When you think of shock therapy, what comes to mind? If you’re of a certain age, it would probably be the movie One Flew Over the Cuckoo’s Nest, in which a shock is delivered to Jack Nicholson’s character while he’s awake as a form of punishment.
Electroconvulsive therapy (ECT) continues to be performed, and while stigmatized views characterize it as barbaric, the reality is very different. I’ve seen that reality as both a mental health nurse and a patient.
What it’s used for
ECT is primarily used for depression, although it may also be used for mania or for psychotic disorders. It’s particularly good for depression with catatonic, melancholic, or psychotic features. For patients at a high risk of suicide, ECT would start to take effect well before medications would. As counterintuitive as it may seem, it’s safe in pregnancy, and safer than some of the medication options.
A number of different mechanisms have been proposed for how ECT works, but a firm answer hasn’t been established that. What is known, though, is that it works.
How ECT is performed
ECT involves applying an electrical stimulus across the head to produce a seizure. It’s performed under general anaesthetic, often using the drug propofol. The muscle relaxant succinylcholine is also used, which prevents a visible seizure.
Before the procedure starts, the patient is hooked up to various monitors. An IV is inserted, and a mask is applied to load the patient up with extra oxygen. Once everything’s set up, the anaesthesiologist administers the anaesthetic and muscle relaxant, and it’s time for the actual ECT to begin. The image below shows what the patient is hooked up to.
The black rods shown on either side of the patient’s head in the above image are the electrodes through which the electrical stimulus is applied. The treatment may be bilateral (as shown above) or unilateral, with both electrodes on the same side of the patient’s head.
The patient wakes up not too long after the procedure. While some people might feel a bit groggy from the anaesthetic, I always felt clearly awake. The patient’s vital signs are monitored for a while, and then they are either sent back to their ward or sent home.
There may be a headache and/or jaw pain that occur shortly after treatment; these are usually side effects of the muscle relaxant rather than effects of the seizure. Both the muscle relaxant and the anaesthetic can lower blood pressure, which can result in lightheadedness.
The most significant side effect is memory loss. For most people this is mild, but for others it can be much more prominent. It mostly affects memories from the time frame when the treatment is occurring, but it can go further back. The ability to form new memories after completing a course of ECT is nor normally affected. Effects on memory are greater with bilateral treatments than with unilateral.
ECT can be done on either an inpatient or outpatient basis. As an inpatient, it would typically be administered 2-3 times per week. Outpatient is usually less often, but it can pose some logistical hurdles as typically ECT programs require to have a babysitter, essentially, each treatment day because of the anaesthetic used during the procedure. A typical course of treatment is somewhere in the range of 6-12 treatments, but the exact number is determined by how the patient is doing. During both my first and second hospitalization I had 17 treatments.
No more barbaric practices
Some people still describe ECT as barbaric, and there is a great deal of stigma around it. However, it’s a safe and effective treatment that can save lives. It’s certainly helped me a great deal when I’ve had it in the past. Like any form of treatment, it’s not right for everyone, and for some people, the side effects will outweigh the benefits. For myself, even though I had significant memory effects, that was acceptable given the level of benefit.
As currently practiced, there is nothing barbaric about ECT. It’s not something that is only used as a last resort, and there is plenty of research evidence to support its effectiveness, especially for people who are the sickest and hardest to treat.
The stereotypes likely aren’t going anywhere anytime soon, but that just makes it all the more important that those of us who’ve had ECT talk about.
About the guest author:
Ashleyleia is a talented blogger and author from Canada. Her entertaining and informative blog is called: Mental Health @ Home.