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Electroconvulsive therapy (ECT) is a procedure used to treat severe
depression. It may be used in people who have symptoms
such as delusions, hallucinations, or suicidal thoughts or when other
treatments such as psychotherapy and antidepressant medicines have not
worked. It is also used for other psychiatric and neurological conditions, such
as schizophrenia and Parkinson's disease.
Before ECT, you are given anesthesia to put you in a sleepy
state, and you are given medicines to relax your muscles. Then an electrical current is
briefly sent to the brain through electrodes placed on the temples or elsewhere
on the head, depending on the condition and type of ECT. The electrical
stimulation, which lasts up to 8 seconds, produces a short seizure. Because of
anesthesia, the seizure activity related to ECT does
not cause the body to convulse.
It is not known exactly how this brain stimulation helps treat
depression. ECT probably works by altering brain chemicals (similarly to
neurotransmitters like serotonin, natural pain
relievers called endorphins, and
catecholamines such as adrenaline.
ECT treatments are usually done 2 to 3 times a week for 2 to 3
weeks. Maintenance treatments may be done one time each week, tapering down to
one time each month. They may continue for several months to a year, to reduce
the risk of relapse. ECT is usually given in combination with medicine,
psychotherapy, family therapy, and behavioral therapy.
Because of the effects of anesthesia, you may not remember the
procedure. You may experience some confusion, nausea,
headache, and jaw pain immediately following ECT. These effects may last
several hours. You may also experience short-term memory loss. This effect should gradually get better within several weeks.
ECT is used for severe depression and other psychiatric or
neurological conditions (such as Parkinson's disease or schizophrenia).
Sometimes ECT is used for older adults who are taking multiple
medicines for other illnesses and who are not able to take additional
medicines for depression. And sometimes ECT is used for people who cannot tolerate the side
effects of the medicines for depression.
Studies have shown that ECT is an effective short-term treatment
for severe depression. ECT may be used after other treatments have not worked.1
It is important to have follow-up treatment with medicine or
maintenance ECT to reduce the risk of relapse.
In rare cases, ECT may increase blood pressure, cause changes in
heart rhythm, or produce seizures that last longer than expected. These
physiologic changes typically occur right away after the ECT treatment and
can be managed by the health professionals doing the procedure, if needed.
Often, though, these changes resolve quickly without treatment.
The risks of untreated, severe depression (refractory
depression) are often greater than the risks of ECT.
Other side effects of ECT may include headaches, muscle pain,
nausea, and short-term and possibly long-term memory problems.
A person having ECT will have a thorough physical exam prior to
Complete the special treatment information form (PDF)special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
National Institute for Health and Clinical Excellence (NICE) (2003). The clinical effectiveness and cost effectiveness of electroconvulsive Therapy (ECT) for depressive illness, schizophrenia, catatonia and mania.
London: National Institute for Health and Clinical Excellence (NICE). Available online: http://www.nice.org.uk/TA059.
January 11, 2013
Kathleen Romito, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry
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