Electroconvulsive therapy (ECT)

Overview: 

Electroconvulsive therapy (ECT) is a medical technique that includes running a mild electric current through the brain to initiate a seizure. The Seizures have been shown to have a significantly positive effect on treating certain specific mental health conditions for which other treatments haven’t worked. However, this technique doesn’t work for everyone. 

ECT leads to certain changes in the chemistry of the brain that help in reversing the symptoms of mental health conditions. Research indicates that the method is safe and very effective. During the procedure, the person is given anesthesia so that they do not feel any pain. 

Most people seem to have a misconception about the procedure as earlier the doses of electricity that were administered were very high, causing loss of memory, fracture in the bones, and various other side –-effects that were severe. 

In present times, ECT is considered very safe as it uses metered doses of electricity in a controlled setting to get the best possible outcomes with minimal risks. 

Where Is Electroconvulsive Therapy Used? 

ECT offers prompt and significant reversal in the symptoms of the following conditions: 

• Severe Depression: Severe depression is when a person is suicidal, suffers from psychosis, and refuses to eat. ECT helps patients with treatment-resistant depression, which is a severe depressive state of mind that doesn’t improve with any kind of medication or treatment. 
• Mania: This is a state of intense hyperactivity, aggression, or euphoria and is a symptom of bipolar disorder. It is also characterized by symptoms like inability to make decisions, impulsivity, and chances of substance abuse. 
• Catatonia: Catatonia is usually caused by a medical illness and is also associated with schizophrenia. The symptoms include abrupt and weird movements and impaired speech.  
• Dementia: When agitation and aggression get difficult to handle and treat in dementia patients, ECT is applied. 
• Pregnancy: The procedure is advised for women during pregnancy if certain medicines that can harm the baby cannot be taken. 
• For Aged People: ECT is advised for older people who cannot manage the side effects of drugs. 

The procedure is recommended for people who have benefitted from it in the past and for people who prefer this method over taking medicines. 

Who Should Not Opt For Electroconvulsive Therapy: 

 People suffering from the following conditions should not opt for ECT: 

• A recent heart attack or stroke. 
• Any medical condition related to the brain, such as a tumor or bleeding in the brain brain tumor or bleeding in the brain. 
• Diseases of the lung such as chronic obstructive pulmonary disease (COPD). 

The Procedure: 

Before the process begins, the doctor assesses the medical history of the person and conducts a thorough physical check-up and psychiatric assessment. The doctor may prescribe blood tests, an electrocardiogram to evaluate the heart health and discuss the risks for anesthesia with the patient. 

The electroconvulsive procedure takes not more than ten minutes and can be conducted in a clinic or hospital. During the procedure anesthesia is given and hence dietary restrictions are recommended. The person cannot have water and food after midnight and can only take a sip of water to medicines.  

An Intravenous (IV) tube is inserted in the arm through which fluids and medications are administered. A muscle relaxant is also given to reduce the impact of seizures and avoid injury. 

Electrode pads are out on the patient’s head, either one or both sides depending on where the current has to be focused.  

A blood pressure cuff is wrapped around one ankle that restricts the muscle relaxant from entering the foot and affecting the muscles there. During the procedure, the doctor checks the seizure activity by observing the foot movement. The vitals of the person are constantly monitored, and oxygen is delivered through a mask. A mouth guard is put between the teeth to protect the teeth and tongue from getting injured. 

Once the person is asleep, and their muscles are relaxed the doctor starts the ECT machine. This sends a mild electric current to the brain initiating seizures that lasts for less than a minute. The person remains unaware of the seizure and the only indication is the movement of their foot. 

A procedure called an electroencephalogram (EEG) records the internal electrical activity in the brain. Sudden spurt of activity means the seizure is taking place and levelling indicates that the seizure is finished. 

After a couple of minutes, the effects of anesthesia and muscle relaxant begin to decrease, and the patient is taken to the recovery room, where they are kept under observation for any complications. When the person wakes up, they may feel confused for some time. They are taken to a recovery area, where they are monitored for any potential problems.  

The frequency of ECT depends on the severity and symptoms and how the person responds to the treatment. The person can resume their normal activities after a couple of hours, but if the doctor advises rest, they may have to avoid working and driving. In case of multiple sessions, the person is asked to rest for 24 hours after each session once the confusion and memory loss is resolved. 

Most people begin to see an improvement in their symptoms after six treatments of electroconvulsive therapy. Complete improvement takes a longer time. 

Even after the reduction of symptoms, the person is required to continue the treatment for depression to avoid recurrence. 

What Are The Risks Of Electroconvulsive Therapy: 

• Memory Loss: Most People who go through the procedure may experience memory loss for a short time accompanied with a confused state of mind. These symptoms however subside after a few months. But there are people who may have permanent memory loss. 
• Need for trained professionals: ECT requires a team of skilled and trained professionals to be present, and hence, the procedure may not be accessible in certain smaller facilities and centers. 
• Follow-up required: Although the method has short term symptoms, the person is required to regularly adhere to the follow-up schedule which may stretch to weeks and months.  

The doctor should be contacted immediately in the occurrence of the following symptoms: 

• Severe headache. 
• Fast heartbeat (tachycardia) or irregular heartbeat (arrhythmia). 
• If the person doesn’t feel better after two to three days of the procedure. 
• If the person experiences significant changes in their mental state. 

Conclusion: 

Electroconvulsive therapy is a safe procedure and helps people to reduce severe symptoms of mental health conditions where medications and other forms of treatment have failed. However, the procedure comes with its own set of advantages and disadvantages, and it is crucial to discuss the details with the doctor before making any important decisions. 

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