When Is Ect The Right Treatment
ECT is indicated for severe clinical depression or bipolar disorder, and other conditions. ECT is typically used when depression is very severe, or has lasted for a long time and not gotten better with psychotherapy and medications.
Sometimes a change in medication dosage, or a switch in medication will be effective for depression, but when it is not, there may be a role for ECT.
Certain types of depression or catatonic symptoms predict better response to ECT. Older age also predicts better response to ECT.
Ect Is Part Of A Whole
Along with the ECT schedule, Mandal works with patients to develop an exercise and psychotherapy plan. With this combination, patients have an 80% chance of staying in remission years after ECT, Mandal said.
Its like the mind is a garden with tons of weeds, he explained. ECT clears the weeds, it tills, it brings the water and all of that, but it doesnt plant anything. ECT is only as good as the therapy that follows it. Thats where patients make enduring changes in their brain.
Talk therapy is proven to be the best intervention to rewire the brain. The problem, Mandal explained, is that a persons brain needs to be functioning well for talk therapy to work.
If a person has severe depression, there is not a lot of electricity in the frontal lobe, which is what we use to retrieve memories, put things together with meaning, and understand vocal inflections, he said. When you have a severe illness, you cant do any of that. You can give a person all the talk therapy you want, but they cannot do anything with it. They will just be stuck in therapy for years. Thats where ECT comes in. It gets you out of that cycle. ECT builds that engine and talk therapy pushes on the gas pedal.
Hannah continues to meet with Mandal for medication management. She also sees a talk therapist.
Her advice to others is to seek help.
Hannah can now move forward. Im looking into the next steps of life. What can I be successful at, and what can I do to be helpful to others? she said.
What Happens During This Procedure
ECT involves multiple healthcare providers, including a psychiatrist, anesthesiology specialist and other trained personnel.
Anesthesia and other preparations
ECT procedures start with general anesthesia, which puts you into a deep sleep and keeps you from feeling any pain, discomfort or anxiety during the procedure. Providers will also give you a muscle relaxant to avoid any injuries or strain that might happen during the seizure.
Providers will also insert a bite guard into your mouth to protect your teeth, and also insert an intravenous needle into one of your veins . The IV allows quick injection access for medications for anesthesia reasons or to counteract any side effects.
A healthcare provider will then place electrodes, which are contact points for the electric current to travel through, against the skin of your head. The placement depends on your specific needs, and providers will choose a placement with the lowest chance of causing side effects. There are three different ways that providers can place the electrodes.
A healthcare provider will coat the electrodes in a conductive gel that should prevent irritation and burns to your skin. While the electrical current involved is very low, skin irritation and burns are still possible.
The electrical current duration for ECT is also very brief. For most treatments, delivery of electrical current to your brain only lasts a few seconds.
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What Is Electroconvulsive Therapy And Does It Help In Treating Depression
In modern healthcare, electroconvulsive therapy is reserved for patients who have not had much luck in the other forms of treatment. The patient is sedated under general anesthesia, together with a muscle relaxant which keeps them from having any vigorous motion which could cause harm. A mild electrical current is then passed through the patients head, causing a brief controlled seizure which typically lasts a couple minutes.
ECT has been indicated for use in severe cases of depression, bipolar disorder, and catatonia. This is especially so when the patient is unresponsive to medical treatment or has adverse reactions associated with other forms of therapy. It is also reserved for patients experiencing acute feelings of suicide and need rapid treatment. Most anti-depressive medications take a few weeks to be sufficiently effective.
What Are The Disadvantages Risks Or Possible Complications Of This Procedure
Though it is extremely effective, ECT does have some disadvantages.
- Theres a risk of memory loss. Most people who undergo ECT have temporary memory loss and confusion. Most people’s confusion clears up quickly, and memory loss usually goes away entirely within a few months. However, some people do have permanent memory problems. Using the right-unilateral electrode placement and shortening the electrical current duration can reduce the risk of this happening.
- Its a medically intensive procedure. Each ECT procedure requires multiple providers with advanced training to be present. That means this treatment is often not available in smaller healthcare facilities and communities.
- This procedure might only have short-term effects. Some people who receive ECT need follow-up treatments. These maintenance procedures may need to happen for weeks or months. Usually, these follow-up treatments can happen once a week or even once every several months. The use of medication along with ECT can help with this.
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What Can Electroconvulsive Therapy Help With
With the ability of ECT to reset or rewire the brains activity, the treatment can help with a range of symptoms and conditions. Whether a person has been struggling with a mental health condition for decades or they are experiencing a new or worsening symptom, electroconvulsive therapy could offer relief that is quick and effective.
Experts continue to test and expand upon the uses of ECT for various conditions.
Currently, electroconvulsive therapy is used to treat the following:2,4
- Severe depression, especially in cases of suicidality
- Treatment-resistant depressiondepressive symptoms that have not responded to the standard battery of therapy and medications
- Schizophrenia, especially when the person presents as being very disconnected from society with disorganized thoughts or actions
- Bipolar disorder, especially when manic symptoms are prevalent and healthy decision making is replaced by impulsivity and risky behaviors
- Catatoniaa symptom of depression or schizophrenia where a person could be unresponsive to outside communication or stimulation
- Dementia, when the person tends to become agitated, violent, and aggressive
Some people are good candidates for ECT if they are unable to use psychiatric medications. Those with allergies or very significant side effects may consider ECT to help manage their unwanted symptoms.1
What Are The Benefits Of Ect
ECT has significant benefits. They are:
- It is effective. It treats mood disorders such as depression in patients who cannot tolerate other forms of treatment
- It is a safe procedure. Thanks to modern techniques e.g. anesthesia, muscle relaxants, and control of electrical stimulus, ECT has become one of the safest therapeutic procedures even among those with heart conditions who can be prepared and monitored adequately before and after the session
- It is safe for pregnant women.
- It works rapidly. Most patients report improvement after three to five sessions, with some noting changes after even the first session.
- It works especially well in combination with medical treatment.
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Clinical Observation By Medical Imaging Programs
Medical imaging programs are a powerful tool in clinical practice. Among these medical applications, magnetic resonance imaging is more suitable for the measurement of ECT-related alteration. Regarding MRI, both structural and functional parameters were noted as useful for describing the profile of ECT. Therefore, we conducted MRI comparison at baseline and after ECT to illuminate the possible benefits of ECT. All the MRI studies were conducted in the last 5 years.
Although there remain controversies on the role of gray matter enlargement in clinical improvement and outcomes, the increased volume of gray matters in specific regions was relatively significant. As for a structural analysis, a functional algorithm may favor the use of MRI when examining the application of ECT in depression.
In short, according to the functional MRI studies mentioned above, ECT studies have brought renewed interest to the neuroplasticity of the brain, not only the hippocampus, but neural networks also showed more profound activity .
Clinical studies have been conducted to provide evidence and suggestions for clinical practice. With respect to what is suggested by the results of the work above, we discuss the safety of ECT and the predictions of response and remission in ECT used to provide instructions for depressed individuals.
Ect Can Be A Good Treatment Option For Serious Depression
Electroconvulsive therapy can effectively treat depression, and is as safe as antidepressant drugs along with psychotherapy, a new analysis found.
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Electroconvulsive therapy, or ECT, can be effective for the treatment of major depression and is just as safe as antidepressant drugs combined with psychotherapy, a large new study concludes.
The procedure, once referred to as electroshock therapy, has a controversial and largely unfavorable history. This was partly due to inaccurate portrayals in popular books and films like One Flew Over the Cuckoos Nest, and partly the result of real problems with the earliest versions of the procedure, which used strong electrical currents and no anesthesia.
Today, ECT is performed under general anesthesia, and the doctor, working with an anesthesiologist and a nurse, applies a weak electric current to the brain for one to six seconds. This causes a seizure inside the brain, but because of the anesthesia, the patient does not experience muscular contractions. The seizure leads to brain changes that relieve symptoms of depression and certain other mental illnesses. Usually, doctors administer a series of ECT treatments over a period of days or weeks.
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What Are The Signs Of Depression
Risk factors are just that. Genetic predispositions or having a medical condition doesn’t mean you’ll experience depression. Quite honestly, it can be hard to differentiate sadness from something more serious. Use these signs and symptoms to help you identify if you may have depression. Note that symptoms will vary and can range from mild to severe. Everyone’s experience will differ, there is no one-size-fits-all definition for how depression looks. However, general themes emerge.
- Loss of interest in activities you once enjoyed
- Feelings of sadness or consistent low mood
- Sleep troubles — both insomnia and sleeping too much
- Feelings of fatigue or having no energy
- Loss of appetite
- Thoughts of self-harm or suicide
To be diagnosed with clinical depression, symptoms must persist for at least two weeks and impede your ability to function in your daily life. According to the DSM-5, a major depressive disorder diagnosis comes after five of the nine main clinical symptoms of depression are experienced. The duration of symptoms will vary, from a few weeks, months to even years.
It’s worth noting that the symptoms of depression overlap with other conditions, like vitamin deficiencies or thyroid issues, so it’s essential to seek medical treatment to confirm a diagnosis. Depression symptoms can also overlap with other conditions like anemia, infection, sleep disorders, neurological disorders and side effects due to medications.
How Is Depression Treated
There’s no cure for depression. It’s an ongoing disorder, though treatable, with up to 90% of people eventually responding to treatment. Treatment is an ongoing journey, and remission is the goal. Relapses do happen.
Feeling comfortable with your treatment plan and feeling empowered to advocate for yourself when things aren’t working is essential. Depression treatment is a marathon, not a sprint. You should expect treatment to evolve and change as your life does. Even severe depression is treatable. However, seeking treatment as early as possible will often yield the most effective results.
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What Is Electroconvulsive Therapy
ECT is a therapeutic procedure in which a doctor induces a medically controlled seizure using electrical currents in a patient who is put under general anesthesia. The seizure lasts 30 to 45 seconds, and the entire procedure lasts only about five minutes. ECT is generally well-tolerated. Most patients report feeling back to baseline within a few hours.
While we dont know 100 percent how ECT works, we know it is highly effective. Researchers believe the seizure affects specific circuits or neurotransmitters in the brain that are associated with symptoms of mental health disorders.
What To Know About Electroconvulsive Therapy For Depression
There are many treatments for depression, but they dont have the same effects for all people. Electroconvulsive therapy can be used to treat several types of depression. It is often given as an option for people whose depression has not been helped by medication or other treatments.
ECT uses brief, controlled electrical stimulation to the brain. It can produce chemical changes in the brain that lessen symptoms of depression. ECT is done under general anesthesia.The possible benefits of ECT were first recognized by accident. Doctors noticed that some patients experiencing psychosis who developed epilepsy showed improvement in psychotic symptoms after a seizure. Eventually, researchers developed methods of inducing a seizure, which in turn led to using ECT to treat depression.
Elizabeth K. Shultz, D.O., medical director of Neuromodulation at Vanderbilt University Medical Center, answers some questions about this therapy and its use for people who have depression thats difficult to treat.
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The Results Of Juliane’s Ect Experience
For the next few years, I was successful in battling various minor episodes of recurrent depression. It was during this time, I discovered a wonderful support group for depressives and manic depressives , where my family resided. Not only did I find friends and support, but received life-giving education and coping skills concerning clinical depression.
Upon relocating to Florida soon afterward, my participation in the San Antonio DBSA Chapter aided me in establishing DBSA Mid-Orlando in 1992. When I experienced a major depressive setback soon after, a DBSA support group friend and member stayed with me day-after-day, taking care of my physical and mental needs while my husband went to work.
For months, I fought a downhill battle of medication trials and treatments, only becoming increasingly ill. My family grew exhausted from the tremendous strain I was putting on them. Time-after-time, I came close to losing my struggle with depression. Only the perseverance of my doctor, loved ones, friends, and countless prayers in my behalf, kept me fighting to overcome this illness that seemed to want to devour me.
After three years of constant battling, I finally responded to a successful medication combination. It was as if I had risen from the dead! Because of the excellent training and support provided by DBSA on a local, state and national level, I was able to resume active DBSA leadership and help train others to in the same pursuit.
Why Does Ect Work
There are a lot of unknowns about why ECT works. Doctors believe it promotes changes in how brain cells communicate, stimulates the development of new brain cells and increases neurotransmitters such as serotonin and dopamine. Another theory is that a seizure somehow resets the brain.
Many patients notice an improvement in their symptoms after about six treatments.
Patients need to continue with ongoing treatment for their mental health condition to prevent relapse. Ongoing treatment may include medication and psychotherapy.
What Are The Advantages Of Ect
ECT has many advantages that make it a critical tool for treating mental health conditions.
- It is extremely effective. Experts agree that ECT is one of the most effective treatments for mood disorders like depression. It is also especially effective at helping people with depression that resist other forms of treatment like medication or therapy.
- It is very safe. The use of anesthesia and other modern care practices have greatly improved this procedure’s overall safety. Even people who have heart problems can often receive ECT with adjustments to their medication or close monitoring of their vital signs.
- It is very safe in pregnancy.
- It works quickly. People who receive ECT typically see improvements in their symptoms, especially with conditions like major depressive disorder, after three to five treatments. Thats especially helpful when a person has a very severe mental health condition that puts their safety in jeopardy.
- It can help people when other treatments are unavailable. People who cant take medications for mental health conditions for any reason can often still receive ECT. This can make a big difference for people with organ function problems or people who are pregnant .
- Its especially effective in combination with medication. People receiving ECT often also receive medications for treatment, which can further improve the chances that their mental health condition will improve.
How Long Is The Treatment
At the start, treatment is usually done two to three times a week for several weeks. This may go on for months depending on patient symptoms and disease progression. Most patients show significant improvement within months of treatment and some even report improvement after their first ECT session. Some patients require occasional sessions throughout their lives to help with exacerbations of symptoms.
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Starting Electroconvulsive Therapy For Depression
Hannah first met Dr. Mandal on a Thursday.
I appreciated sense of humor because that is very much me, Hannah said. I try to keep things light. Its part of my internal coping mechanism. But its also my personality. The combination of getting along well with Dr. Mandal, and the knowledge that he was more qualified and more experienced with what I was dealing with than anyone I had seen before, gave me a sense of trust in my psychiatrist that I had never experienced, and, in my opinion, is a big part of the reason this has all turned out so well.
The following Monday, Nov. 9, 2020, she was back at the clinic for her first treatment.
ECT only takes about three minutes, but the appointment takes about two hours because nurses have to prep the patient for the procedure. ECT emits electrical pulses throughout the brain, so patients are under general anesthesia, hooked up to an IV and monitored afterward.
When I initially decided to go for ECT, I really didnt have any hesitancy, I just wanted to get better, Hannah said. But as my nurses were prepping me, I became increasingly nervous. As I was about to go under for the first time, I began to cry because I was so fearful. I will never forget asking my nurse, Jason, if I could hold his hand, and with absolutely zero hesitation, he grabbed my hand and reminded me that everything was going to be alright. The rest is history.
Hannah started to notice changes within the first week.