Integrative Medicine & Psychiatric Services,Inc
Geriatric Health Care Associates,Inc
ECT Treatment - ECT Information & FAQ's
Patients Information on ECT Treaments WHAT IS ECT? Electroconvulsive therapy is an extremely safe and effective medical treatment for certain psychiatric disorders. It is a treatment for severe episodes of major depression, mania, and some types of schizophrenia. It involves the use of a brief, controlled electrical current to produce a wellcontrolled seizure within the brain. This seizure activity is believed to bring about certain biochemical changes which may cause your symtoms to diminish or even disappear. A series of seizure treatments, generally 6-12, given at a frequency of 2 or 3 per week, is required to produce such a therapeutic effect; although sometimes a lesser or greater number of treatments maybe necessary or recommended WHO IS TREATED WITH ECT ? ECT has been used for over 70 years. In the United States, about 100,000 individuals are estimated to receive ECT each year. ECT is most commonly given when patients have severe depressive illness, mania,or some forms of schizophrenia. Frequently ECT is given when patients have 1. Not responded to other treatments, 2.When other treatments appear to be less safe or difficult to tolerate 3. When patients have responded well to ECT in the past 4. When psychiatric or medical considerations make it particularly important that patients recover quickly and fully. Not all patients improve when treated with medications or psychotherapy ( Talk Therapy). Indeed, when illnesses such as depression become particularly severe, it is doubtful that psychotherapy alone will be sufficient. For some patients, the medical risks of medications or psychopharmacology alone may be greater than the medical risks of ECT. Typically these are patients with serious medical problems, such as certain types of heart disease or Diabetes. When patients have life threatening psychiatric problems, such suicidal tendencies ,ECT is also often recommended because it usually provides faster relief than medications. Overall , the majority of depressed patients treated with ECT show substantial improvement. Even the majority of those who have not been helped by medications respond to ECT. This makes ECT the most effective of the antidepressant treatments. WHO ADMINISTERS ECTS ? A treatment team administers ECT. The team consists of the: 1. Psychiatrist who is trained in administering ECT 2. Anesthesiologist, and 3. ECT trained nurses The physicians responsible for administration of ECT are exprerienced psychiatrist who are specially trained in ECT. ECT is administered in a dedicated suite of a hospital or a medical facility. The suite contains a waiting area , treatment room , and a recovery room. We provide ECT inpatient and outpatient services at the INOVA Mt Vernon hospital ECT suite with a team of extremely competent and experienced nurses and anesthesiologists. HOW IS ECT ADMINISTERED? Before ECT is administered ,the patients medical condition is carefully assessesed. This includes a Medical history and physical examination, and medical tests as needed. ECT is usually administered 2-3 times per week Monday, Tuesday ,Wednesday, and Friday or as determined by the physician Administering ECT. At Mt Vernon we usually treat outpatients twice /week ( Tuesdays & Friday in order to space out the treatments to where they are effective without causing ecessive memory problems. It can be given on either an inpatient or outpatient basis.Maintenance ECT is offered for atients who are good responders to ECT but suffer from relases. Treatments are spaced out during maintenance ECT anywhere from Once/ week ---once every 3 month based on on treatment reponse. Pt will not eat or drink after midnight the night before each treatment. Patients should also refrain from smoking the morning of the ECT. Before the treatment a small needle is placed in a vein so that medication that is used to induce sleep and relax the muscles can later be given at the time of the treatment. Patients are brought into the Treatment Room and asked to lie down on a comfortable stretcher, after which a blood pressure cuff will be placed on your arm and ankle and a number of electrodes will be placed on the scalp, chest and finger, so that the brain waves (EEG), heart waves (ECG), and body oxygen levels can be monitored and so that the electrical stimulus can later be given after the patient is asleep. They will also be provided oxygen to breath by mask, and any pre-ECT medication, if indicated, will be given, followed by anesthetic medication itself, which will help them to sleep. Within a minute after injection of the anesthetic medication, patients will be asleep, and the medication to relax their muscles will be given. Within one to three minutes, patient's muscles will be relaxed. A controlled electrical stimulus, lasting a fraction of a second to six seconds, will then be applied across the two stimulus electrodes, which will typically be placed either on both temples(Bilateral ECT) or on the right temple and top of the head (unilateral ECT). Alternatively Bilateral ECT can also be given as Bifrontal or L.A.R.T ( Left Anterior Right temporal ) which are being used and have been found to have the benefits of bilateral ECT with less cognitive impairments and Side effects. These new ECT electrode placements are not as widely studied and researched as the RUL and BL (Temporal placement). Unilateral ECT has less effect on memory than bilateral ECT. However, some doctors believe that it may not be as effective in all patients. The electrical stimulus will trigger a seizure within the brain, which typically last around a minute. The muscular response to the seizure is greatly reduced by the muscle relaxant drug given prior to the stimulation. Very little body movement usually occurs. Within a few minutes after the seizure, when patients are breathing well on their own, they will be moved to recovery room where they will start to wake up within 5 to 10 minutes. Because of the anesthetic drug and effects of having had the seizure, they will temporarily feel somewhat groggy. Usually within 20- 30 minutes after leaving the treatment room, patients will be brought back to the hospital room (if they are an inpatient), or if they are an outpatient, they will go to another area of the Treatment Suite, where they will wait till they are medically cleared and ready to leave the hospital (typically about an hour or more). IS ECT PAINFUL ? No. Because the procedure is done under Anaesthisia and a muscle relaxant is used minimal body movment occurs and so ECT is not painful but we do have some patients that complain of minor headaces or jaw pain and some nausea. . We usually manage these sideeffects very easily with a tylenol or motrin and nausea with some anti nausea medication. If headache or pain occur the anesthesiologists will give additional Nausea or pain meds intravenously prior to the treatment to provide least amount of discomfort IS ECT EFFECTIVE? Although there have been many advances in the treatment of mental disorders in the recent years, ECT continues to have the greatest and most rapid therapeutic effect for some people, particularly when other treatments, usually medication, are either not effective or not safe. Your doctor will discuss with you why ECT is being recommended in your case and what alternative treatments maybe available. ECT is the most effective in major depression, where it has a strong beneficial effect in 70-90% of patients, depending on the case. Still, there is no guarantee that ECT or an alternative treatment) may bring an episode of illness to an end, it will not in itself prevent another episode from re-occurring, weeks, months, or years later. Because of this situation, you and your doctor will need to consider additional treatments to follow any ECT that you receive. Such, treatments generally consist of medication, psychotherapy, and/or additional ECT (given as an outpatient at a much less frequent rate which is called '' Maintenance ECT '' usually once or twice a month). IS ECT SAFE? All treatments have risks and side effects even no treatment at all. For most patients, the side effects of ECT are relatively mild. The risk of death is very rare, about 1 per 10,000 patients for typical cases however due to risk from Anesthesia , but higher in those with some types of serious pre-existing medical problems. Patients are evaluated during the the ECT consultation process for these risks and may be advised against ECT if the risks are too high. Patients medication may also have been adjusted to minimize the risk and/or maximize the effectiveness of the treatments. Serious complications, which are also quite rare; include temporary or permanent heart abnormalities, reaction to the medication used at the time of the treatment. More common side effects include headache, muscle soreness, nausea, confusion, and memory difficulties. Headache, muscle soreness, and nausea are usually mild and can be prevented or at least diminished by medications. Confusion and memory problems may build up over a course of ECT, but generally diminish as soon as the treatments have stopped. When memory problems occur, they vary considerably from patient to patient, but are generally greater for larger numbers of treatments or when both sides of the head are stimulated (bilateral ECT). Because of the possibility of memory loss, it is recommended that important life decisions be postponed until any major negative effects of ECT on memory have worn off (usually within a week or two following completion of the treatment course). Also, working, driving, and the use of dangerous equipment are not allowed during an index course of ECT treatments. At the end of the ECT series, you should ask your doctor when such activities can be resumed. ECT-related memory problems can be of two types: a difficulty remembering new information, and a loss of some memories from the past, particularly the recent past, e.g., during some months prior to receiving ECT. In this regard, research studies have shown that the ability to learn and remember new information returns to one’s usual level over a period of weeks to months after ECT. The ability to remember material from the past, i.e. prior to ECT, likewise tends to improve over a similar time period, except that in this case, some memories from the recent past, mainly days to months prior to the treatments, may be delayed in recovery or even permanently lost. Some patients, however, have reported longer gaps in memory or even that their memory in general has not returned to normal years after ECT. Still, scientifically conducted patient surveys have indicated that most patients receiving ECT are not greatly disturbed by memory effects and would have ECT again if it was felt to be indicated. IS ECT CURATIVE ? ECT is extremely effective in providing relief from psychiatric symptoms. However , permanent cures for psychiatric illness are rare, regardless of the treatment given. To prevent relapse after ECT, most patients require further treatment with medications or with ECT. If ECT is used for relapse prevention, it is usually administered to outpatients on a weekly to monthly basis. DOES ECT CAUSE BRAIN DAMAGE ? The scientific evidence strongly speaks against this possibility. Careful studies have shown no evidence of brain damage from brief seizure such as those given with ECT. In the adult, seizures must continue for hours before brain damage can occur, yet ECT seizure lasts only about a 60 seconds. Brain scans after ECT have shown no injury to the brain. During ECT ,the amount of electricity that reaches the brain is too small to cause electrical injury . IS ECT FRIGHTENING ? ECT has often been portrayed in the movies and on television as a painful procedure used to control or punish patients. These portrayals have no resemblance to MODERN ADVANCES DUE TO THE USE OF ANESTHESIA ,MUSCLE REALAXANT in administering ECT. One survey found that after ECT most patients reported that it was no worse than going to the dentist, and found ECT less stressful. We recommend that you watch the video of the modern ECT being done which is shown to the patients and their families as a part of the ECT consulatation so they can make an informed decision. Other information on ECT: Please feel free to ask your doctor or nursing staff any questions you have about ECT. A variety of types of information are available concerning this type of treatment, including videotaped material. You should understand that ECT is a treatment for which you (or your legal guardian, if applicable) must consent for on a voluntary basis, and that consent for future treatments can be withdrawn at your (or your representative’s) request at any time . Additional Recommended reading : 1. Holiday of Darkness by Norman .S Endler 2. A therapist Reckoning with depression - by Martha Manning' Both books were written by psychologists who were against people having ECT treatment. Drs Endler and Manning describe their illness , their experience in treatment with medication and psychotherapy , and their experience with ECT.
Geriatric Psychiatry and ECT Treatment Reston Virginia |
