ECT has been given a bad rap due to how it was done in the past and how it is portrayed in movies like "One Flew Over the Cuckoo's Nest". It is seen as something violent and painful and something people are forced to do. This is completely opposite of what ECT is actually like now.
What ECT actually is is an electrically induced seizure in the brain. It is a short seizure that is controlled with medication and specifically designed to help people with severe depression. There is no real evidence as to why ECT helps but it is shown to be an effective therapy for people with treatment resistant depression. There are 3 types of ECT: bilateral, unilateral and bi-frontal. All of these relate to the placement of the leads. In bilateral, the leads are planted on both sides of the head. This type generally is seen with more memory loss. Unilateral is just one side of the head and is seen to have less effect on memory. Bi-frontal is where both are placed in the front of the head. All three types of ECT can be used to help someone and it is up to the treating physician to determine which one would be the best fit.
When ECT is first considered as an option, the psychiatrist and the patient usually talk about whether they think it would be an effective treatment. Then the referral is made to the ECT psychiatrist. From there, the psychiatrist sees the patient and asks multiple questions to determine if the patient is a candidate for ECT. They also will usually explain how ECT works and give the patient a run down of how the process will go or have them watch a video to make sure they feel comfortable going through it. If the psychiatrist thinks the patient could be a candidate then a series of tests are performed including an EKG and a chest x-ray. Consents are signed and then the first ECT is scheduled.
The night before the first ECT appointment, you can't eat or drink after midnight. The next morning you get up early and they take you to the ECT area of the hospital. Some hospitals require that you sign a consent form for each treatment so you would come in and sign that form first. They have you change into a gown and put all your personal belongings in a bag. Then they start an IV, put a blood pressure cuff on your arm and put the EKG stickers on to monitor your heart From there, they take your vitals. After that, it can differ depending on where the ECT is done. In some places, they will give medication ahead of time to prevent headache and nausea, other places will not. So part of the preparation process would include getting that medication.
When ECT is first considered as an option, the psychiatrist and the patient usually talk about whether they think it would be an effective treatment. Then the referral is made to the ECT psychiatrist. From there, the psychiatrist sees the patient and asks multiple questions to determine if the patient is a candidate for ECT. They also will usually explain how ECT works and give the patient a run down of how the process will go or have them watch a video to make sure they feel comfortable going through it. If the psychiatrist thinks the patient could be a candidate then a series of tests are performed including an EKG and a chest x-ray. Consents are signed and then the first ECT is scheduled.
The night before the first ECT appointment, you can't eat or drink after midnight. The next morning you get up early and they take you to the ECT area of the hospital. Some hospitals require that you sign a consent form for each treatment so you would come in and sign that form first. They have you change into a gown and put all your personal belongings in a bag. Then they start an IV, put a blood pressure cuff on your arm and put the EKG stickers on to monitor your heart From there, they take your vitals. After that, it can differ depending on where the ECT is done. In some places, they will give medication ahead of time to prevent headache and nausea, other places will not. So part of the preparation process would include getting that medication.
Once you are completely prepped, then you wait for your turn. This was probably one of the most anxiety bringing parts because you watched people before you go in the room looking like you and coming out of the room asleep from the anesthesia so that could be draw up some anxiety. Once it gets to your turn, they come and talk with you about your symptoms and how you have been doing. They ask if you think it has been having any effect on you. Based on that conversation will determine if that session will be your last session or if they will continue doing sessions.
From there, you are wheeled into a small room and are surrounded by medical professionals. There is the ECT doctor, the ECT nurse, the anesthesiologist and the nurse anesthetist and sometimes some med students. I think this is what made me feel the most anxious was laying on my back and being surrounded by people. Once you enter the room, they do the preparation for the ECT. They put the blood pressure cuff around your ankle. They clean places on your head where they will place the pieces that administer the shock (this varies based on what type of ECT you are having) and then the put a mask over your face and tell you to take deep breaths while they put a short acting anesthetic in your IV, which usually burns your hand as it goes in. Sometimes they warn you about that, sometimes they don't. When I had ECT and was preparing to go under, that was what I focused on, the burning sensation in my hand.
Once you are under, they put a bite guard in your mouth, inflate the blood pressure cuff around your ankle, give you a paralytic so you don't actively seize and then give the electroshock. The whole process takes no more than 5-10 minutes. The seizure itself lasts no more than a minute and then is stopped. Once the process is over with, you're wheeled back out to the preparation/recovery room with the nurses who wake you up and ask if you are in any pain or need anything. They check your vitals to make sure they are stable and make sure that you come out of anesthesia okay. From there, you are set up to leave the hospital if you are doing it outpatient and wheeled out to your ride home.
ECT is usually done on a schedule of three times a week for 2-4 weeks and then if it is seen to be effective, it is tampered down to once a week, then once every other week and then to once a month which becomes maintenance treatments. If it is effective for someone, they can maintain treatments for lengthy periods of time by just keeping up with maintenance treatments.
There are a couple downsides to ECT. One is that it can affect your memory. That was my experience with my first trial of ECT, I had significant memory loss which scared me. Memory loss varies person to person and varies from the different types of ECT. Another downside to ECT is that it can make people who are bipolar manic. It is used to treat depression and if there is hidden bipolar disorder there, then ECT treatment can lead to that person entering mania which has it's own set of challenges. Both of these things have to be taken into consideration when looking at doing ECT.
Overall, ECT is not like it's shown in the movies. It's well controlled with medicine and you are under anesthesia the entire time. It can be a very effective treatment for people with treatment resistant depression that medication didn't work for.
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