Electroconvulsive Therapy

What Is ECT And How Does It Work?

Electroconvulsive therapy or ECT is a psychiatric shock treatment which has been around since 1938. It is a form of treatment used for major depression, catatonia, schizophrenia, schizoaffective disorder, bipolar/depressive types and bipolar disorder. The stigma of ECT still maintains its presence due to its mechanism of action.

ECT involves a machine connected to wires which have scalp electrodes that are placed on the patient’s head. The electrodes may be placed bilaterally or unilaterally. When placed bilaterally, they can be positioned on top of the forehead (frontal lobe) or sides of the head (temporal lobes); also known as bifrontal or bitemporal.

When placed unilaterally, the position is usually over the non-dominant hemisphere of the brain. The difference between bilateral and unilateral has to do with the effectiveness and the cognitive side effects of the treatment. Bilateral ECT delivers more bang for its buck: more electrical stimulus means a greater likelihood of improved symptoms.

Unilateral ECT is not as effective because of less stimulus delivered to the brain, but it causes less cognitive symptoms such as transient memory loss. Unilateral may be used in a patient who is already suffering from memory problems, or experiencing symptoms which are not bad enough to warrant a bilateral stimulus.

There is no magic number as to how many ECT sessions a patient needs to receive, but usually 12-20 is the range in which patients start to see a difference. ECT works particularly well for depressed patients. Some patients are so depressed that they refuse to get out of their beds. After ECT, they become a changed person: they get out of bed, walk around like everyone else and look more vibrant and alive.

Fortunately, as mental health stigma dissipates, so is the stigma around ECT. The reason the stigma became alive in the first place is because ECT induces a generalized tonic-clonic seizure in the patient. At first, the patient undergoes general anesthesia with Brevital. After the patient becomes unconscious, a button is pushed on the ECT machine, causing the patient to have a seizure.

The seizure can be observed via either the left or right foot shaking; the rest of the body is not observed to be seizing due to succinylcholine inducing muscle relaxation. The seizures usually do not last longer than 180 seconds. The idea of inducing a seizure in a person with the hope of alleviating their psychiatric symptoms does not sit well with many people.

Whether you agree with it or not, ECT is proven to be one of the best treatments around for severe mental illness!

Are you Ready? (This is Defeating Stigma Mindfully)