ELECTRO-CONVULSIVE THERAPY (ECT)

What is ECT?

ECT is basically an electric shock delivered to the brain which produces fits or seizures in the person receiving it. It has been controversial since it was first introduced and remains so today.

How many times is it given?

Usually between 6 and 12 times in a course of treatment.

How is it done?

The patient is asked to lie down on a bed in the treatment room. Their shoes, dentures, watches and jewellery are then removed.

Present in the room should be an anaesthetist (a doctor who specialises in putting you to sleep, looking after you while you are asleep, and then waking you up again), a pyschiatrist (a medical doctor specialising in mental illness), and one or more nurses.

The patient is hooked up to a few monitors via electrodes (or to most people sticky pads), generally placed on their head and fingers. These allow the doctors to monitor the patient during the treatment. The patient is then given injections. This is usually done via a needle that is inserted in the back of the hand, this is only done once and allows more than one drug to be put into the body without the need for a lot of injections.

The first drug injected puts the patient to sleep. Often at this point the patient will be given an oxygen mask to try and enrich the amount of oxygen in their blood, and thus reaching their brain and vital organs. Once the anaesthetist is satisfied that all the vital signs being monitored are safe, they will inject another drug. This is a muscle relaxant, that is designed to reduce the physical effects of the fit that the treatment will produce. In other words to stop peoples' arms and legs flailing around when they fit as this may injure them or other people.

The current is then charged up to the right level, this is typically around 80 volts. The psychiatrist then puts two padded electrodes on the patient's temples (or occassionally on the same side of the head), and the person is given a shock. Almost immediately, the patient stiffens as their muscles tighten up, and they will start to twitch. The anaesthetist will pass a tube down the patient's throat to ensure that the person can breathe and doesn't choke. The amount of time the twitching lasts is written down, this is basically how long the fit lasts.

Once the fit has finished, and the team is certain that there are no medical complications, the patient is ready to be woken up. A nurse will monitor a persons' recovery, and remove all the tubes and leads that were used in the treatment. This is often done in a specialised recovery room. When the person wakes up they are usually given a cup of tea or some such similar drink, and left for a while longer before they are ready to return to a hospital ward.

How does the person feel afterwards?

Pretty rough but this doesn't usually last for too long.

As people wake up they may feel confused, disorientated and even agitated. People have reported having headaches and a loss of recent memories (not too surprising really!). These usually fade and return to normal although it is common for people to go back to bed when they return to the ward and sleep for a couple of hours.

Sounds horrible why have it?

Because it's been shown to work, although nobody really knows how. Some people think that during the fit, a person's brain 'resets', almost like a computer.

It's usually used as a last resort treatment for serious long term (the technical name is endogenous) depression that won't go away using other more common treatments (like medication and psychotherapy). However, how it is used varies a lot from one area or hospital to another. Some professionals believe that it helps treat conditions like Schizophrenia, Mania (this is basically being 'hyper' or extremely excitable.

There is no convincing scientific evidence that it works for anything other than serious long-tern depression!

What are the risks with ECT?

The statistical risk of dying is roughly 4 in 100,000 people that receive ECT. Since it has been estimated that there are around 138,000 treatments a year in Britain, this means that six people may die.

Sounds bad, but when compared with how many people die from unintentionally overdosing on anti-depressant drugs (over 400 in Britain), the risk can be better judged.

Memory loss has also been reported to last a lot longer than a few hours, although there really isn't much research around in this area.

What should I check?

Before ECT is given, doctors are required by UK law to gain consent for treatment. If consent is not given, or if it is withdrawn at any time, the ECT should be stopped.

The only circumstances when it can be given without the patient's consent are when immediate ECT is judged necessary to save a patient's life or to prevent serious injury or death to other people (Perhaps meant for such cases as suicidal parents, who may pose a risk to their children?). Or, when the patient is detained in hospital under the law (in the UK, this is under something called the Mental Health Act, 1983 and is known as being Sectioned. However, even if the person is sectioned, this only applies under certain parts of the law, and a doctor is still required to get the agreement of two other people who have been caring for the patient, one must be a nurse, and the other is usually a social worker.

BEWARE  ECT is still given for what seems to us at SimplePsych as dubious, not really thought through reasons. Often as a 'try it and see what happens' form of treatment or for various conditions such as Schizophrenia where there is no good evidence that it is more effective that other forms of treatment around. It is our opinion, that people with Personality Disorders may also be receiving it, quite inappropriately at times.

Since we have already said that about 138,000 treatments occur in Britain each year, and that only a small minority of people who suffer from depression, have an endogenous depression, the case for the misuse of ECT remains quite strong. Therefore, as a sort of safeguard checklist we would encourage you to ask the following questions before agreeing to ECT -

• Is there any therapy that can be used instead of ECT at the moment?
• Does the ECT offered here follow the guidelines recommended by the Royal College of Psychiatrists?
• How many treatments are planned and when will you know the person has had enough?
• If you remain unconvinced, seek some independent psychological/medical advice.

Summary

To summarise, ECT has been shown to work sometimes in severe long-term (endogenous) depression. Nobody really knows how it works but it is thought that something happens during the fit which some people think is like the effect of resetting a computer, all the basic things are still there when you start up again, but you may have lost some of the programs (ie negative thoughts and feelings) you have been running recently.

Finally, make sure that you fully understand why ECT is being given, and if in doubt seek some sort of independent advice.

We are thinking of creating a SimplePsych factsheet on ECT which goes into more detail while still using easy to understand English. If you would be interested at this service being offered to you please let us know by emailing us Click Here

Thank you.

*** RECOMMENDED BOOKS ***

If you are interested in going into even more depth, the following book(s), sold by are recommended by us.

Each is followed by a rating for ease of reading (1-3).

1 = Simple and Easy to comprehend.

2 = More Complex, but still a good read.

3 = Very Complex, only for professionals/those studying to degree level.

"Clicking" On The Book will take you to Amazon where if you "Click" on the shopping basket you will be able to buy it.

	Handbook of ECT (Kellner (ed.)) Price £18.95
RATING = 3	An Excellent Guide aimed at Medical Professionals.

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