Article About ECT

11/21/2013
Nina Allen

Ect – History, How, Pros And Cons

“Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.”

It is uncertain how ECT helps treat depression and other mental illnesses, but chemical aspects of brain function are changed during and after seizure activity.  These chemical changes somehow reduce the symptoms of severe depression and other mental illnesses.  This treatment works best for people who receive a full course or multiple treatments to help chemical changes in the brain build upon one another.  Currently it is estimated that 100,000 patients are undergoing ECT treatments yearly.

ECT has been used since 1940 and although ECT has become a safer procedure, there is still a strong stigma attached to the procedure.  This is due to early treatment which was performed without anesthesia and high doses of electricity were used as well early risks and side effects were caused by misuse of equipment and improperly trained staff.  This caused various side effects including fractures and amnesia.  Media also played a role by reporting that patients were painfully shocked into submission.  Today the procedure is more controlled with anesthesia and fewer risks and side effects.  Over the last ten years the average ECT patient has become middle class women over 65 versus what used to be the average of lower class males in their 40’s.  the rise in the population of elderly people and the use of Medicare has “pushed” patients to use ECT as a quick fix treatment.  This raises concerns about inappropriate and potentially dangerous treatment of older patients with heart and other medical problems, and whether or not ECT is being performed in proper informed patient consent.

ECT treatments, which normally take five to ten minutes and are administered in the morning before breakfast, can be performed as an outpatient procedure but can also be done while one is hospitalized due to issues with mental illnesses.  ECT is used as a treatment for a number of mental illnesses and is generally used when medication and therapy aren’t effective.  ECT can also be used when medication cannot be taken due to pregnancy, for elderly adults who experience serious side effects from medications, and in some cases people prefer this method over taking medication for their illness.  This form of therapy is used to treat severe depression and depression that is resistant to medications, psychosis, suicidal ideations, severe mania that includes psychosis and impulsive behaviors, catatonic states, schizophrenia, and dementia.

Of course, with any medical treatment there are always forms of side effects.  The days of administration, people may experience nausea, vomiting, migraines, muscle pain and spasms.  Because ECT can cause memory loss and confusion, some studies even suggest that the treatment should be used as a last resort only because of the permanent memory loss.  This can last for hours, or on rare occasions it can last for days, with the need for rest due to the inability to resume normal activities or recognize your surroundings.  Memory loss, or retrograde amnesia, can cause a person to lose the memories of the months before treatment and occasionally loss of years before treatment.  Although the memories usually improve months after treatment, the weeks of treatment and even events after treatment has stopped can still be troublesome to remember.  In rare cases, serious heart issues can develop due to the increase of blood pressure and heart rate during ECT treatment.

After receiving an IV, anesthesia, and muscle relaxers to avoid injury, electrode pads that are the size of a silver dollar are placed on your headTop of Form.  To avoid the muscle relaxers from reaching the feet which affect the muscles in the feet, a blood pressure cuff is placed around the ankles.  This is done so that the doctor can monitor seizure activity by observing movements of the feet.  One is often given a mouth guard to protect the teeth and tongue.  Once the anesthetic and muscle relaxers take effect, a seizure which lasts about one minute is induced by introducing a small amount of an electrical current that passes through the electrodes to the brain.  The ECT seizure therapy can be unilateral or bilateral (more on this later).  Unilateral treatment focuses electrical currents on one side of the brain while bilateral treatment delivers currents to both sides of the brain.

During the procedure, one is completely unaware of what is happening due to the anesthesia and muscle relaxers.  The activity in the brain increases drastically and an EEG, or electroencephalogram, records the brain activity.  Spikes in the EEG signal an oncoming seizure.  Not long after, the anesthesia and muscle relaxers wear off and the patient is taken to a recovery room.  The patient is monitored and the aforementioned confusion and memory loss begins to take place.

ECT treatments are generally administered up to three times a week for nearly a month at a time.  Depending on the illness and severity of issues, more treatments may be needed.  After the first few treatments, patients begin to notice a difference in symptoms and improvement.  Maintenance therapy is still needed after symptoms improve to prevent a relapse.  This can be coupled or treated solely with medication and psychotherapy.

Another form of ECT is trans cranial magnetic stimulation, or TMS.  TMS sends electric pulses through a device held to the prefrontal cortex area of the forehead which is connected to mood.  TMS uses a much smaller electric current by creating a magnetic field to target a specific area of the brain.  This treatment is done by using an electromagnetic coil that delivers the pulses through the forehead without inducing seizures or unconsciousness.  TMS also does not require any form of sedation and is an outpatient procedure.  There is also a device that works like a pacemaker called a vagus nerve stimulator or VNS.  “The NeuroCybernetic Prosthesis (NCP; Cyberonics, Webster, Tex), a vagal nerve stimulator, is composed of a pulse generator, a bipolar VNS lead, a programming wand with accompanying NCP software for an IBM-compatible computer, a tunneling tool, and handheld magnets. The lead is attached to the left vagus nerve (midcervical portion) and delivers a biphasic current that continuously cycles between on and off periods. The programmable NCP generator is placed on the patient's chest (upper left side).  Areas possibly activated by VNS include the medulla, cerebellum, parabrachial nucleus, locus ceruleus, hypothalamus, thalamus (including the intralaminar and ventroposterior parvocellular nuclei), amygdala, hippocampus, cingulate gyrus, and contralateral somatosensory cortex.” - http://emedicine.medscape.com/article/1186123-overview#aw2aab6b3

ECT can be rather effective, some studies cite an 80% improvement in severely depressed patients, but one must keep up with the treatments.  If a patient is to stop the treatments for an extended period of time and isn’t utilizing psychotherapy or medications, the patient may develop reoccurring symptoms and a relapse.  Yet, since ECT has a history of abuse and less than positive supportive medical, former patient and media reports; the debate of ECT’s usefulness is still heated.  It’s suggested that more research is needed, perfection of techniques, and lessoning of risks and side effects are necessary to continue this practice.  Ultimately, it is up to the patient to inform themselves and weigh the pros and cons of this practice as well as the different options of treatment.  I personally still find such a practice scary and even though I may have some rather unpleasant memories, I’d rather keep them because they made me who I am.

REFERENCES:

http://www.nmha.org/go/information/get-info/treatment/electroconvulsive-therapy-ect

http://emedicine.medscape.com/article/1186123-overview#aw2aab6b3

http://www.webmd.com/depression/guide/electroconvulsive-therapy

http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129