Amorsolo, Aris Ainar, A.

Group 1-RLE
4-ACN NCMH

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is a procedure in which electric currents are passed through the
brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes
in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often
works when other treatments are unsuccessful. Electroconvulsive therapy is based on early
treatments in which high doses of electricity were administered without anesthesia, leading to
memory loss, fractured bones and other serious side effects. Electroconvulsive therapy is much
safer today. Although electroconvulsive therapy still causes some side effects, it now uses
electrical currents given in a controlled setting to achieve the most benefit with the fewest
possible risks.

Electroconvulsive therapy can provide rapid, significant improvements in severe symptoms of a

number of mental health conditions. It may be an effective treatment in someone who is
suicidal, for instance, or end an episode of severe mania. ECT is used to treat:

 Severe depression, particularly when accompanied by detachment from reality

(psychosis), a desire to commit suicide or refusal to eat.
 Treatment-resistant depression, long-term depression that doesn't improve with
medications or other treatments.
 Schizophrenia, particularly when accompanied by psychosis, a desire to commit suicide
or hurt someone else, or refusal to eat.
 Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part
of bipolar disorder. Other signs of mania include impaired decision making, impulsive or
risky behavior, substance abuse and psychosis.
 Catatonia, characterized by lack of movement, fast or strange movements, lack of
speech, and other symptoms. It's associated with schizophrenia and some other
psychiatric disorders. In some cases, catatonia is caused by a medical illness.
 Electroconvulsive therapy is sometimes used as a last-resort treatment for:
 Treatment-resistant obsessive compulsive disorder, severe obsessive compulsive
disorder that doesn't improve with medications or other treatments
 Parkinson's disease, epilepsy, and certain other conditions that cause movement
problems or seizures
 Tourette syndrome that doesn't improve with medications or other treatments
ECT may be a good treatment option when medications aren't tolerated or other forms of
therapy haven't worked. In some cases ECT is used:

 During pregnancy, when medications can't be taken because they might harm the
developing fetus
 In older adults who can't tolerate drug side effects
 In people who prefer ECT treatments over taking medications
 When ECT has been successful in the past.

Although ECT is generally safe, there are known risks and side effects. These include:

 Confusion. Immediately after an ECT treatment, you may experience a period of

confusion. You may not know where you are or why you're there. This confusion may
last from a few minutes to several hours. You may be able to return to work and normal
activities right away; or, you may need to rest for several hours after treatment. Rarely,
confusion may last several days or longer. Confusion is generally more noticeable in
older adults.
 Memory loss. ECT can affect memory in several ways. You may have trouble
remembering events that occurred before treatment began, a condition known as
retrograde amnesia. It may be hard to remember things in the weeks or months leading
up to treatment, although some people do have problems with memories from years
previous, as well. You may also have trouble recalling events that occurred during the
weeks of your treatment. These memory problems usually improve within a couple of
months.
 Physical side effects. On the days you have an ECT treatment, you may experience
nausea, vomiting, headache, jaw pain, muscle ache or muscle spasms. These are
common and generally can be treated with medications.
 Medical complications. As with any type of medical procedure, especially one in which
anesthesia is used; there are risks of medical complications. During ECT, heart rate and
blood pressure increase, and in rare cases, that can lead to serious heart problems. If
you have heart problems, ECT may be more risky.

Before having your first ECT treatment, you need a complete physical examination, in addition
to a psychiatric evaluation. You may also see an anesthesiologist to go over risks associated
with having anesthesia. A pre-ECT evaluation usually includes:

 A medical history
 A physical examination
 Basic blood tests
 An electrocardiogram (ECG) to check your heart health
The ECT procedure takes about 10 or 15 minutes, with added time for preparation and
recovery. ECT may be performed while you're hospitalized or as an outpatient procedure. In
either case, it's done under general anesthesia, which means you'll be unconscious during the
procedure. Your health care team will tell you how long you must avoid food and drinks before
ECT treatment.

When it's time for the procedure, you may have a brief physical exam to check your heart and
lungs. An intravenous (IV) catheter is inserted in your arm or hand through which medications
or fluids can be given. During the procedure, monitors constantly check your heart, blood
pressure and oxygen use.

You may be given oxygen through an oxygen mask. Doctors place electrode pads, each about
the size of a coin, on your head. ECT can be unilateral, in which only one side of the brain is
subject to electricity, or bilateral, in which both sides of the brain receive electrical currents. An
anesthetic is injected in the IV to make you unconscious and unaware of the procedure. A
muscle relaxant also is injected to help prevent your body from convulsing violently during the
seizure. When the procedure begins, the doctor can make sure you're actually having a seizure
by watching for movement in that one hand or foot. You may also be given a mouth guard to
help protect your teeth and tongue from injury.

When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a
button on the ECT machine. This causes a small amount of electrical current to pass through the
electrodes to your brain, producing a seizure that usually lasts 30 to 60 seconds.

Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure.
The only outward indication that you're experiencing a seizure may be a rhythmic movement of
a foot or a hand. But internally, activity in your brain increases dramatically. This is recorded by
an electroencephalogram (EEG) in much the same way as an ECG measures your heart's
activity. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a
leveling off that shows the seizure is over. A few minutes later, the effects of the short-acting
anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you're
monitored for problems. Upon awakening, you may experience a period of confusion lasting
from a few minutes to a few hours or more.

After your symptoms improve, you likely will need ongoing treatment to prevent a recurrence.
That ongoing treatment, known as maintenance therapy, doesn't have to be ECT, but it can be.
More often, it includes antidepressants or other medications or psychological counseling
(psychotherapy).