When depression is severe and medications aren’t helping, there is another option. Electroconvulsive therapy (ECT) is an effective treatment for people with debilitating mental health problems. ECT is considered the best treatment available for severe depression, offering lifesaving, long-term treatment.
ECT is a safe and effective treatment for major psychiatric disorders.
Treatments are done by a psychiatrist, anesthesiologist, and treatment nurse and must be performed in a hospital or day surgery center.
The ECT treatment itself is quick, with a low-impulse electric shock to the brain, inducing a seizure lasting 30–90 seconds.
Treatments are repetitive, usually starting at 3 times a week for 2 weeks, then tapering off, with ongoing maintenance if/when (either one) needed.
There is a shortage of treatment facilities nationwide, especially in rural areas, and travel is often an issue.
The history of electroconvulsive treatment
ECT treatment began in the mid-1930s and has been used since then to treat psychosis, severe depression, and debilitating anxiety. A shock wave is administered to certain areas in the brain and essentially “re-boots” the neurotransmitters, creating new thought pathways and relief for mental health challenges.
The idea for this treatment came about when a doctor noticed that a psychotic patient with epilepsy would have a change in mood and behavior after experiencing a seizure. In 1938, Italian neurologist, Ugo Cerletti, and his psychiatrist colleague, Lucino Bini, built the first ECT device. It delivered electrical impulses to the frontal lobe of the brain to cause a seizure. The treatment was a great success, alleviating the psychotic symptoms of their schizophrenic patient, and they were nominated for the Nobel Prize in Medicine. By the early 1940s, ECT treatment was used in every major city worldwide, effectively treating people with severe mental health disorders.
What conditions does ECT treat?
- Severe depression.
- Suicidal ideation.
- Bipolar disorder in the manic phase.
Patients with hard-to-treat psychiatric conditions that are unable to take or aren’t responding to psychiatric medicines are referred by their physician or psychiatrist to a neuropsychiatric treatment center. Psychiatrists specializing in ECT treatment evaluate the patient and ensure that a work-up, including a physical exam, EKG, chest x-ray, and blood work, is completed before treatment.
ECT is a safe and lifesaving treatment for people with debilitating psychiatric symptoms; it’s the most effective acute treatment for depression when medication alone isn’t enough. However, it isn’t a cure and is often needed long-term to control the ongoing symptoms of depression, anxiety, and psychosis.
Today’s ECT is a state-of-the-art therapy
The advent of pre-medicating patients with anesthesia and muscle relaxants has brought about “modified treatment;” a much easier and safer way to receive electro-convulsive therapy. This type of modern treatment requires an anesthesiologist, psychiatrist, and nurse to be present during the procedure. A general anesthetic and muscle relaxer is given by IV injection, which keeps the patient asleep and relaxed during treatment. Once asleep, a low voltage of electricity is delivered to the brain for 30–90 seconds, inducing a seizure. After therapy is completed, the patient is observed in the recovery room for 20–30 minutes, and once awake, they are given something to eat and drink, then discharged home.
On the day of treatment, patients aren’t able to drive themselves, since they receive a general anesthetic. They may have short-term memory loss and confusion from the medications but can return to normal activities in a day or so. Many people live active, independent lives while receiving ECT treatment.
What happens to the brain during ECT
Although the actions of the electrical current on the brain aren’t fully understood, the chemical changes that occur are known to positively affect the debilitating symptoms of mental illness. The electrical impulses cause a burst of neurons to fire rapidly, restructuring neuropathways, and essentially re-booting the brain. Thought patterns are altered and negative symptoms are lessened or removed by the treatment.
MRI imaging has shown that brain function increases after continued ECT treatment and positively affects memory. State-of-the-art modified ECT therapy causes changes in the brain that stabilize mood, decreasing symptoms of depression. Studies support the safety of continual treatment in aging adults and disprove brain impairment, dementia, and long-term memory loss as side effects of treatment.
The ECT treatment course
ECT starts with an “index course”: 3 treatments a week for 2 weeks totaling 6–12 treatments, then decreasing slowly to once a week for a month. The psychiatrist and patient determine the frequency of ongoing ECT needed. It isn’t a cure; symptoms will reoccur and continual treatment is commonly needed. It’s a matter of how long the patient can go without returning symptoms. Many people have monthly treatment regimens for their lifetime.
ECT has provided remarkable results for people who have suffered untreatable symptoms from depression, schizophrenia, and bipolar disorder. The old opinion of shock therapy is no longer accurate; it’s a safe and effective treatment that not only changes but saves lives. Dr. Leigh Brown, DO, an ECT provider at Seattle NTC, states, “ECT is a highly effective treatment for depression, and should not be thought of as a ‘last resort.’”
Sadly, ECT treatment facilities are lacking in rural areas, and traveling for treatment is a major hurdle for many people. More psychiatrists are needed to develop treatment programs in smaller, community hospitals.
The stigma surrounding mental illness and ECT treatment is outdated and inaccurate. As the general public and medical professionals educate themselves about the safety and efficacy of today's modified ECT treatment, mental health care will improve nationwide.
- PSYCHOLOGY TODAY. A Brief History of Electroconvulsive Therapy.
- NIH. Maintenance ECT is associated with sustained improvement in depression symptoms without adverse cognitive effects in a retrospective cohort of 100 patients each receiving 50 or more ECT treatments.
- Cleveland Clinic. Electroconvulsive therapy (ECT).