ECT: Shock Treatment

Shock treatment (Electroconvulsive treatment, ECT) sounds barbaric and if you or a loved one have ever been recommended it I'm sure it's extra frightening. On occasion I'll recommend for my patients to have ECT and I need to do a lot of teaching and reassurance. I will share with you what I tell my patients. If the proceedure is demystified it becomes less frightening.

The whole concept of ECT arose when while at an asylum two patients had grand mal seizures and for some unexplainable reason, they improved! That was an era when patients would be placed in asylums for years or forever and because of the stigma were often left and forgotten by their families. There were no psychiatric medications available; after all, psychiatric medications are relatively new to us, anti-psychotic have been around since 1945, antidepressants early 1960's, prozac 1986. Cold water treatments, spinning chairs, straight jackets and insulin shock were the mode of the day.

It was postulated that if a seizure was induced, the symptoms would remit and the patient would improve. Unfortunately, any ways were attempted to cause a seizures and there were deaths along the way. Placing electrodes on both temples with a jolt of electricity was tried and was found to be effective. I know a seasoned psychiatric nurse who tells me that in the 60's she, along with strong mental health techicians, would help hold the patient's arms and legs while they seized vigorously. In this day and age the treatment is done under brief general anesthesia and there is barely any movement. There is a brief pulse of electricity and you hope for a good seizure that lasts 45-90 seconds.

ECT is very helpful for stubborn, difficult to treat depression. As opposed to the typical antidepressants that have a likelihood of 60-80% of being effective with depressed patients, ECT is about 70 to 80% effective and these are usually the most recalcitrant depressions. It can work faster than antidepressants, sometimes improving depression, at least somewhat, after the first or second treatment.

Side effects are generally not too problematic. The general anesthesia helps prevent seizure-related problems like fractures of the vertebrae. The main concern the effect on memory and new learning. There are two ways of doing ECT, unilateral with one electode on the right temple and one on the forehead and bilateral with electrodes on both temples. Unilateral treatments seem less effective with more treatments needed to effect a change, but they do not cause as much memory loss. I have had patients that do well with regular ECT and memory is not effected whatsoever. If memory is affected, however, it generally improves gradually over the subsequent few weeks and up to 3 months. There are some who report that memory is indefinelty affected, however, neuropsychological testing does not support this. Recent studies indicate ECT actually improves memory, probably because depression so negatively impacts memory and as the depression improves, so does the memory. There have been brain biopsies studies of rats who have been given multiple, repeated ECT and no evidence of damage to the brain tissue itself has been found.

Overall, ECT is a great form of treatment. It is not a treatment that should be avoided, infact, it can be life saving. The only contraindication is anything that would increase intracranial pressure, eg. brain tumor. The ultimate question I am asked is that if a family member or I are recommended ECT would I agree to it, and the answer for me is...sure.