ECT is a form of electric shock treatment in which patients are administered an electric current to induce a generalized convulsion. Before application, patients are given general anesthesia and a muscle relaxant. Depending on the practitioner, the anesthesia dose will either strongly sedate or fully anaesthetize the patient. At the time of treatment, electrodes are placed in accordance with the patient’s condition. Stimulus waveform, electrode placement, and number of treatment iterations all contribute to ECT’s effect. Stimulation is normally applied above an individual’s seizure threshold. It should be noted that increasing ECT dose has been positively correlated with cognitive impairment probability.1Additionally, the National Institute for Health and Clinical Excellence (NICE) has noted that bilateral electrode placement is associated with likelier cognitive impairment than unilateral placement. An ECT session generally lasts 5-10 minutes, with several sessions performed per week for sometimes over a month. To maximize relief, pharmacological agents are often taken periodically after treatment to prolong ECT’s therapeutic effects.
When ECT is preferential:
According to the FDA’s 2011 executive summary, because ECT is a controversial treatment, it is generally reserved as a last-stitch treatment for select disorders, such as: major depressive disorder, mania, and catatonia. Beyond this scope, WebMD assesses ECT as suitable for patients who are: at severe risk of suicide, resistant to pharmacological treatments, in a catatonic stupor, schizophrenic, bipolar (either phase), and depressed. Although controversial, ECT was shown to relieve depression twice as well as TMS for treatment-resistant patients, using Hamilton’s depression scale.2 Moreover, the Mayo Clinic asserts ECT as a safe technique today, and attributes the lack of anesthesia in early ECT to the stigma it landed. There is speculation on the exact mechanisms behind ECT, and at this point the mechanisms of action remain unclear.
Side-effects of ECT:
Side-effects of ECT include: confusion, soreness, seizure, pain, and retrograde amnesia. The bout of retrograde amnesia that commonly comes with ECT is usually transient, and can be assessed with the autobiographical memory interview (AMI). A pulsating technique has been shown to incur less memory loss, and this is a common technique for current ECT practitioners.3
1 Rudorfer, M. V., Henry, M. E., & Sackeim, H. A. (2003). Electroconvulsive therapy. Psychiatry, 2, 1865-1901.
2Micallef-Trigona, B. (2014). Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression: a systematic review and meta-analysis. Depression research and treatment, 2014.
3Benbow, S. M. (2004). Adverse effects of ECT” In AIF Scott (ed.) The ECT Handbook secod edition, The Royal College of Psychiatrist.