Electroconvulsive Therapy

Electroconvulsive therapy, provided at the Institute of Living for many years, has gained a resurgence among psychiatric providers since the 1990s. Yet the stigma associated with the procedure persists due to its representation in television and movies. 

The benefits of ECT, however, have increasingly become apparent to the general population as positive reports have appeared in the popular press. Notably Kitty Dukakis, wife of former Massachusetts governor and 1988 Democratic presidential candidate Michael Dukakis, who has suffered with major depressive disorder and has found relief with ECT, has become a strong public advocate for this vital treatment.

In the past, ECT was viewed as a treatment of last resort. It has since become more socially acceptable and seen as a viable option earlier in treatment depending on the severity of symptoms and past treatment failures. It is the fastest option to help restore the quality of life for a patient suffering with severe depression.  

The exact mechanism of ECT is unknown, but it’s thought that as the brain attempts to suppress seizure activity triggered by the treatment, it releases a surge of neurotransmitters that help reset pathways associated with symptoms of depression and other mental health issues.

After a course of ECT at Center for Neurostimulation at the Institute of Living, patients follow up with their outpatient psychiatric provider to help maintain stability. The psychiatrist performing the ECT is assisted by an anesthesiologist, with support from a team of nurses. 

What Is ECT?

Electroconvulsive therapy, a medical procedure to treat psychiatric and neurological illnesses, is highly effective and efficient. ECT’s use dates to 1938, but technological advancements have made the modern application look much different. The goal is to generate a controlled seizure, occurring multiple times during treatment to help the brain “reset” neurotransmitters and alleviate symptoms.

Electricity, the stimulus that generates the seizure, is optimized to the lowest amount that will cause seizure activity for 30 to 60 seconds. A course of treatment consists of a session every 2 to 3 days for 6 to 12 treatments.

ECT is not a cure for mental illness, but it can help a patient recover from an acute episode after not responding to previous treatments. ECT may be administered on an inpatient or outpatient basis depending on the symptoms.   

Indications For ECT

Severe depression, including Major Depressive Disorder and Bipolar Depression.

  • Imminent risk: First-line treatment for acute safety risk to life or medical status.
  • Treatment resistant depression: No improvement after several medication trials.
  • Depression during and after pregnancy.

Severe mania.

Catatonia.

Refractory psychosis as seen in schizophrenia.

  • Limited or failure to respond after several medication trials. 

ECT Procedure

Preparations for ECT

  • Physical examination including electrocardiogram and laboratory tests.
  • Anesthesia consultation.
  • Consent for ECT and anesthesia.

Prior to Treatment

  • Nothing by mouth after midnight including food, water and medication.
  • Wear comfortable clothes.
  • Use restroom to empty bladder, if needed.

Procedure: 5 to 10 minutes

  • Verification of patient identifying information, procedure type, allergies.
  • Monitors placed, including blood pressure cuff, pulse oximeter, EKG, EEG and IV.
  • General anesthesia and muscle relaxant administered.
  • Oxygenation by bag masking.
  • Mouthguard placed to protect teeth and soft tissue from clinching of teeth produced by the  electrical stimulus.
  • Stimulus administered.
  • Seizure activity for approximately 30 to 60 seconds.
  • Respirations supported until consciousness is regained.

Recovery: 20 to 30 minutes

  • Vital signs monitored.
  • Orientation and alertness assessed.
  • Assessed for side effects and treated as needed.

Limitations, Risks And Benefits of ECT

Limitations

  • No driving during during the course of ECT and for 2 weeks thereafter.
  • Due to possible cognitive side effects patient may not be able work during course of treatment
  • No alcohol or illicit drugs during treatment

Risks

Common:

  • Transient: Headache, muscle ache and nausea
  • Short-term memory deficits: Typically transient and primarily effects memory formation around the time of treatment making it difficult to recall specifics or unable to recall events entirely. Rarely impairs long-term memory or biographical information. The memory may or may not be recovered after a course of ECT is complete. Individuals with preexisting cognitive deficits are at higher risk.

Rare:

  • Death: Extremely low risk with a mortality of less than 1 per 70,000 treatments. Reduced by optimizing physical health, specifically heart and lung function.

Benefits

  • Severe depression: 60 to 90 percent respond to ECT.
  • Faster and greater than antidepressant medications.
  • Fastest way to reduce acute safety risk from mental illness in terms of suicidal thinking and restore functioning in the form of self-care and nutritional intake.
  • Significantly improves quality of life.   

How To Initiate Electroconvulsive Therapy at IOL?

Outpatient Referrals

Discuss option with outpatient psychiatric provider.

Referrals

  • Your healthcare provider can make a referral to the Center for Neurostimulation by calling 860.545.7364. (Download form here and fax to 860.545.7482.)
  • Outpatient consultation will be scheduled to discuss current symptoms and determine if ECT is an appropriate option.
  • Inpatient referrals for ECT from an outside hospital may be made to the Institute of Living Center for Neurostimulation at 860.545.7364.

Center for Neurostimulation