Nature and Working of ECT

ECT (Electroconvulsive Therapy) is a psychiatric treatment for mental diseases that was devised in early 1930s. It has had various incarnations before modern method has evolved. ECT is used only for severe illnesses, though it still remains a controversial therapy. An electric charge is employed to stimulate a controlled seizure meant for treatment for chemical imbalances in the brain.

ECT works on the basis of seizures, which are specifically and purposefully induced in a person. Treatment through causing seizures is how this therapy works. Previously, chemicals were used to induce seizures, which also caused some side effects. In the modern method, electric charge is made to pass across the brain of a person in a controlled condition, using a sophisticated apparatus. The electric charge can be applied selectively to one side of the brain (unilateral ECT), or to both the parts of the brain (bilateral ECT).

The frequency of electroconvulsive therapy is generally 2 to 3 times a week. A more severe condition of a patient may require up to 15 treatments. Maintenance treatment for a couple of times may be necessary to prevent possible relapse. The modern ECT is considered safe and without any pain.

ECT Procedure

The patient is administered a short duration sleep inducing medication and also a muscle relaxing drug to prevent muscles from tightening, which act may induce bone fractures. In unilateral ECT procedure, an electric conductor is positioned above the temple of the non-dominant side of the brain (for right-handers, right side of brain is non-dominant as left lobe of brain controls right hand functions) and another conductor is positioned near the center of forehead. In case of bilateral ECT, conductors are positioned on temples on both sides of the head, besides one on the forehead.

A minute electric charge is sent across the brain to activate it, which acts as a stimulus to create a seizure. The electric charge may not last more than a second and oxygen is supplied to the patient all through. Arrangements will be in place to observe seizure behavior and heart beats. These seizures will be like the ones that an epileptic person undergoes frequently. The quantum of electric current that is needed for inducing seizures is decided based on the type and severity of illness and the seizure generally lasts between ten and fifty seconds.

Purpose of ECT

The aim of ECT is to give succor from the symptoms of several mental illnesses. ECT may provide relief to people with following conditions:

Clinical depression with sleeping disorder; weight alterations; desperation; suicidal inclinations; self-criticism; and homicidal tendencies.

Clinical depression that could not be cured from antidepressants or counseling.

Clinical depression in patients who are allergic to antidepressant medications.

Acute mania that is insensitive to medications. Talkativeness, sleeplessness, weight loss, etc are some of the symptoms of acute mania.

Schizophrenia that is non-responsive to medications.

ECT is recommended to patients whose behavior is going out of control and when patients are increasingly becoming suicidal and self-inflicting in nature. It is also prescribed when patients refuse to eat or drink, refuse medications, or can not take medications due to allergic reasons, and who become a danger to themselves. Antidepressant medications will take at least 2-6 weeks to take effect in severely depressed patients, but these patients may become uncontrollable, which may warrant immediate ECT.

Side Effects of ECT

ECT patients are given anesthesia during the therapy. This anesthesia may result in temporary adverse effects. The very procedure of seizure-inducing ECT will result in side effects. The question of long-term consequences of ECT has become a contentious issue. Some people are worried about permanent memory loss. Others complained of personality changes and lost skills which they had prior to ECT. Both the above mentioned factors are generally the cause of adverse effects. The possible side effects include:

Loss of memory that is of short-term duration and temporary in nature.

Perplexity and disorientation.

Aching muscles and twitching fingers.

Severe headaches and heaviness in head.

Nausea

Changes in blood pressure.

Changes in heart beats or erratic heart beats.

Precautions with ECT

As general anesthesia will be given during ECT, it is advisable to avoid eating or drinking at least eight hours before ECT treatment to prevent aspiration or vomiting during the procedure. Bladder should be emptied to avoid incontinence. Patients who have blood pressure problems or who are very sensitive to anesthesia should consult physicians before submitting themselves to ECT.