Understanding the truth about ECT (Electroconvulsive Therapy)




ECT, the name itself scares a lot of people. People know it as “shock therapy” also. When this treatment option is presented as the best option, patients and their attendants generally refuse this option due to the myths that surround ECT.



Let’s discuss about this treatment option in detail.


ECT: How does it work?


During ECT a small amount of electric current is sent to the brain. This current produces a seizure which affects the entire brain, including the centres which control thinking, mood, appetite and sleep. Repeated treatments alter chemical messages in the brain and bring them back to normal. This puts you back to recovery path from your illness.


Indications:

Most people who receive ECT are suffering from a severe mood or psychiatric disorder. Although we have medications like oral tablets or injectables for rapid management of acute psychiatric illnesses, some people do not recover completely and others take long time. ECT is often used for these patients. In severe cases, ECT may be the best treatment and it can be life saving.


Some situations where ECT can be a saviour:


  1. To treat severe and refractory depression, schizophrenia, catatonia.

  2. No response with medications.

  3. To avoid medicines related side effects.

  4. History of responsiveness to ECT in past.

  5. Overwhelming psychiatric disorder disrupting daily routine and activities.



Preparation a day before ECT:



Physician might evaluate you in the following manner before she plans a ECT session for you.

  • Obtain detailed medical history

  • Complete physical examination

  • Psychiatric assessment to understand the disorder and it's severity

  • Basic blood tests, ECG

  • Clearance from different departments(Anaesthesia, Endocrinology, Cardiology etc) might be required if you have prior co-morbidities

  • A written consent: Before you sign the form your doctor should explain what the treatment involves, and why you are having it, and should be available to answer any questions you may have about the treatment. You can refuse to have ECT and you may withdraw your consent at any time, even before the first treatment has been given. The consent form is not a legal document and does not commit you to have the treatment. It is a record that an explanation has been given to you and that you understand to your satisfaction what is going to happen to you. Withdrawal of your consent to ECT will not in any way alter your right to continued treatment with the best alternatives available.



Preparation on the day of ECT:

  • For the treatment you should wear loose clothes or night clothes.

  • You will be asked to remove any loose jewellery, hairslides or false teeth if you have them.

  • You will need to fast (have nothing to eat and drink) from about midnight the night before each treatment.

  • This will involve having no breakfast on the morning that you have ECT.


Procedure:

The treatment takes place in a separate room and only takes a few minutes. The anaesthetist will ask you to hold out your hand so you can be given anaesthetic injection. You will be given some oxygen to breathe as you go off to sleep. Once you are fast asleep a small electric current is passed across your head and this causes a mild fit in the brain. There is little movement of your body because of the relaxant injection that the anaesthetist gives. When you awake up you will be back in the waiting area/on your bed. It can be given as inpatient or outpatient.



How will I feel immediately after ECT?

Some people wake up with no side-effects at all and simply feel very relaxed. Others may feel somewhat confused or have a headache.



How effective is ECT?

Over eight out of ten patients who receive ECT respond well, making ECT the most effective treatment for severe psychiatric illnesses. Most patients recover their ability to work and lead a productive life after their illness has been treated with a course of ECT.



How many sessions does a patient usually require?

ECT is usually given two or three times a week. It is not possible to say exactly how many treatments you may need. Some people get better with as few as 6-7 treatment sessions, others may need as many as twelve and very occasionally more.



Side-effects of ECT:

  • Some patients may be confused just after they awaken from the treatment and this generally clears up within an hour or so.

  • Your memory of recent events may upset and dates, names of friends, public events, addresses and telephone numbers may be temporarily forgotten. In most cases this memory loss improves within few days or weeks, although occasionally patients may continue to experience minor memory problems for several months.

  • ECT does not have any long-term effects on your memory or your intelligence.



ECT is among the safest medical treatments given under general anaesthesia. The risk of death or serious injury with ECT is about one in 50000 treatments which is considered as low.



ECT on OPD basis

If you are having the treatment as an out-patient, there are some rules which must be followed because you will have a brief anaesthesia which will be given by injection into a vein in your arm.

  • You must not have anything to eat or drink after midnight on the day before your treatment.

  • If you are taking tablets in the morning, don’t take them on the morning of your treatment; bring them with you and inform the ECT staff who will ensure that you receive them after ECT.

  • You must not drive a car or any motor vehicle on the day on which you have a treatment.

  • You should not travel unaccompanied.



Author :

Dr Nikita Rajpal

(MD - Psychiatry ( PGIMER - Chandigarh) )

Consultant Psychiatrist

Kalpavriksh Superspeciality Center, Delhi.

www.kvsc.in


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