The Healing Power of Electroconvulsive Therapy, part 2
I said in my last post that I would briefly discuss some aspects of Electroconvulsive Therapy (ECT). We don't do ECT at Cottonwood but I had told the story of someone we referred for the treatment that had called back to let me know it had helped her.
ECT remains the most effective treatment for severe depression. It helps when medication and psychotherapy have failed and that is when it is used today. ECT is not provided in the way it was in the past and is nothing like what a lot of people envision it.
ECT is usually provided in the surgical recovery room of a hospital. There is the psychiatrist, an anesthesiologist, and a trained ECT nurse. The patient is monitored by leads that measure heart rate, blood pressure, oxygen level and brain waves. The patient is given intravenously a short acting anesthetic. A muscle relaxant is given so that the patient's body has no movement during the seizure. The anesthesiologist then hyperoxygenates the patient and the psychiatrist applies an electrical stimulus to the head that induces a brain seizure that last for about one minute and is monitored by the EEG which measures the brain waves. The patient wakes up shortly afterwards and after a half hour or so staying in the recovery room then goes home. It usually takes 6-8 different sessions of this procedure give every other day to achieve a full antidepressant effect.
Like any treatment ECT has it's risks and side effects but is usually effective and is a good treatment to have for depression when nothing else works. It should remain available to those whose sufferings cannot otherwise be alleviated. I welcome any comments or questions on this often misunderstood treatment. For anyone interested in more information about this I recommend the book Shock; The Healing Power of ECT by Kitty Dukakis who has been an ECT patient.
Thought for the day
"I'm trading my sorrow. I'm trading my shame. I'm laying them down for the joy of the Lord. I'm trading my sickness. I'm trading my pain. I'm laying them down for the joy of the Lord".
ECT remains the most effective treatment for severe depression. It helps when medication and psychotherapy have failed and that is when it is used today. ECT is not provided in the way it was in the past and is nothing like what a lot of people envision it.
ECT is usually provided in the surgical recovery room of a hospital. There is the psychiatrist, an anesthesiologist, and a trained ECT nurse. The patient is monitored by leads that measure heart rate, blood pressure, oxygen level and brain waves. The patient is given intravenously a short acting anesthetic. A muscle relaxant is given so that the patient's body has no movement during the seizure. The anesthesiologist then hyperoxygenates the patient and the psychiatrist applies an electrical stimulus to the head that induces a brain seizure that last for about one minute and is monitored by the EEG which measures the brain waves. The patient wakes up shortly afterwards and after a half hour or so staying in the recovery room then goes home. It usually takes 6-8 different sessions of this procedure give every other day to achieve a full antidepressant effect.
Like any treatment ECT has it's risks and side effects but is usually effective and is a good treatment to have for depression when nothing else works. It should remain available to those whose sufferings cannot otherwise be alleviated. I welcome any comments or questions on this often misunderstood treatment. For anyone interested in more information about this I recommend the book Shock; The Healing Power of ECT by Kitty Dukakis who has been an ECT patient.
Thought for the day
"I'm trading my sorrow. I'm trading my shame. I'm laying them down for the joy of the Lord. I'm trading my sickness. I'm trading my pain. I'm laying them down for the joy of the Lord".
Labels: Daily-Musings, Dr.-Jim-Seymour, Electroconvulsive-Therapy
3 Comments:
Dr. Seymour,
Thanks for your posts on ECT.
A couple quick questions:
Why and how does ECT work? What do they think causes a reduction of symptoms related to depression?
Is loss of memory a possible side-effect?
Ryan
Ryan, no one really knows how ECT works. There are three main theories. One theory is that it works by it's action of enhancing dopaminergic, serotonergic and adrenergic transmission similar to antidepressants.
The neuroendocrine theory is that ECT releases hypothalamic and pituitary hormones. ECT does release prolactin, thyroid stimulating hormone, adrenocorticotropin hormone and a variety of neuropeptides.
The third theory is that ECT exerts a strong anticonvulsive effect. It is probable that all three may be factors.
The biggest problem with ECT is the memory loss issue. ECT causes significant immediate memory loss for the time in which ECT is given. This is a transient effect which diminishes and there is no evidence that ECT causes any anterograde amnesia. Neuropsycholocal testing demonstrates that people perform better on cognitive tasks after ECT than before.
The big problem is retrograde amnesia. ECT can cause mild memory loss for past events but in some cases it can be severe. ECT can be delivered by a series of techniques that reduce this possibility but it can occur. With our current medications I do not recommend ECT in most cases. It should be strongly considered in a patient with intractable depression unresponsive to any medications and it is the first line and most effective treatment for psychotic depression with real suicide risk . It also is first line treatment for those rare patients who present as mute, unable to get out of bed and have quit eating or drinking fluids.
I hope this helps. I am glad to discuss it further if you would like.
Ryan, no one really knows how ECT works. There are three main theories. One theory is that it works by it's action of enhancing dopaminergic, serotonergic and adrenergic transmission similar to antidepressants.
The neuroendocrine theory is that ECT releases hypothalamic and pituitary hormones. ECT does release prolactin, thyroid stimulating hormone, adrenocorticotropin hormone and a variety of neuropeptides.
The third theory is that ECT exerts a strong anticonvulsive effect. It is probable that all three may be factors.
The biggest problem with ECT is the memory loss issue. ECT causes significant immediate memory loss for the time in which ECT is given. This is a transient effect which diminishes and there is no evidence that ECT causes any anterograde amnesia. Neuropsycholocal testing demonstrates that people perform better on cognitive tasks after ECT than before.
The big problem is retrograde amnesia. ECT can cause mild memory loss for past events but in some cases it can be severe. ECT can be delivered by a series of techniques that reduce this possibility but it can occur. With our current medications I do not recommend ECT in most cases. It should be strongly considered in a patient with intractable depression unresponsive to any medications and it is the first line and most effective treatment for psychotic depression with real suicide risk . It also is first line treatment for those rare patients who present as mute, unable to get out of bed and have quit eating or drinking fluids.
I hope this helps. I am glad to discuss it further if you would like.
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