What Happens Before This Procedure
Before you start ECT, your healthcare provider will explain to you what ECT is and how it works. Theyll also make sure you dont have any underlying health conditions or reasons that might mean you shouldnt receive ECT.
Several tests are possible leading up to ECT, including the following:
- Blood and urine tests. Some examples include complete blood count, a metabolic panel , thyroid function, kidney function and more.
- Imaging tests on your skull, brain and spine. These may include X-rays and computerized tomography scans.
- Electrocardiogram . This test looks at your heart function and can spot any unusual changes or problems with your hearts electrical system.
Reasons why you shouldnt receive ECT
There are some conditions and reasons why you shouldnt receive ECT. Known as contraindications, these are all considered on a case-by-case basis. Even if you have a contraindication, providers can often adjust the treatment procedure to take these into account so you can still receive ECT. Contraindications include:
- Severe lung diseases like chronic obstructive pulmonary disease .
- Certain other life-threatening conditions or people who meet the level 4 or 5 requirements on the American Society of Anesthesiologists physical classification system.
Stoppage of food and liquids
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What Are The Risks And Benefits
Like any medical procedure, ECT is has some risks. ECT treatment has been associated with short-term memory loss and difficulty learning. Some people have trouble remembering events that occurred in the weeks before the treatment or earlier. In most cases, memory problems improve within a couple of months. Some patients may experience longer lasting problems, including permanent gaps in memory.
The risks of general anesthesia, which is needed for ECT, are similar to the risks when anesthesia is used for other procedures such as minor surgeries. The most common side effects of ECT on the day of treatment include nausea, headache, fatigue, confusion, and slight memory loss, which may last minutes to hours.
These risks must be balanced with the consequences of ineffectively treated severe psychiatric disorders. For some patients, the risks of ECT may be less than those of ongoing treatment with medications. ECT can work more quickly than medications. It can be especially useful if a patient is suicidal, is not responding to medications or cannot tolerate the side effects of medication.
Why Do Physicians Perform Electroconvulsive Therapy What Types Of Health Care Professionals Administer Electroconvulsive Therapy
ECT is quite useful in psychiatry for the care of certain patients with significant depression, particularly for those who cannot take or are not responding to antidepressants, suffer from severe depression, or are at a high risk for suicide. ECT often is effective in cases where antidepressant medications and psychotherapy do not provide sufficient relief of symptoms. Physicians often consider if a treatment known as magnetic stimulation therapy is ineffective. The effectiveness of this medical treatment has been shown for the depressive symptoms of both major depressive and manic-depressive disorders. Studies also show it to be a sound treatment in the care of people who suffer from mania, psychosis in the form of schizophrenia, schizoaffective disorder, schizophreniform disorder, and any severe decrease in movement and speech . ECT is an effective treatment for people of a wide range of ages, from children and adolescents to elderly patients.
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How Is Ect Performed
Prior to ECT treatment, a patient is given a muscle relaxant and is put to sleep with a general anesthesia. Electrodes are placed on the patient’s scalp and a finely controlled electric current is applied. This current causes a brief seizure in the brain.
Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding it, and is often confused. The confusion typically lasts for only a short period of time.
ECT is usually given up to three times a week for a total of two to four weeks.
Electric Shock Treatment Has Serious Potential Side Effects
Typically, electroshock therapy is a last-ditch effort used when all other treatment options have failed to offer symptom relief to those suffering from severe depression, bipolar disorder, schizophrenia, or other serious and debilitating mental illnesses. The current modified procedure for administering electric shock therapy is certainly more humane than earlier variations, however, the treatment still comes with a rather extensive list of long-term and short-term side effects. When faced with these possible side effects, patients are often forced to make hard choices about whether or not electroshock therapy is worth the risk.
Side effects associated with ECT are rare but typically include prolonged seizure, stroke, cardiovascular complications, blood pressure changes, dental damage, physical trauma, and, in some cases, even death.
Cardiovascular complications are rare, but when they occur are a common cause of ECT-related death. Other cardiovascular complications can also occur as a result of electric shock treatment.
Furthermore, a typical ECT regimen will typically involve up to three treatments each week, for multiple weeks. Therefore, memory loss can accumulate quickly, covering vast swaths of time over a short period. Although it is common for individuals to regain these memories in the following days and weeks, even temporary confusion and amnesia can be frustrating and unsettling for many patients.
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Electric Shock Therapy And Depression Treatment
Six days after receiving electric shock therapy for depression, renowned writer Ernest Hemingway killed himself. He’d suffered severe memory loss after the treatment. Although mental health professionals are well aware of the severe side effects associated with this electric shock therapy, some regard it as one of the best treatments for severe depression, especially when antidepressants and counseling are not effective.
The change of heart may be due to progress in how electric shock therapy is administered. Mental Health America explains that while images of draconian shock treatment linger, advances have occurred that make electroconvulsive therapy–the more PC term these days–safer and less likely to cause serious cognitive damage. Their stance is that many of the severe side effects occur when a practitioner does not administer the treatment according to clinical guidelines.
What Is Electric Shock Therapy?
The MHA describes electroconvulsive therapy as a type of electrical stimulation of the brain, usually overseen by a psychiatrist, anesthesiologist and other medical staff. The two main types of stimulation currently used are bilateral pulse stimulation and unilateral pulse stimulation .
The goal is to stimulate a grand mal seizure for 30 seconds to about a minute. Unlike popular depictions of electric shock therapy , patients do not convulse and should feel no pain.
What Are the Side Effects of Electric Shock Therapy?
Electroconvulsive Therapy Was Once Referred To As Electroshock Therapy
Electroconvulsive therapy is a psychiatric treatment notorious for its long list of severe potential side effects. Despite its murky history, more than 100,000 individuals undergo ECT in the United States annually. How exactly does ECT work? Lets start with a quick history lesson.
In the early 1930s, researchers noticed the positive effects schizophrenic patients with epilepsy experienced immediately following epileptic seizures. In an attempt to duplicate these results, medical professionals began using chemicals to artificially induce grand mal seizures in patients for temporary symptom relief. Unfortunately, patients frequently reported extreme dread, and even outright terror per some reports, prior to the onset of these chemically induced seizures. Looking for a more humane alternative to Metrazol, a team of Italian researchers proposed the idea of sending electric currents through the brain to produce the intended grand mal seizure. This led to the popular common phrasing of electroshock therapy.
ECT is by no means a cure for depression. To maintain the positive effect of electroshock treatment, patients may need to return for electric shock therapy sessions multiple times a year.
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What Alternative Treatments Are Used For Depression
Alternative treatments can sometimes provide relief that traditional Western medicine cannot. While some alternative therapies have become accepted as part of modern health care practice, others still have not been proven safe or effective.
Whether or not they are scientifically proven, alternative therapies, by providing forms of relaxation and relief from stress, may have a place in healing and general health and well-being. Examples of alternative therapies include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, and massage.
In general, alternative therapies by themselves are reasonable to use for mild but not more severe forms of clinical depression.
Risks And Side Effects Of Ect
The most common side effect of ECT is short-term memory loss. However, some people report that they have long-term memory loss, as well. ECT also causes a brief rise in heart rate and blood pressure during the procedure, so it may not be recommended in people with unstable heart problems. A physical examination and basic laboratory tests including an electrocardiogram are necessary before starting ECT to assure that no medical problems are present that could interfere with the safe administration of ECT.
ECT can often work quickly, but 50% or more of the people who receive this treatment will relapse within several months if there is no subsequent treatment to prevent relapse. Your doctor will typically advise a medication regimen including antidepressants, or possibly additional periodic ECT sessions to help prevent relapse.
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Health Benefits And Side Effects Of Electroconvulsive Therapy
Formerly known as electroshock therapy, this treatment for mental disorders dates back to the 1930s. While no one is certain how or why this therapy works, it seems to be still popular and remains a medical option in the U.S. Advances in how the treatment is delivered has been made, such as using general anesthesia .
Electroconvulsive Therapy as its now known involves sending electrical current through the brain, deliberately triggering a seizure. While there have been improvements reported in patients, there are also possible side effects to consider. Lets look at seven positives and negatives about electrotherapy
How Long Is An Ect Procedure
A single ECT session usually lasts one hour. This includes the time the patient will be in the treatment room and the time spent in the recovery room .
Typically, ECT is given two to three times a week for a total of six to twelve sessions. Some patients may need more or fewer treatments.
These sessions improve depression in 70 to 90 percent of patients, a response rate much higher than that of antidepressant drugs.
Although ECT is effective, its benefits are short-lived. For this reason, patients take antidepressant medication after ECT or may continue receiving ECT periodically to prevent relapse.
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Brain Damage: Tms Doesnt Cause Brain Damage
There is no evidence of pathological change in brain tissue resulting fromTMS treatmentdelivered within the safety ranges. Published data show exposure to accelerated dosing generally appears safe as well. Studies in animals, as well as studies of subsequently resected anterior temporal lobes of humans subjected to direct cortical stimulation or TMS, have failed to demonstrate evidence of histotoxicity . The maximal field strength generated by commercially available stimulators is in the 2 Tesla range. The field is induced for a brief period only and the fields strength falls off rapidly with distance from the coil. There is no evidence of adverse effects from magnetic field exposure during TMS.
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What Are The Side
The immediate side effects of the procedure which may last for about an hour include:
- Muscle aches and soreness
- Disorientation and confusion
Patients may also develop memory problems. Memories formed closer to the time of ECT are at greater risk of being lost while those formed long before ECT are at less risk of being lost. The ability to form new memories is also impaired after a course of ECT treatments but this ability usually makes a full recovery in the weeks and months following the last treatment.
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Effects On Cognition: Tms Doesnt Cause Memory Loss
There were no adverse cognition effects of TMS in fact, studies demonstrated a better performance trend on measures such as delayed story recall. Several additional safety studies have not reported adverse long-term effects or sustained cognitive function changes in subjects receivingTMS. In several studies, performance on standard neuropsychological tests was not adversely affected by TMS sessions instead, verbal memory tended to improve, and motor reaction times tended to decrease.
How Shock Therapy Feels
When you awake from the anesthesia, you may be confused and tired. You will likely experience short-term memory loss around the time of the procedure. With multiple treatments, this may increase. Adverse cognitive effects tend to be the most concerning factors around ECT and tend to affect the frequency and duration of treatments and whether ECT is offered at all. Your vital signs will be monitored closely after the shock treatment to ensure proper recovery. You may feel head, muscle or back pain. Such discomfort tends to be relieved by mild medications. If any post-treatment effect is concerning you, you should talk to the treating physician immediately.
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Risks And Side Effects
Despite its controversial history, the risks and side effects of modern ECT are very low.
Like any procedure involving anaesthesia, ECT carries a small degree of risk. The most common side effects are headache, stomach upsets, aching muscles and short-term memory loss.
Studies have shown that ECT does not harm the brain or change its anatomy in any way, as the strength of the electrical current is too low to cause damage.
What Happens After This Procedure
After the seizure stops, healthcare providers will monitor you as you awaken from anesthesia. They’ll also check your vital signs to look for any signs of side effects or other anesthesia-related problems that might happen.
Most people are fully conscious within 10 to 15 minutes after this procedure and can be on their feet and walk around within 30 minutes.
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Can Depression Return If You Stop Treatment
Even when treatment such as ECT, TMS, vagus nerve stimulation, or other alternative therapies is successful, depression can return. Psychotherapy and/or maintenance antidepressant medication can help prevent depression from coming back. Psychotherapy does this by correcting the beliefs, perceptions, and behaviors that contribute to your depression. If you do experience recurring symptoms, don’t hesitate to seek help again.
Magnetic Seizure Therapy: A New Treatment For Depression
UT Southwestern is the only clinical trial site in the country using a new form of brain stimulation to treat major depression. Preliminary findings indicate that magnetic seizure therapy can ease depression without the cognitive side effects associated with electroconvulsive therapy.
MST is similar to ECT but uses magnets in place of electrical currents to stimulate the brain. We know that bilateral ECT is superior to MST and unilateral ECT . Preliminary data suggests that right-unilateral ECT and MST are comparable, but MST carries fewer memory-loss symptoms. We are excited about this trial because we hope to, in the future, offer magnetic therapy as an alternative for patients who are concerned about cognitive side effects of ECT.
Another therapy for treatment-resistive depression is repetitive transcranial magnetic stimulation , which does not carry some of the side effects of ECT. While rTMS is not as effective as ECT, there is exciting research in progress that could lead to rTMS becoming a more effective option for patients in the future.
Additionally, the drug ketamine was approved by the FDA in as a therapy for treatment-resistant depression. Ketamine is still being studied for other major depressive disorders clinical studies are currently being conducted at UT Southwestern.
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Electroconvulsive Therapy Side Effects
Confusion is a change in mental status in which a person is not able to think with his or her usual level of clarity. Frequently, confusion leads to the loss of ability to recognize people and or places, or tell time and the date. Feelings of disorientation are common in confusion, and decision-making ability is impaired.
Confusion may arise suddenly or develop gradually over time.
If Youve Been Shocked
If you receive an electric shock, it might be difficult for you to do anything. But try to start with the following if you think youve been severely shocked:
- Let go of the electric source as soon as you can.
- If you can, call 911 or local emergency services. If you cant, yell for someone else around you to call.
- Dont move, unless you need to move away from the electric source.
If the shock feels minor:
- See a doctor as soon as you can, even if you dont have any noticeable symptoms. Remember, some internal injuries are hard to detect at first.
- In the meantime, cover any burns with sterile gauze. Dont use adhesive bandages or anything else that might stick to the burn.
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What Is Electroconvulsive Therapy
Electroconvulsive therapy is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments.
ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia. It is typically administered by a team of trained medical professionals that includes a psychiatrist, an anesthesiologist, and a nurse or physician assistant.
Stigma As A Barrier To Care
Despite that track record, ECT has been shrouded in stigma, particularly in popular culture through movies such as One Flew Over the Cuckoos Nest, a 1975 film that portrayed a punitive, painful treatment of a patient transferred to a hospital from a prison farm.
Todays treatment is a far cry from the film version. Its usually done on an outpatient basis. Patients receive general anesthesia and a muscle relaxant that puts them to sleep for five minutes and relaxes the body so there is little, if any, movement. Electrodes are placed on the scalp, usually on the right temple and on the top of the head, and low-intensity electrical pulses are administered to trigger a grand mal seizure. Treatments generally are given two or three times a week until the symptoms are in remission.
Seiner noted that todays treatment reflects a lot better understanding of how much stimulus is needed and the best places in the brain to induce a seizure to minimize side effects. The patients are completely asleep, so there is little to no movement when the seizure is induced. We also have better monitoring to make it safer. We have better medications to make it more comfortable. And now its done more often on an outpatient basis, and patients tend to tolerate it pretty well.
Fiction number one is that its painful, stated Seiner. The only mildly painful part for people is when we put a tiny IV in. And occasionally, most often after the first treatment, people have a mild headache.
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