Electro-Convulsive Therapy (ECT)

1. What is electro-convulsive therapy (ECT)?

In electro-convulsive therapy (ECT), a small electric current stimulates the brain cells in order to correct the abnormal physiological condition in brain. During the therapy, there is a brief period of observable muscle convulsion.

In 2003, a research paper in the Lancet, a medical journal, affirmed the particular therapeutic effect of ECT on severe depression, especially when the depression does not respond well to antidepressant or other forms of treatment. Patients with other types of severe mental illnesses, including schizophrenia and mania, might also benefit from ECT.

The World Health Organization and experts from numerous medical professional groups worldwide advocate ECT as an effective treatment. From medical research, it is concluded that ECT is not only an effective therapy, but it can even save life in certain patients with severe mental illness. For example, most patients with depression show rapid improvement after ECT.

Certainly, ECT is only part of the whole treatment package. It is necessary to manage the psychological issues and other social problems such as problems in family and workplace. Psychiatric medications should be used as well.

2. How is an ECT conducted?

Currently, an ECT is provided by a team of professionals which include psychiatrists, psychiatric nurses and anesthetists, and the procedure is conducted in an appropriate setting with precise instrument. Before the ECT, the patient undergoes a thorough physical assessment to ensure that the patient can withstand the anesthesia and the electric stimulation.

In the night before ECT, the patient stops eating after midnight. Without the permission of the anesthetist, the patient should not eat or drink (including water) to ensure that the stomach is empty before the ECT. The patient should avoid tight-fitting clothing and remove any denture or ornament on body.

In the ECT suite, an anesthetist injects anesthetic agents and muscle relaxant to the patient. The patient breathes in pure oxygen, and gradually falls into sleep. The function of heart, lungs and other important organs are under close monitoring.

A small electric current is passed to the head of the patient, causing a response from the brain electric activities. As the patient is under general anesthesia, he will not experience pain. He only has mild twitching in the body. The whole process lasts for two to three minutes.

When the patient wakes up, he will find himself resting in the recovery room and a nurse is next to him. The nurse monitors the patient’s condition. Most patients do not have discomfort when they regain consciousness after the ECT. Some of them have a brief period of confusion and headache.

The number of ECT sessions in the whole course of treatment might range from two or three to more than ten. The patient usually has three to four days of rest before the next session of ECT.

3. Is a written consent required for ECT?

A written consent is a piece of medical record, indicating that the doctor has explained the treatment to the patient and the patient understands the nature and the risks of the treatment. It is not a business contract. It does not incur an obligation for the patient to receive the treatment.

The patient can withdraw the consent at any time. A withdrawal of consent for ECT does not affect his rights to receive other treatments.

If a patient opts for other treatments instead of ECT, the illness might take a longer time to recover and the patient might need to endure the suffering of the illness longer. Medication treatment and other treatments also have their own side-effects. Therefore, patients should discuss in detail with their doctors about which treatment best meets the patients’ needs.

4. What are the risks and complications of ECT?

There is no evidence showing that ECT will lead to permanent brain damage or alter the personality.

After a session of ECT, some patients have a brief period of confusion and forget what has happened around the time of ECT or some recent events. This memory problem will mostly recover in a few weeks. Please consult your doctor for details.

During ECT, the blood pressure and heart rate change and might have risk of abnormal rhythm. Therefore, if a patient has heart disease or other disease, he should tell his doctor so that the doctor can take the necessary precaution. Also during the ECT, there is muscle twitching which can result in muscle ache after the ECT. Damages to teeth or even fractures of bone are possible, but these are rare because of the necessary precautions taken in the modern ECT procedures.

The process of anesthesia might cause side effects such as headache, nausea and vomiting. The patient should report these problems, if any, to the doctors and nurses. They can provide some medications to relieve these problems.

The overall risk of ECT is low. Among medical procedures conducted under general anesthesia, ECT has nearly the lowest rate of mortality. The risk of death or serious injury from ECT is lower than that of childbirth.

5. Is ECT suitable for everyone?

This article has not included all possible complications of ECT. The actual risk of ECT to patients with particular characteristics can vary. Other unforeseeable complications can happen. If you want to know more about ECT, please contact your psychiatrists. The content of this article is for reference only.