Electroconvulsive therapy (ECT)
When is ECT used?
ECT is still the strongest and most powerful treatment we have for severe depression. It can and does save lives. Sadly, it has had a very bad press. When ECT was introduced in the early 1940s, it was undoubtedly overused. It began because some psychiatric patients, who also had epilepsy, seemed to do better than similarly ill patients without epilepsy. Medically induced fits were then shown to help patients with severe depressive illness. At that time there were no antidepressants or tranquillisers – just sedatives. People were desperate to find an effective treatment.
Then it was given without anaesthetic, which made it look a frightening and fierce treatment. Memories of this (plus reminders through the media) perpetuate the bad old image of ECT. ECT is now given under strictly prescribed guidelines and is very different from its original practice.
ECT is given to people with severe and life-threatening depressive illness, and it includes those people who are not eating or drinking adequately, or who are judged to be a serious suicide risk. Some depressive illnesses cause abnormal thinking – delusions (or false beliefs). This type of depression responds well to ECT. ECT is sometimes recommended for people with resistant depression (an illness not improving after two full courses of antidepressant medication). It may be given when the side-effects of medication are risky. This may happen in the elderly or frail. It is sometimes used in serious postnatal depressive illness, because it is fast and effective. It is essential to try and gain improvements quickly in this situation. A sick mother cannot bond with her baby.
If ECT is recommended it does not mean that you are potentially incurable and that the doctors are suggesting a ‘last ditch treatment’. I am worried that I will be asked to have ECT when I am in hospital.
Can ECT harm – or even kill you?
ECT is safe. It can be safely given to people with other illnesses, and does not clash or interact with medication. It is particularly effective in severe depression. There is no evidence that it can cause brain damage, and does not affect your intelligence or personality. The risk of dying during the procedure is about 2 per 100,000 procedures – this is the risk of having a general anaesthetic; ECT itself does not itself pose a danger. There is good and strong evidence that it prevents suicide.
What happens during ECT?
You will also be asked to sign a consent form (because an anaesthetic is to be given). A relative cannot consent for ECT on another person’s behalf. Prior to each treatment, you can have nothing to eat or drink for 5 hours. This is standard preanaesthetic practice – for all anaesthetic procedures, not just brief ones like ECT.
You will have routine blood tests, and a physical examination (as for any other anaesthetic) before treatment. The treatment involves having a carefully controlled current of electricity passed via both temples while you are fully anaesthetised (totally asleep and totally muscle relaxed).
The amount of current used is low. The anaesthetic is brief – a matter of a few minutes. The current causes a brief and controlled seizure (or fit). The exact mechanism by which ECT works is not fully known (but then we are not sure how may drugs work either), but it does seem to increase the sensitivity of the brain to its own neurotransmitters. After the treatment, you sleep for perhaps 5-15 minutes. You may be a little drowsy, but you usually awake longing for a cup of tea within 30 minutes of treatment.
Are there any side-effects of ECT in the short term?
Yes. Headache is common – it usually is short-lived and responds to a simple analgesic like aspirin or paracetamol. There may besome muscle aches and pains – this is an effect of the muscle relaxant agent given with the anaesthetic. It is most prominent during the first or second treatment and will go away. Memory is usually fuzzy for a time just before treatment and just after it (as it would be with any other anaesthetic).
Are there any long-term effects of ECT?
Almost certainly, no. This is a question that has been widely and very carefully researched both in Europe and the USA. It is still debated. If damage does occur, it is a result of the anaesthetic not of the actual seizure. People who were given very long and frequent courses of ECT in the past may show some memory impairment. ECT given as it is today has given rise to no discernible problems with memory. In fact, overall, of people who are equally severely depressed, those who have ECT do better than those who do not (if you test their memory some years later). The memory problems that have been reported are very difficult to evaluate. People who are depressed enough to warrant ECT generally have poor concentration – if you haven’t taken in information it will not be there to retrieve. It may seem that you have forgotten something but in fact the information wasn’t processed. Another complicating variable is that of medication.
Some antidepressants are sedating and contribute to a feeling of poor memory.
How many ECT treatments are necessary?
This depends very much on the individual’s response. The average course of ECT is about six to eight treatments. Treatments are usually given twice weekly. You may start to feel better after the first treatment – perhaps sleeping better that night, or there may be no discernible change until after the second or third treatment. Some people need only two or three treatments, others need up to 12. Treatment will be stopped when the rate of improvement levels out.
