What is Electroconvulsive Therapy (ECT)?
BDS (Bachelor of Dental Surgery), 6 years of experience
What is the meaning of Electroconvulsive Therapy (ECT)?
Electroconvulsive therapy (ECT) is an intrusive procedure that is used as a “final ditch” attempt to salvage patients from psychiatric conditions. Due to the apparent risks posed by this form of therapy, it is seldom used in general practice, unless it is indicated. Indications for the same are also dynamic and depend on the “risk to benefit” ratio posed by the condition
ECT works when other treatments are ineffective and after the full course of treatment is completed. However, it may not prove effective for everyone.
ECT, also commonly referred to as shock therapy, is misunderstood by many people. They think that this therapy includes giving a high dose of electric shock to the patient without anesthesia that can cause memory loss, bone fractures, and other serious side effects. According to the doctors, ECT is much safer today than other therapies, but it can still cause some side effects. ECT uses electric currents given in a controlled setting to obtain maximum benefits with the least possible risks.
Let us explain in detail Electroconvulsive Therapy in today’s article.
- What is the purpose of Electroconvulsive Therapy?
- What are the symptoms that need Electroconvulsive Therapy?
- What are the tests done before Electroconvulsive Therapy ?
- What is the preparation done for Electroconvulsive Therapy?
- What is the procedure of Electroconvulsive Therapy?
- What are the steps of care after Electroconvulsive Therapy?
- What are the risks of Electroconvulsive Therapy?
- How successful is Electroconvulsive Therapy?
- What is the cost of Electroconvulsive Therapy in India?
What is the purpose of Electroconvulsive Therapy?
Electroconvulsive therapy is an intervention used in psychiatry in cases showing severe to extreme symptoms, that by nature are refractory i.e. they do not respond to medicinal therapy. It has gained popularity by virtue of being effective and less time-consuming, showing early clinical results.
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What are the symptoms that need Electroconvulsive Therapy?
In practice, it can be performed to help people suffering from the following conditions and symptoms-
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- Mania causes nutritional deficiencies due to refusing food
- In cases of emergency like pregnancy where immediate treatment is required
- When antidepressant therapy is not working in patients with depression
- Depression patients who can not use anti-depression medications due to underlying health disorders
- Catatonic stupor (a behavioral disorder where the patient is unable to move properly, remains still, lacks speech and there is other unusual behavior )
- Depression accompanied by mania and psychotic features
- Extreme stress
- Bipolar disorders (where the patient has both mania and depression)
- Suicidal patients
- Previous history of ECT treatment
- Aggression in patients with dementia
- Other mental disorders like schizophrenia
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What are the tests done before Electroconvulsive Therapy?
The doctor will evaluate the patient before the first ECT session. The evaluation includes-
- Complete medical history
- Physical examination
- Psychiatric assessments
- Drug or any anesthesia-related allergies is tested
Your doctor may perform the following diagnostic tests before recommending electroconvulsive therapy-
- Complete blood count
- Serum Chemistry
- Urine analysis
- Renal function test
- Neuropsychological or neuroradiological test
- Spinal radiographs
- Electrocardiogram (ECG)
- Electroencephalogram
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What is the preparation done for Electroconvulsive Therapy ?
The decision to use ECT is one that entails a lot of consideration. The patient, closely studied by the mental health practitioner, is assessed in detail on whether ECT will benefit the life-threatening conditions the patient faces.
Another very important aspect of ECT is that the practitioner must take “informed consent” from the patient they are treating. Informed consent is when all information about the procedure is told to the patient firsthand, including the risks and benefits, the potential complications of the procedure and everything that comes with it. An exception to this rule is when the patient is in an unsound state of consciousness, delirious or severely delusional.
The following steps are done before the ECT procedure-
- Patient is put under general anesthesia so the patient is asked to not eat or drink after midnight, a night before the ECT procedure. Only a sip of water is advised to be taken, other diet modifications are given by the team of doctors.
- A brief physical and medical examination is done just prior to the ECT procedure, to check the lung and heart functions on the day of the procedure.
- IV line is inserted before the procedure to supply essential fluids and medications during the ECT procedure.
- Electrode pads are placed on the head ( either on one side of the head for unilateral ECT or on both sides for bilateral ECT ).
What is the procedure of Electroconvulsive Therapy?
- During electroconvulsive therapy, firstly, general anesthesia is given to the patient via the IV line placed. This helps to make the patient unconscious during the procedure.
- A muscle relaxant is also given through the IV line so that injury or seizure activity is minimized.
- Once the patient is unconscious, the doctor places the electrodes at specific locations on the patient’s scalp to pass small amounts of electric current that causes a brief seizure for 60 seconds.
- EEG or Electroencephalogram is used to record and monitor the increased electrical activity in the brain as the current is passed and seizure begins.
- The patient feels no pain due to the anesthetic administered, nor do they convulse due to the concomitant use of a muscle relaxant.
- A blood pressure cuff is placed around one ankle of the leg, to prevent the muscle relaxant from flowing into that foot. This is done so that seizure activity can be assessed by the doctor with the movements of that foot, as the procedure begins.
- Throughout the procedure, brain activity, heart rate, blood pressure and oxygen saturation are monitored. An oxygen mask may be placed if required.
- Also, a mouth guard is placed to prevent any damage or injury to the teeth and tongue while the patient undergoes mild seizures.
- The patient often regains consciousness after around 10 minutes and feels in complete control in about 30 minutes after the treatment. Mostly, there is very little to no recollection of the event or post-procedural pain.
This therapy is completely safe. There will be no memory of treatment after the patient wakes up, but sometimes he may feel anxious. The memory of the events may gradually return. There might be some symptoms of confusion for a few hours after the therapy and the patient wakes up.
Every patient requires a different number of treatment sessions depending on their condition. Usually, it ranges from 6 to 12 sessions over a period of several weeks. Some doctors may use a newer technique that is known as right unilateral ultra-brief pulse ECT which is done daily.
If the procedure is done on an outpatient basis, the patient is not permitted to handle any heavy machinery or drive for at least 24 hours after. Care must be taken to see that the patient is accompanied by an acquaintance, whether family or friend, for at least the day following the procedure.
Generally, it takes about 2-3 sessions for the patient to start showing response to therapy. The treatment should be stopped when the patent responds adequately, so as to minimize adverse effects. Results too, show extreme interpersonal variation from person to person.
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What are the steps of care after Electroconvulsive Therapy?
Following electroconvulsive therapy, the patient needs to keep the following points in mind-
- One must resume the day-to-day activities only after complete regain of memory and after the confusion is resolved. Do not drive or return to work at least for 24 hours to 2 weeks time interval ( as advised by the doctor)
- Regular exercise along with some lifestyle changes can decrease the rate of depression and change the mood
- Stay relaxed to reduce anxiety and stress
- Take an adequate amount of sleep
- Take healthy and nutritious food in your diet
Usually, the treatment team at the medical facility will also maintain communication with the patient’s family in order to track and assess response to treatment.
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What are the risks of Electroconvulsive Therapy?
As is with any medical procedure, ECT too has its drawbacks and doesn’t come without certain disadvantages and risks.
Electroconvulsive therapy may involve the following risks-
- Mental confusion
- Memory loss
- Nausea
- Headache
- Pain in the jaw
- Muscle pain
- Allergic reaction to anaesthesia
- Increased heart rate
- Increase in blood pressure
Generally, these side effects resolve in a few hours, however, some may persist. The patient is thus advised to note down important information like PINs, passwords & important numbers, as they may not be able to recollect it for a short period after therapy.
Research shows that 1 in 3 people will face the commonest side effect of memory loss post ECT. This is, however, also variable, based on person to person. The good news though is that it is usually temporary and restricted and the patient soon gains insight. As a general rule, the degree of memory loss and the other side effects are directly proportional to the frequency of the procedure.
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How successful is Electroconvulsive Therapy?
ECT is found to be effective in 80-85 percent of the patients who otherwise are not benefiting much from the conventional or medication therapy. Patients show a very good prognosis and improvement rates for many months after the ECT sessions. Patients also need to continue with the medical treatment along with the ECT session to avoid any relapse. Also the frequency of the ECT sessions in a month depends upon the individual need of the patient, response to previous ECT sessions, etc.
What is the cost of Electroconvulsive Therapy in India?
The total cost of Electroconvulsive Therapy in India can range from INR 25,000 to INR 1,00,000. However, many prominent hospitals and doctors in India specialize in Electroconvulsive Therapy. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of Electroconvulsive Therapy, there will be an additional cost of living in a hotel and the cost of local travel. So, the total cost of Electroconvulsive Therapy in India comes to be around INR 50,000 to INR 1,20,000.
We hope that we could answer all your questions regarding Electroconvulsive Therapy (ECT) through this article.
If you want to get more information and treatment of Electroconvulsive Therapy (ECT), you can contact a Psychiatrist.
We only aim to give you information through the article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice and correct treatment plan.
