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How Does Ect Work For Depression

What Is Electroconvulsive Therapy And How Does It Work

The truth about electroconvulsive therapy (ECT) – Helen M. Farrell

Dr. McDonald answers the question: ‘What Is Electroconvulsive/Shock Therapy?’

& #151 — Question: What is electroconvulsive therapy and how does it work?

Answer: Electroconvulsive therapy is a treatment for depression. Electroconvulsive therapy’s been around since the 1930s and is one of our oldest treatments for depression. And the reasons it’s lasted this long that it’s one of the most effective treatments for depression — particularly for people with depression that hasn’t responded to the typical medications.

Electroconvulsive therapy works by stimulating the brain. Essentially electroconvulsive therapy releases the same types of neurochemicals — or transmitters — that are released when you take antidepressant medication. However electroconvulsive therapy can actually work much quicker than medications and people can actually get well in a period of a week as opposed to the six to eight weeks it can take with medication. So it’s used in people who have very severe depression that needs an immediate treatment.

Electroconvulsive therapy’s also used when patients have treatments that are resistant to medication — that is the patient who’s tried multiple different medications and not really responded very well.

Using Ect To Treat Depression

Effective treatments for depression include counseling, psychotherapy, and prescription medications. However, for an estimated 100,000 people a year in the United States, like Neville, these options fall short. And for them, ECT is safe, reliable, and effective.

The treatment has evolved since the 1930s, when psychiatrists hypothesized that grand mal seizures could help treat schizophrenia, based on the observation that some nerve cells in the brains of people with schizophrenia appeared to be arranged in a way that was the opposite of people with epilepsy. However, it turned out that the seizures were most effective in treating depression and other mood disorders.

Scientists know seizures can reset brain function. And because brain activity involves electrical signals passing through neurons, ECT is like when you reboot your computer when something has gone awry, said Paula Bolton, MS, APRN-BC, program director of McLeans Psychiatric Neurotherapeutics Program. Although there are a lot of theories, no one is really quite sure why it works.

The mystery of how to treat depression goes beyond ECT. Psychiatrists are also hard-pressed to explain exactly how medication or psychotherapy affects the synapses.

What is clear is that for severe illness, such as psychotic depression or catatonia, where patients can lose 40-50 pounds and can be at some risk of death, ECT has been shown to be 80-95% effective.

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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By Nicholas Bakalar

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 To Expect At Your First Appointment

The first ECT appointment may feel intimidating or scary because the process is new. Ideally, the treatment staff will fully describe the treatment to reduce fears and encourage comfort.

In most cases, the patient will remember very little of the ECT treatment. They will enter the treatment room, receive an IV, and fall asleep shortly after the staff administers the anesthesia. The patient may be awake for the electrode pads, a mouth guard, and an oxygen mask to be applied.2

Next thing they know, the person will be in the recovery room. They may feel disoriented and slightly confused. A loved one will drive them home, or they will return to their hospital room to continue the recovery process. It may take a few hours for the side effects of nausea, headache, and fatigue to pass.4

Side Effects Of Electroconvulsive Therapy

Electroconvulsive therapy transforms lives

Like other treatments for mental health conditions, electroconvulsive therapy may lead to side effects for some patients. A combination of mental health and physical health side effects are possible, and even though they may be uncomfortable or concerning, they are usually better than the risks of severe depression.

Common side effects of electroconvulsive therapy include:1,2

  • Quicker heart rate

As the safety of ECT improves, the side effects become more mild and sporadic. In the past, memory loss was much more common, but now, people experiencing permanent loss of memory from ECT is rarer.1

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Concerns With Electroconvulsive Therapy For Depression

Electroconvulsive therapy is one of the most rapid and effective ways for inducing complete remission of major depression symptoms. ECT is rarely used as the first line of treatment for depression and is usually tried as a last resort for patients who have had no success with conventional treatment, including antidepressant drugs, psychotherapy, and TMS.

Although ECT is effective, its not recommended for certain patients. Also, patients with severe depression who would typically benefit from ECT may be concerned about the side effects. But in most cases, ECT is an effective treatment method for people who do not respond to antidepressant medications. ECT may also be a favorable alternative to people with severe depression where suicide is a risk, or in pregnant mothers who do not want to expose their babies to medications.

Debunked 4 Myths About Electroconvulsive Therapy For Depression

Electroconvulsive therapy is one of the most effective treatments for severe mental health conditions, most commonly treatment-resistant depression. ECT also can be used to treat other psychiatric issues, such as psychosis and catatonia .

ECT is approved by the U.S. Food and Drug Administration and has been shown to be highly effective, giving some patients full reversal of severe depression symptoms. Overall, ECT is approximately 80 percent effective when a patient is a good candidate. By comparison, about 50 percent of patients respond to antidepressant medication.

ECT is primarily reserved for patients who do not respond to other types of therapy, but in some patients with severe symptoms, failure of other therapies is not a requirement.

Electroconvulsive therapy is one of the most effective treatments for severe mental health conditions, most commonly treatment-resistant depression, and can also be used to treat other psychiatric issues, such as psychosis and catatonia .

While ECT can be incredibly effective, the internet is rampant with misinformation about the therapy. People liken ECT to the outdated treatment in the movie One Flew Over the Cuckoos Nest. But thats simply not the case. Lets discuss ECT and debunk four myths about this advanced therapy.

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Effects On Brain Structure

Considerable controversy exists over the effects of ECT on brain tissue, although a number of mental health associationsâincluding the APAâhave concluded that there is no evidence that ECT causes structural brain damage. A 1999 report by the US Surgeon General states: “The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals.”

Many expert proponents of ECT maintain that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent ECT researcher and former chief editor of the Journal of ECT, stated in a 2007 interview that, “There are a number of well-designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT.” Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments. Kellner stated “Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness.” Two meta-analyses find that ECT is associated with brain matter growth.

Pros And Cons Of Tms Vs Ect

ECT: Disrupting the Stigma Around An Essential Treatment Option

Taking all the above into consideration, we can summarise the pros and cons of both treatments quite simply.

TMS is more affordable , and elicits fewer side effects than ECT. It has also been proven to be an effective treatment for depression.

However, it appears to be less effective than ECT and requires more sessions.

Alternatively, ECT is typically more effective than TMS and can be completed in a much smaller number of sessions .

However, ECT is more expensive, causes more side effects, and requires the use of a general anesthetic meaning that it may not be suitable for everyone.

Also, you cannot drive at all during the treatment course of ECT. Someone has to drive you to and from all treatments and sometimes it is recommended not to drive in between treatments bc the seizure and anesthesia can affect coordination and response time. So youre losing independence and relying on someone else for transportation.

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How Long Does Ect Take

An ECT procedure generally takes five to 10 minutes plus time for preparation and recovery in total, approximately one to two hours. Most patients have treatment 2 or 3 times a week for approximately 1 month for a total of 8 to 12 treatments. Additionally, some patients may need maintenance treatment.

What Is The Ect Procedure Like

Heres what you can expect before, during, and after ECT therapy.

Step 1) Full Medical Examination

Just like every other medical procedure, a full medical examination will be carried out.

Your medical history will be carefully investigated to ascertain if theres an underlying medical condition to be worried about.

Step 2) Tests before ECT

Bloodwork, head CT, xrays of chest and spine as well as an electrocardiogram is also carried out to ensure youre able to withstand the treatment.

The doctor or anesthesiologist explains to you the risk of anesthesia and the procedure itself. Once these details are verified and your consent or that of your legal guardian is received, you are good to go.

Step 3)Administering Anesthesia

Typically, you will be asked not to eat 24 hours before the procedure.

After you arrive at our facility for the procedure you are prepped, you will have an intravenous tube inserted into your arms so medications and other fluids can be passed. You will then be anesthetized, putting you to sleep for about 5- 10 minutes.

You will also receive a muscle relaxant that will minimize the seizure, prevent movement of muscles and injury.

Step 4) ECT Therapy

Cardiac monitoring pads will be placed on your chest to monitor your heart and lung conditions during and after the treatment.

2 of these 4 electrodes monitor your brain waves, the other 2 deliver the electric impulse to the brain.

The ECT treatment is only effective when it causes a seizure.

Step 5) Recovery

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Why Does Ect Work For Depression Other Mental Health Conditions

ECT is one of the most evidence-based interventions available to get a client into remission, Mandal said. Remission is not only feeling better. It is being indistinguishable from someone who does not have an illness. It is not a cure but total control of the illness. No other treatment in psychiatry has better data to return a person to their pre-illness functioning.

ECT works in the same way a defibrillator or pacemaker helps restore a normal rhythm to a persons heart, he said. Heart heart arrhythmia occurs when electrical signals that coordinate heartbeats beats dont work correctly, mental illness occurs when electrical signals in the brain dont function properly.

Its not that the healthy wires arent there, its just that electricity is not going through the wires for whatever reason, Mandal said.

ECT has excellent results for those over age 65 but has amazing data for younger people too, Mandal said.

He explained that the more genetic loading a person has of a specific illness meaning a strong family history the earlier in life the condition will appear for that person. ECT data shows high remission rates for people in their 20s, setting them on a positive course for the rest of their life by significantly decreasing the likelihood theyll ever have to deal with that illness again.

The Future Of Severe Depression Treatment

Ect For Depression

As effective as ECT can be for treatment-resistant depression, there is room for improvement and UT Southwestern is leading the charge. We are the only medical center in the U.S. participating in a National Institute of Mental Health-funded clinical study for magnetic seizure therapy . Along with the University of Toronto Centre for Addiction and Mental Health , we are enrolling patients to compare the effectiveness of right-unilateral ECT and MST.

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How Does Ect Work For Treating Depression

There is no singular cause of depression. Instead, the disorder happens because of a unique combination of genetic factors, temperament, environmental stress, and neurochemical vulnerabilities. ECT cannot treat the first three depression causes, but it is sufficient for addressing neurochemical imbalances that are known to play a role in depression. Since a combination of known factors causes depression, depression treatment is most successful when methods are tailored to the patient and utilized as a multi-pronged approach for treatment. Patients need medications, deep brain stimulation techniques, and also therapy to treat symptoms and prevent relapse. Drugs, therapy, and ECT alone are usually not enough for alleviating the disorder.

With antidepressant medications, the drugs block the brain from reabsorbing vital neurochemicals that play a role in depression symptoms. These chemicals are dopamine, serotonin, and norepinephrine. The unfortunate thing about medications is that they take several weeks to take effect. Also, up to 30% of patients wont find any relief with medications, and they will need to try alternative therapy methods, including deep brain stimulation techniques.

When ECT is administered, the patients brain is immediately and rapidly flooded with neurotransmitters. Thus, patients will experience a complete and total reduction in symptoms in up to 90% of ECT cases.

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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Clinical Observation By Questionnaire Assessments

Additionally, owing to the work of the CORE group, which showed the equal performance of continuation ECT and combination pharmacotherapy in preventing relapse following response to acute ECT, the Prolonging Remission in Depressed Elderly group was established. The PRIDE/CORE group was established to investigate whether combined pharmacotherapy and ECT, personalized according to patient reaction, is more effective in preventing relapse in depressed older individuals than pharmacotherapy alone. For the phase I study, right unilateral ultrabrief pulse ECT combined with venlafaxine was introduced for the treatment of geriatric depression, showing that right unilateral ultrabrief pulse ECT combined with venlafaxine worked quickly and effectively against geriatric depression, with excellent safety and tolerability . Phase II participants were recruited from the remitted individuals of the PRIDE phase I study, and phase II was conducted using a novel Symptom-Titrated Algorithm-Based Longitudinal ECT regimen. As a result, the continuation ECT plus medication was preferable in clinical performance and did not show statistically different cognitive impairment from that of continuation medication alone , and STABLE resulted in overall net health benefits . As for health-related quality of life in elderly depressed patients who underwent ultrabrief-pulse ECT, an open-label study suggested that attaining remission was critical to acquiring better health quality .

What Is Ect And What Is Tms

Cheryl Overcomes Depression with Electroconvulsive Therapy

So is TMS, ECT? No.

Transcranial magnetic stimulation and Electroconvulsive therapy are 2 different depression treatments.

Both are proven to have very positive effects on your mental health.

They have become increasingly popular in healthcare circles because of their effectiveness.

But what are they? And is one better than the other?

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Does Ect Cause Brain Damage Or Memory Loss

Researchers and experts have looked at ECT using many different tools, imaging technologies and diagnostic tests. The available research shows that permanent negative effects from ECT like memory loss are rare. Memory loss does happen in some cases, but its usually temporary and goes away within a few months. Researchers also found that ECT stimulates certain types of brain function, which improves the symptoms that happen with many mental health conditions.

Cost Of Electroconvulsive Therapy

Because ECT is a medical procedure that requires the time, space, and resources of several medical professionals, the treatment is expensive, especially when compared to medication or therapy services. One ECT treatment can cost as much as $1,000, while a year of antidepressant medication costs just a few hundred dollars.7

Even though ECT may seem expensive, there are two important considerations:4,7

  • Many insurance companies will pay for all or some of ECT treatment.
  • ECT is cost effective when balanced against the cost of being severely depressed with missing work and needing intensive treatment.

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How Does Ect Work

This is a question I face in clinical practice all the time. It is a very important one, and while there has been a lot of research on it and there are some clues about it, we still have work to do. Therefore, it should be no surprise that I was extremely excited to start a collaboration with Dr.Timothy Murphy to use optogenetics technology to address this question. Here is some preliminary work on this that will be presented at the 2nd International Brainstimulation conference in two weeks.

Title: Mesoscale cortical mapping reveals region-specific and frequency-dependent changes in a mouse model of electroconvulsive therapy.

Introduction:

Depression is a leading cause of disability worldwide. As a treatment for depression, electroconvulsive therapy remains the most effective. In spite of such unparalleled efficacy, our understanding of the therapeutic mechanisms of ECT remains lacking. Using Electroconvulsive stimulation an animal model of ECTwe determine how ECT alters the mesoscale spatiotemporal activity of different brain regions.

Methods:

Wide-field fluorescent imaging of resting-state activity was performed in awake head-fixed mice expressing GCaMP6 . This allowed longitudinal imaging of intracellular calcium which reflect changes in spiking activity at a cellular level. ECS was done once daily, every other day, for a total of 10 treatments. Imaging was done daily ~10min and 24h after ECS.

Results:

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