3. Small JG, Klapper MH, Kellams JJ, Miller MJ, Milstein V, Sharpley PH, Small IF: Electroconvulsive treatment compared with lithium in the management of manic states. Arch Gen Psychiatry 45:72732, 1988
4. Weiner RD, Coffey CE: Electroconvulsive therapy in the medical and neurological patient, in Psychiatric Care of the Medical Patient. Edited by Stoudemire A, Fogel B. New York: Oxford University Press, pp 207224, 1993
5. Weiner RD: Does ECT cause brain damage? Brain Behav Sci 7:153, 1984
6. Meldrum BS: Neuropathological consequences of chemically and electrically induced seizures. Ann NY Acad Sci 462:18693, 1986
7. Coffey CE, Weiner RD, Djang WT, Figiel GS, Soady SAR, Patterson LJ, Holt PD, Spritzer CE, Wilkinson WE: Brain anatomic effects of ECT: A prospective Magnetic resonance imaging study. Archives of General Psychiatry 115:10131021, 1991
8. American Psychiatric Association: The Practice of ECT: Recommendations for Treatment, Training, and Privileging. Washington, DC: American Psychiatric Press Inc., 1990
next: A Comparison of Some Retrograde and Anterograde Effects of Electroconvulsive Shock in Patients With Severe Depression
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