Electroconvulsive Therapy
Most people have a respectful fear of electricity. Combine that with general attitudes toward convulsions, and you can see why electroconvulsive therapy (ECT) hasn't been high on anybody's favorite activities list. ECT has been around since the late 1930s, however, and back in its infancy, was administered without anesthetic. Today, however, ECT has gone modern. The procedure is done under general anesthesia, so it's painless. If you are having suicidal thoughts, and these thoughts are progressing to the point you may decide to act on them, ECT is a viable option.
According to the Mayo Clinic, approximately 100,000 Americans receive ECT each year. Making the decision to have ECT is something you should discuss with your psychotherapist, psychiatrist, or primary health care provider. Also, if you aren't able to tolerate antidepressants or have already had a positive experience with ECT, you may decide on this course of treatment.
Essential
ECT is done on either an in-patient or out-patient basis at the hospital. You'll have an anesthesiologist, primary physician (your psychiatrist), and nursing staff as your team.
How It Works
During ECT, you're put under anesthesia and then given the drug succinylcholine to temporarily relax the muscles so that they do not contract during the treatment and cause fractures. Then an electric current is passed through electrodes that are positioned on your head. The current is applied for one second or less. During this time, your heart function is monitored by an electrocardiogram (EKG) and your brain function with an electroencephalogram (EEG).
Risks
No medical treatment is 100 percent safe. There is always the possibility of potential risk, and some risks can be life-threatening. If you've had surgery, you're aware of the forms you're required to fill out — the ones that explain that even the simplest, most benign procedure may result in your death. It's a result of our litigious society. Risks, such as cardiac arrest, associated with anesthesia are not common in otherwise healthy individuals.
Alert
A rare, potentially fatal condition called malignant hyperthermia (MH) may be triggered by some anesthetics. The anesthetics most commonly associated with malignant hyperthermia include the muscle relaxant succinylcholine.
Side Effects
Side effects of ECT are generally of short duration. Immediately after you awaken, you may feel confused and have some memory loss. This may last from a few minutes to several hours. You may also experience nausea, vomiting, headache, muscle ache, or jaw pain. The length of time that you feel confused may increase with subsequent treatments, but everything usually subsides after the course of treatment is completed.
How Many Treatments Are Necessary?
The course of ECT therapy usually extends over a few weeks, with three sessions being the typical number per week. Nine treatments are about average. When your therapy is completed, your doctor may suggest follow-up sessions to prevent relapse. The National Alliance for the Mentally Ill estimates that ECT is effective in about 80 percent of people who receive the full course.
Why Does It Work?
Scientists don't know with absolute certainty why ECT works, although they have some theories. One theory suggests that the induced seizures cause changes in the brain's neurotransmitters. Another line of thinking is that stress levels are changed at their source — in the brain. What is known, though, is that many chemical aspects of brain function are altered during and after seizure activity. Also, researchers think that these changes may be cumulative, building over the course of treatment. That's the reason for having a series of treatments rather than just one session.
