Electroconvulsive Therapy (ECT)
Dukakis, the wife of former governor and presidential candidate Michael Dukakis, took her first diet pill at 19, and continued for 25 years. In 1982, the minute she ended her dependency on amphetamines, the depression started. Subsequently in 1988, her husband lost his presidential bid and Kitty Dukakis resorted to seek relief from severe bouts of depression by turning to alcohol. For the next 20 years, she often frequented psychiatric centers seeking treatment for depression. Kitty was overwhelmed with despair and drug and alcohol addictions worsened her miseries. She tried every available medication and treatment; nothing worked for long. Not until she tried electroconvulsive therapy, or ECT, when she could proclaim and reclaim her life once again. In her own words, as she claimed, ECT was a miracle in their lives.
Later in 2006, she detailed her life’s saga in her book “Shock: The Healing Power of Electroconvulsive Therapy” separating scare from the promise, real complications from the explicit headlines. In the process she provided through her book practical guidance to prospective patients and their families, audaciously addressing the controversy surrounding ECT and arousing millions to its capacity to heal.
Understanding ECT
Deliberate passing of electric current to trigger brief seizures to cure certain mental illnesses including depression is called Electroconvulsive therapy (ECT) or electric shock.
During this therapy which is administered in the hospital environment, the patient is given general anesthesia (putting the patient temporarily under deep sleep with the help of a medicine so that the patient does not feel any pain), then a small amount of electricity is delivered to the brain through electrodes attached to the scalp to cause seizures for a short period of 40 seconds. Medicine is given so that the seizure does not spread to other parts of the body. ECT is given once in 2-5 days lasting not more than 6-12 sessions.
ECT seems to work by bringing changes in the chemistry of the brain and applied when other treatments prove unsuccessful. In the present day, ECT is much safer though there was a stigma attached to the treatment in the earlier days.
Applications of electroconvulsive therapy
Electroconvulsive therapy (ECT) may be applied to patients suffering from the following conditions.
- Patients of severe depression who exhibit symptoms of sleep disturbances, changes in weight, feelings of melancholy, hopelessness and despair, suicidal (hurting or killing oneself) or homicidal (hurting or killing others) thoughts
- Patients of severe depression who do not respond to the usual treatment of anti-depressants or counseling
- Patients of severe depression who cannot take anti-depressant medications
- Patients who suffer from sever maniac conditions such as severe agitation, hallucinations or confusion or delusions
- Patients who suffer from schizophrenia (mental disorder with disorientated process of thinking and response)
- Patients who suffer from Catatonia manifested by absence of movement, abnormal movements, absence of speech, and other symptoms.
- ECT is applied as a last resort therapy for obsessive compulsive disorder resistant to treatment and failed to respond to medicines and other treatments
- To patients with Parkinson’s disease (gradually worsening disorder of the brain and spinal cord lacking speech, movement and other conditions), epilepsy (mental disorder with recurrent seizures) , and certain other conditions that cause movement problems or seizures
- Tourette syndrome (mental disorder acquired from parents or ancestors characterized by sudden, non-rhythmic, stereotyped motor movements) that failed to improve with medications or other treatments
Mechanism of ECT
The seizures caused by ECT make the brain cells to release certain chemicals called neurotransmitters which transmit messages from one brain cell to another making the brain cells work cohesively, and thereby improving the mood of the patients.
Preparing for ECT treatment
Before an ECT, you will be subjected to psychiatric evaluation by a psychiatrist (medical professional trained in mental health). Your doctor conducts physical exam to evaluate whether you are fit to undergo the therapy. He may also check your complete medical history. Your blood test also may be carried out to check for any other complications. Electrocardiogram (ECG) may be carried out to check for your pulse, heart rate and rhythm. You may be required to meet your anesthesiologist (doctor who specializes in administering anesthesia) who may check your lungs and heart.
ECT treatment
The treatment is administered by a psychiatrist together with an anesthesiologist. The treatment is given in a hospital. Subsequently, ether you can continue to stay in the hospital or go home. ECT treatment is given 3-4 times a week and not more than 12 sessions.
An intravenous line is prepared before the treatment so that medicine can be injected directly into your bloodstream. A medicines to relax your muscles (muscle relaxant) and to put you to sleep temporarily (anesthetic) so that you do not experience any pain during the course of treatment are given. During the whole process your blood pressure and heart rates are closely monitored and watched. Electric current is passed to your brain through electrodes for 1 or 2 seconds making your brain to have seizures for 40 seconds. These seizures are controlled so that they do not affect other parts of your body.
Normally, it takes 5-10 minutes for you to wake up after treatment and subsequently you will be taken to recovery room to be watched. You can eat or drink when you are completely awake and recovered, and return to your hospital or go home.
Side effects of ECT
ECT treatment and anesthesia may cause some side effects. The common side effects include loss of memory for a short period, nausea, headaches or muscle aches or confusion. Other side effects observed are long-term loss of memory and changes in the blood pressure or heart beats. These are treated immediately as patient is watched throughout the treatment carefully.
After ECT treatment
Once all the ECT treatment sessions are completed, your depression will improve and you may be prescribed to take some anti-depressant medications or other medicines or you may be advised to continue psychological evaluations. It is very important for you to strictly follow your doctor’s instructions and take medicines and treatments regularly so that you will not be depressed again.
Summary
Electroconvulsive therapy is passing electricity into your brain so that seizures for 40 second are caused under general anesthesia. These seizures cause release of neurotransmitters in your brain, thereby improving transmission of messages between the brain cells. ECT is treatment is given to patients who suffer from severe depression and other psychological problems which do not respond well for conventional medications and counseling. ECT is given 2 to 5 times a week in the hospital by a psychiatrist and for not more than 12 treatments. Subsequently, you will feel better and you may be given some medications or advised to undergo counseling.
