ECT Electro Convulsive Therapy

The FDA was considering re-classifying electroshock therapy (ECT) from a high risk to a medium risk medical device; however, they decided to keep it in the high risk category. Electroconvulsive Therapy hence (ECT).

We seldom use ECT because of the many new medications that are very effective. Maybe 1 in a 1,000 times have I seen it used. Unfortunately, ECT shock therapy has had a stigma attached to it as being Barbaric; especially after Hollywood gets hold of it, and is therefore underutilized. ECT is the gold standard of antidepressant treatments. It is very effective, nearly 95% to 99 % of the time and usually painless. Some people do experience a mild headache that last a few hours. It is one of the few therapies reserved for treating severe depression or those who don’t respond to drugs or cannot tolerate the side effects.

Most people think that this is an extreme option, most likely, due to the stigma surrounding its use and the way that it was used in the movies; however, we don't perform ECT in the way that it was done in these movies. An anesthesiologist anesthetizes the patient in an operating room. The patient is asleep through the procedure. After the patient is asleep, he or she is given a muscle relaxant. The muscles don't contract.

How ECT shock treatment works isn't known. The most widely accepted theory is that ECT causes the release of large amounts of serotonin, norepinephrine, and dopamine in the brain and that is what improves the depressive symptoms. We think that the seizure activity causes this to happen. We know that the illness of depression is caused by a deficiency in these neurotransmitters. So, it goes to reason that with increasing their levels, the depressive symptoms resolve, just like what the antidepressants do in increasing their levels in the brain.

The procedure lasts only 40 seconds and involves the delivery of a small amount of electric current to the head, which causes a lowering of the seizure threshold and induction of seizure activity in the brain. Stimulation of one side of the brain with the electrodes is called unilateral electrode placement; and when electrodes are placed on both sides of the brain, it is called bilateral electrode placement. The different placement is for different illnesses and severity of illness. A psychiatrist who has received specialized training in doing this procedure will induce the seizure activity. The amount of electricity used has decreased since ECT was introduced in the 1930’s, which has helped reduce the side effects. At the same time, the patient will have electrodes placed for the ECG machine, so that, his or her heart function is observed at all times. This is to monitor for any rare events of the ECT inducing heart arrthymias.

The U.S. National Institutes of Health (NIH) acknowledges that ECT can be helpful for treating severe depression patients who don't respond to drugs or whose depression is accompanied by delusions or other psychotic symptoms. Severely depressed patients who are suicidal or pregnant also may be candidates for electroshock therapy. According to the NIH, usually six to 12 treatments are needed. These treatments are performed every other day for about two to three weeks. Alternating days help to reduce the amount of memory loss that people may have.