Electroconvulsive Therapy (ECT) Service

The Brain Stimulation Program
The Johns Hopkins Hospital
600 N. Wolfe Street
Meyer 3-181
Baltimore, MD 21287

Phone: 410-614-1732
Directions

Each year hundreds of patients are treated with electroconvulsive therapy (ECT) in the Department of Psychiatry and Behavioral Sciences. This procedure has proven helpful for a number of psychiatric disorders, including major depression, and can be done on an inpatient or outpatient basis. 

Translating Research into Better Treatment

Johns Hopkins now provides ECT treatment with ultra-brief pulses to reduce cognitive side-effects. Recent studies demonstrate that ECT delivered with ultra-brief pulses produces less memory loss and other cognitive side effects than ECT delivered with standard pulses. Historically, ECT has been administered with pulses that are one millisecond in width whereas recent studies have delivered ECT with pulses in the range of 0.25-0.37 milliseconds, which also triggers a seizure but more efficiently and with fewer cognitive side effects. 

A recent study comparing the two modes of stimulus delivery: In this study, patients receiving ultra-brief pulses not only had fewer side effects but responded to the treatment just as well and as quickly as patients receiving standard pulses.

Another study by other researchers also showed ultra-brief pulses produced less cognitive side effects as well as similar rates of efficacy. However, in the latter study patients on average required more treatments to get well with ultra-brief pulses.

What is ECT?

ECT is a safe and effective treatment that involves passing a carefully controlled electrical current through a person’s brain to trigger a seizure — a rapid discharge of nerve impulses throughout the brain. In recent years, the National Institute of Mental Health, the American Psychiatric Association, and the U.S. Surgeon General all endorse ECT as a valuable tool in the treatment of certain psychiatric disorders, and major depression in particular.

Why does ECT work?

No one is sure how ECT helps certain psychiatric disorders. It may promote changes in how brain cells communicate with each other at synapses and it may stimulate the development of new brain cells. ECT may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in conditions like depression and schizophrenia.

When is ECT used?

People with major depression typically first receive antidepressant medication and psychotherapy. These treatments, though often effective, take time to work. This delay can be dangerous for patients whose depression is accompanied by delusions (false beliefs) or intense suicidal thoughts. ECT can work much more quickly than antidepressants and is useful when patients are at immediate risk for self-injury or suicide.

ECT may also be prescribed when antidepressant medications have not worked. It can be useful for older patients who are unable to tolerate antidepressants and for pregnant women in whom medication might damage the fetus. People suffering from bipolar disorder and schizophrenia may also benefit from ECT.

What happens during an ECT procedure?

After the patient receives general anesthesia and a muscle relaxant, electrodes are placed on two specific places on the patient's scalp. A short, controlled set of electrical pulses is then given for a few seconds. The electrical pulses must produce a generalized seizure to be effective. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current.

Patients awaken about 5 to 10 minutes after the end of the treatment, and most are clear -headed within a half-hour. Patients who are given ECT on an outpatient basis should have someone drive them home after the procedure and stay with them until they go to sleep that night. People should not drive in the 24 hours following ECT.

Typically, ECT is given on an inpatient basis two to three times a week for a total of 6 to 12 sessions. These sessions improve depression in 70 to 90 percent of patients, a response rate much higher than that of antidepressant drugs.

Although ECT is effective, its benefits are short-lived. Within a year, about 50 percent of patients relapse. For this reason, patients take antidepressant medication after ECT or may continue receiving ECT periodically to prevent relapse.

What are the side-effects of ECT?

The immediate side effects of the procedure include headaches, nausea, muscle aches and soreness, disorientation, and confusion lasting about an hour. Patients may also develop memory problems. Memories formed closer to the time of ECT are at greater risk of being lost while those formed long before ECT are at less risk of being lost. The ability to form new memories is also impaired after a course of ECT treatments but this abilty usually makes a full recovery in the weeks and months following the last treatment. 

How can I get outpatient ECT?

We offer outpatient ECT treatment at Johns Hopkins. However, outpatient ECT treatment is not appropriate for all patients. Before scheduling you for treatment, you much first be evaluated by one of our ECT psychiatrists to determine if it would be safe and appropriate for you. Please call 410-614-1732 for Jesus Gallegos, who can provide you with details on how to be evaluated for treatment.

Payment and Insurance

As an ECT patient at The Johns Hopkins Hospital Department of Psychiatry, you will receive separate bills from the Physicians and from the Hospital. The Johns Hopkins University submits bills for the professional fees charged by its Physicians. The Johns Hopkins Hospital bills for hospital and facility charges. The Johns Hopkins Hospital and The Johns Hopkins University Physicians participate with Medicare, Medical Assistance of Maryland, and various other payers and managed care organizations. They do not, however, participate with all payers. Regulations also require us to bill for deductibles and co-payments, even for those insurances with which we participate. Co-payments will be required before or at the time of service.

Depending upon your insurance, you may not receive a bill at all, but instead receive an ‘explanation of benefits’ which will outline what your insurance was charged and what was paid on your behalf.

The Johns Hopkins Hospital may participate with a health plan, but The Johns Hopkins Physicians may not. In this instance, you would be responsible for paying for the portion of your physician’s bill that your insurance plan does not cover.

To be evaluated or to learn more, call Jesus Gallegos at 410-614-1732.