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Electroconvulsive Therapy (ECT)

Treatment for Depression, Bipolar and More

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Updated December 02, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Electroconvulsive therapy or ECT is a treatment used to treat severe depression, bipolar disorder, schizophrenia and other conditions. For bipolar disorder, ECT is used to treat both acute mania and depression. Often, electroconvulsive therapy is administered when depression is not responding to medications or when a patient poses a significant suicidal risk.

Thus, ECT is not a first-line therapy. If your doctor suggests electroconvulsive therapy, ask questions and educate yourself to make an informed decision, weighing the potential risks and benefits of the procedure for your condition.

The exact reasons why ECT is effective in treating depression, mania, catatonia and other conditions is not entirely clear. It's theorized that it impacts brain chemistry and neurotransmitters, hormones, and the electrical activity of the brain. This is sometimes referred to as "resetting" or "rebooting" the brain. While many people have been helped by ECT, it's not clear how effective ECT will be for individuals, whether the results will be temporary or long-lasting, for example -- more research is needed.

ECT Treatments

Before you undergo electroconvulsive therapy, you will be checked over by a physician and tested for any medical conditions that might put you at greater risk with ECT. You will likely talk to an anesthesiologist about the risks of anesthesia in general.

ECT induces a seizure, but during your treatment, you'll be given an IV anesthetic and also a muscle relaxant, as you don't need to be awake nor have the physical effects of a seizure for ECT to be effective. Electrodes are put on your head, and a precise amount of electric current is administered. Brain activity is monitored to tell when the seizure starts and stops. These seizures generally last no more than a minute.

After the anesthetic starts to wear off, you'll spend time in the recovery room. After you wake up, you might be confused for awhile. For this reason, you must have someone else drive you to and from your appointment.

The usual course of ECT is to receive treatments 2 to 3 times a week (generally Monday, Wednesday, Friday) for a few weeks. The course can be variable depending on how severe your symptoms are and how rapidly you respond; however, the initial course tends to range between 6 and 12 treatments. Sometimes maintenance therapy is needed, and this can be weekly to every several weeks to continue the benefits.

Unilateral vs. Bilateral ECT

There are two types of ECT: unilateral and bilateral. For unilateral, which affects only one side of the brain, one electrode is placed on your right temple and one on the crown of your head. For bilateral, electrodes are placed on both temples. Unilateral ECT is associated with fewer memory problems (see below), but may be initially slower to take effect.

Treatment is usually initiated as unilateral, as this has fewer cognitive side effects. If you are slow to respond, or the severity of symptoms indicates it, you may be switched to bilateral ECT.

Side Effects of Electroconvulsive Therapy

The most common side effects include headache, jaw pain, muscle aches and nausea. These usually go away within a short time. Short-term memory loss is commonly reported and usually involves the period around the course of treatment. Some people do report more serious problems with memory. If you already have memory problems, you may be more likely to experience more cognitive disruption with ECT.

The Controversy Surrounding ECT

There is a great deal of controversy about electroconvulsive therapy. Some of this stems from the experiences of people who underwent ECT decades ago, without anesthesia or muscle relaxants, and with very different electrical parameters and administration. There was a high rate of side effects, especially memory loss. Broken bones occurred. Also, there was the occasional misuse of ECT, such as using it simply to keep institutionalized patients under control.

Because the procedure has changed so dramatically from earlier days, it is necessary to filter out negative comments about aftereffects of electroconvulsive therapy received, for example, 40 years ago. The techniques have been refined extensively since then, with patient safety in mind.

This doesn't mean, though, that the procedure has no risks today, or that the controversy is likely to die down. These days some ECT patients feel the treatments were a life-saver, while others say they wish they had never tried it.

Sources:
National Institute of Mental Health. Brain Stimulation Therapies.
University of Michigan Psychiatry. Electroconvulsive Therapy Program.

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  6. Electroconvulsive Therapy (ECT)

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