Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a treatment for patients who do not respond to other treatments for severe major depression,bipolar disorder, or schizophrenia.

ECT is a brief electrical stimulation of the brain performed while the patient is sedated. It is usually administered by a team of trained medical professionals consisting of a psychiatrist ,an anesthesiologist , and a nurse.

ECT is typically used when other types of methods of treatment, such as medications and psychotherapy have failed. Electroconvulsive therapy is also used for people who require a quick treatment response due to the severity of their condition, such as suicidal tendency.

Electroconvulsive therapy is very effective for treating episodes of serious mental disorder, but it does not prevent the illness from returning in the future. As a result, the majority of people who receive ECT must continue to receive some type of maintenance treatment. This typically means medication and/or psychotherapy or, in some circumstances, ongoing ECT treatments.

Types of ECT:

There are 2 types of ECT.

Bilateral ECT. This is when the current is passed through both sides of your head.
Unilateral ECT. This is when the current is only on one side of your head.

Procedure

Before the procedure:

The patient should receive medical examination, a thorough psychiatric assessment, some basic blood tests, chest x-ray, an electrocardiogram(ECG) to check heart health and pregnancy tests for women before undergoing a series of ECT treatments.
Informed consent is another important part of the process. A patient must provide written informed consent before ECT is administered.
Patients and their families should discuss all options for treatment with the psychiatrist before making a specific treatment decision.
A patient typically receives ECT 2-3 times a week for a total of 6 to 12 sessions, depending on the severity of symptoms and how quickly the symptoms respond to the treatment.
You must fast for at least 8 hours before ECT, though you may be allowed to drink sips of water to take essential medication as directed by the doctor. This is done to ensure your safety during the anesthesia.

During the procedure:

At the time of each treatment a patient is given general anesthesia through an intravenous (I.V.) line, and once you are asleep, you are given a muscle relaxant.
A mouth guard will be placed in the mouth to protect your teeth from injury.
Electrodes are placed on your scalp to monitor your brain activity. Two electrodes monitor your brain activity. Another two electrodes are used to deliver the electric current.
Then, electrodes are applied to deliver a brief electrical current to induce a seizure. This mild, brief electrical pulse does not cause any harm, pain or damage to your skin, head or brain.
Two metal discs will be positioned on your head. One electrode is placed on each side of the head in case of bilateral ECT, whereas both the electrodes are placed on the same side of the head in case of unilateral ECT.
The patient's brain is stimulated with a brief controlled series of electrical pulses. This causes a seizure within the brain that lasts for approximately a minute.
Your body will stiffen, followed by twitching, most commonly in your hands, feet, and face. The muscle relaxant reduces the amount of movement in your body.
The patient is asleep for the procedure and awakens after 5-10 minutes, much as from minor surgery.
The dose of electric pulses delivered is determined by the amount required to induce a fit. Your reaction will be monitored, and the dose will be adjusted as needed.

After the procedure:

The muscle relaxant will wear off after a few minutes. As you begin to wake up, the medical team will shift you to the recovery area.
The nurse will check your vitals, including your blood pressure, and ask simple questions to determine how awake you are. A small device will be placed on your finger to measure the amount of oxygen level in your blood. You might wake up wearing an oxygen mask.
The whole procedure usually takes about an hour.

Benefits

ECT is an effective therapy for severe depression. It is usually recommended when people have symptoms that have not responded to medications or psychosocial treatments.

ECT can be beneficial for those who are:

suicidal
catatonic
psychotic

Risks

However, despite the pain-free nature of modern ECT, the treatment can still cause some side effects, including:

Confusion right after the procedure that generally lasts for only a short period of time.
Headache may occur, and medication will be given at the time of the procedure.
Blood pressure changes, including low or high blood pressure.
Memory loss, mostly about or surrounding the time of the procedure.
Occasionally patients experience longer memory loss, concerning autobiographical details from the past. This memory problem typically begins to clear after the ECT treatment frequency is reduced.
Muscle soreness from the anesthetic can occasionally occur at the onset of treatments, but is usually mild.
Nausea from the anesthesia. If this occurs, medication is given at the time of the procedure.
Rapid heartbeat or other heart problems. Cardiovascular problems are screened before the procedure.
Some medical problems make ECT a higher risk. The physician will discuss these with you prior to deciding whether ECT is right for you.

Some patients report temporary confusion immediately following treatment lasting from a few minutes to hours. They might also report physical effects, such as headaches, muscle pain and nausea.

Other side effects can include:

Confusion
Minor memory loss
Adverse reactions to anesthesia
Blood pressure problems like hypertension and hypotension.