Electroconvulsive Therapy (ECT) Service

 Director: Irving M. Reti, MBBS

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 and can be done on an inpatient or outpatient basis.  

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.

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 generation 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. It may also help regulate hormones that play a role in these disorders.

People with major depression typically first receive psychotherapy, antidepressant medication or a combination of the two. 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.

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 generalized seizures 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 oriented and alert 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. Patients take antidepressant medication or may continue receiving ECT periodically to prevent relapse.

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.