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Electroconvulsive therapy (ECT) is a procedure in which a brief
application of electric stimulus is used to produce a generalized
seizure. It is not known how or why ECT works or what the
electrically stimulated seizure does to the brain. In the U.S.
during the 1940’s and 50’s, the treatment was
administered mostly to people with severe mental illnesses. During
the last few decades, researchers have been attempting to identify
the effectiveness of ECT, to learn how and why it works, to
understand its risks and adverse side effects, and to determine the
best treatment technique. Today, ECT is administered to an
estimated 100,000 people a year, primarily in general hospital
psychiatric units and in psychiatric hospitals. It is generally
used in treating patients with severe depression, acute mania, and
certain schizophrenic syndromes. ECT is also used with some
suicidal patients, who cannot wait for antidepressant medication to
take effect.
How is it
administered?
ECT treatment is generally administered in the morning, before
breakfast. Prior to the actual treatment, the patient is given
general anesthesia and a muscle relaxant. Electrodes are then
attached to the patients scalp and an electric current is applied
which causes a brief convulsion. Minutes later, the patient awakens
confused and without memory of events surrounding the treatment.
This treatment is usually repeated three times a week for
approximately one month. The number of treatments varies from six
to twelve. It is often recommended that the patient maintain a
regimen of medication, after the ECT treatments, to reduce the
chance of relapse.
To maximize the benefits of ECT, it is crucial that the
patient’s illness be accurately diagnosed and that the risks
and adverse side effects be weighed against those of alternative
treatments. The risks and side effects involved with the use ECT
are related to the misuse of equipment, ill-trained staff,
incorrect methods of administration, persistent memory loss, and
transient post-treatment confusion.
Why is ECT so
controversial?
After 60 years of use, ECT is still the most controversial
psychiatric treatment. Much of the controversy surrounding ECT
revolves around its effectiveness vs. the side effects, the
objectivity of ECT experts, and the recent increase in ECT as a
quick and easy solution, instead of long-term psychotherapy or
hospitalization. Because of the concern about permanent memory loss
and confusion related to ECT treatment, some researchers recommend
that the treatment only be used as a last resort. It is also
unclear whether or not ECT is effective. In some cases, the numbers
are extremely favorable, citing 80 percent improvement in severely
depressed patients, after ECT. However, other studies indicate that
the relapse is high, even for patients who take medication after
ECT. Some researchers insist that no study proves that ECT is
effective for more than four weeks.
During the last decade, the “typical” ECT patient has
changed from low-income males under 40, to middle-income women over
65. This coincides with changing demographics. The increase in the
elderly population and Medicare, and the push by insurance
companies to provide fast, “medical” treatment rather
than talk therapy. Unfortunately, concerns have been raised
concerning inappropriate and even dangerous treatment of elderly
patients with heart conditions, and the administration of ECT
without proper patient consent.
Is ECT an option?
The patient and physician should discuss all options available
before deciding on any treatment. If ECT is recommended, the
patient should be given a complete medical examination including a
history, physical, neurological examination, EKG and laboratory
test. Medications need to be noted and monitored closely, as should
cardiac conditions and hypertension. The patient and family should
be educated and informed about the procedure via videos, written
material, discussion, and any other means available before a
written consent is signed. The procedure should be administered by
trained health professionals with experience in ECT administration
as well as a specifically trained and certified anesthesiologist to
administer the anesthesia. The seizure initiated by the electrical
stimulus varies from person to person and should be monitored
carefully by the administration team. Monitoring should be done by
an EEG or “cuff” technique. The nature of ECT, its
history of abuse, unfavorable medical and media reports, and
testimony from former patients all contribute to the debate
surrounding its use. Research should continue, and techniques
should be refined to maximize the efficacy and minimize the risks
and side effects resulting from ECT.
For more information contact:
National Mental
Health Association
2001 N. Beauregard Street
12th Floor
Alexandria, VA 22311
Phone 800-969-6642
National
Institute of Mental Health
Public Inquiries
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892
Phone 866-615-6464
American
Psychiatric Association
1000 Wilson Blvd., Suite 1825
Arlington, VA 22209
Phone 888-357-7924
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