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Electroconvulsive therapy or electroshock therapy has a bad reputation and is often only recommended as a last resort. It is used only about 100 000 times a year in the US and 1-2 million times a year worldwide.
20% of Americans- about 4 million people- who suffer from major depression do not respond to antidepressants or can’t tolerate their side effects.
Electroconvulsive therapy is more forgiving today than it was in the past. Today we have better equipment, better anesthesia, better control of seizures, and we’re more educated about it. However, it can still improve by addressing complications like memory loss.
It helps with depression, bipolar disorder, and other mental illnesses. Depression is the most common illness for which ECT is prescribed. It accounts for 80% of its use. People with bipolar disorder account for only 3% of its users.
Electroconvulsive therapy can provide immediate relief to 75% of patients when it is properly administered, which is better than any other treatment. However, this still leaves 25% that need another form of treatment.
It is expensive. It adds about $3000 to a hospital stay and costs up to $2000 as an outpatient procedure for a single session. Treatments are usually 6-12 sessions long, which can cost $12 000 to $36 000. However, most insurance plans, including Medicare, cover ECT.
Finding places to get good electroconvulsive therapy can be difficult. Doctors are not required to be trained in ECT and the procedure is always being refined. Many American cities do not have places that offer ECT.
It can be an effective substitute if people’s medication stops working.
Electroconvulsive therapy changes brain chemistry but it does not cause brain damage.
It is as effective and often more effective than medication.
It goes to work faster than antidepressants or therapy, which can save lives if people are suicidal.
Electroconvulsive therapy is accessible to the elderly, pregnant women, the physically ill, and those you can’t tolerate antidepressants.
It can cause memory loss, most of which is short-term and temporary. In rare cases memory loss can be severe and permanent.
There is no consensus on exactly how ECT works. Most patients think of it as resetting the brain when it gets out of balance.
It is generally used as a last resort when drugs, psychotherapy, and other alternatives have failed.
Electroconvulsive therapy is often not administered properly. Some facilities try to limit memory loss, while others don’t. Most, but not all, places use equipment to monitor seizures. There is a ton of variation geographically and among doctors about how ECT should be administered.
ECT works about half as well in community hospitals where most people are treated, compared to academic medical centers where most studies on its effectiveness are run.
The more complicated the depression the better ECT works. Like for psychotically depressed patients who have lost touch with reality. Like for those who are unable to move, speak, or show emotions because of their depression.
The more recent the episode of depression the more likely ECT is to help.
It is also used to treat Parkinson’s disease. This is probably a great option for people who suffer from Parkinson’s disease and depression simultaneously.
Electroconvulsive therapy is not a cure and its effects don‘t last very long. Most patients relapse within months and need further treatment. Follow-up ECT can be used for longer-lasting results. This involves continuing ECT for an extra 6 months, beginning with 1 session a week and decreasing to once a month. Early studies suggest that this often helps to lower the rate at which patients relapse.
The risk of a serious medical injury is 1 in 1000.
The risk of death is 1 in 10000 and this is mostly due to the anesthesia not the ECT itself. Electroshock therapy is one of the safest procedures where general anesthesia is required, with a death rate lower than for most other surgeries.
The more treatments and the more often you get them means the greater the likelihood of cognitive and memory losses.
How It Works
1. 2 electrodes are attached to the person’s head.
2. The doctor presses a button that sends an electric current strong enough to cause a seizure.
3. The strength of the seizure shocks the brain into balance.
Muscle relaxant ensures that the seizure barely causes the body to move.
Anesthesia guarantees that the patient will not remember the paralysis or the convulsion.
Who is most often considered for electroconvulsive therapy?
Suicidal patients need a fast-acting treatment and ECT reduces suicidal thinking. In a 2005 study with 131 patients who were thinking about killing themselves, 38% stopped thinking about suicide after 1 week of treatment and 76% stopped after 3 weeks. Electroconvulsive therapy can extend a person’s life and give them a chance to find a long-term treatment that works for them, like cognitive behavioral therapy. ECT generally starts working within a couple of treatments, which can mean a couple of days, while antidepressants usually take at least weeks to kick in. Physicians should think about turning to electroshock therapy earlier for suicidal patients instead of waiting until medication and therapy have failed.
Older patients are more often insured for the expensive treatment. They are more likely to have heart problems and other conditions that prevent them from taking antidepressants. ECT tends to work better for older people. In a 1999 study involving 268 patients, 54% of those 59 and under responded to ECT, 73% of those between 60-74 responded to it, and 67% of those 75 and older responded to it.
Pregnant women are often reluctant to take medication for fear of hurting the fetus. ECT is a safe and effective treatment for them. It can be used during all 3 trimesters.
Not a lot of research has been done on electroconvulsive therapy use for people 18 and under, but the research that has been done shows that it works for them as well.
ECT is not recommended for people with anxiety disorders, adjustment disorders, and dysthymia.
It works best with biologically based depressions, not with those based on a death in the family, broken relationships, or other changes in circumstances. These types of patients are likely better of trying interpersonal therapy.
Electroconvulsive therapy can be risky for people with retinal detachments, certain cerebral legions, high anesthetic risk, and other heart and brain conditions.
The most common complication of ECT is retrograde amnesia, which involves the loss of memories starting around the time treatment is given and extending back months or years. Recent memories are the most likely to disappear. Memories about world events are more vulnerable than memories about personal matters.
Patients can also suffer from anterograde amnesia, which impairs your ability to learn new things and form new memories.
Nonverbal memory loss can leave a violinist or dancer disabled, but usually just temporarily.
Reasoning can be impaired. This can be anything from recognizing faces to solving problems and thinking creatively.
Most memories typically return within 6 weeks. The ability to learn new things can return in as soon as 10 days. For about 10% of patients these things take longer to return. For these patients, memory and cognitive problems can last 6 months or longer. The losses are worst for the elderly, women, and people with low IQs.
Most patients do better on memory and reasoning tests after electroconvulsive therapy than just before, because the depression that had been clouding their thinking has been lifted.
Some of the lost memories involve trauma, anxiety, guilt, and other reminders of illness, which people often don’t mind forgetting.
Some of the memory loss is due to depression, aging, and medications taken before or after electroshock therapy.
Other complications: headaches, elevated heart rate, nausea, jaw pain, skin burns, prolonged seizures, difficulty breathing, and a resetting of your biological clock, making morning people out of night ones and vice versa.
How can electroconvulsive therapy be safer?
Memory loss can be reduced with unilateral ECT, which is applying 1 electrode to the side of the head and 1 to the back instead of bilateral ECT, which is applying 2 electrodes to either side of the head. Unilateral can spare the part of the brain that controls speech and memory by shifting electrodes to the opposite side. However, it is less effective in treating depression and mania. Bilateral can always be switched to if unilateral doesn’t work. Bilateral can be used as a first line of treatment only for the most severely depressed patients.
The type of electric pulse can determine how much short-term memory loss occurs. Using a brief pulse or an ultra brief pulse instead of sine waves produces less short-term memory loss and is equally effective.
Dose of electricity should be determined by testing various levels and determining the least amount needed to induce a seizure. This ensures that patients don’t get more electricity than they need.
In Canada and Europe ECT is usually given twice a week. This is less likely to produce memory loss. In the US, Ireland, and India it is usually given thrice a week. This is more likely to produce quicker relief of symptoms and means shorter and cheaper stays for inpatients. The choice of frequency should be based on whether someone is more interested in quick relief or avoiding complications.
Many doctors and clinics are still performing the more dangerous forms of electroconvulsive therapy by using bilateral, sine waves, and too high a dose of electricity.
If you notice that a doctor is starting you off with bilateral ECT, you can ask him about unilateral or go to another doctor.
You can use electroconvulsive therapy as an on-demand treatment. Instead of having scheduled sessions, you can ask for it when you’re experiencing an episode of depression and want quick relief.
On finding the right doctor:
Ask your psychiatrist. Ask your local hospital. Ask support groups like the Depression and Bipolar Support Alliance and the National Alliance on Mental Illness. Try Google or other internet search engines. Academic medical centers, especially those doing electroshock research, usually have higher success rates with ECT.
Things you should ask your doctor:
Why are you recommending Electroshock therapy?
Do you offer unilateral ECT?
What technique do you use to set the dose of electricity?
Do you use brief or ultra-brief pulse?
Can you tell me about memory loss and other possible side effects?
Where should I go for ECT?
Prepare for memory loss by writing down important information like phone numbers and security codes. Tell relatives and friends that you might need their help.
Electroconvulsive therapy is an effective treatment for depression, but memory loss is a possible side effect. It can be especially useful for severely depressed patients for whom other treatments often fail, suicidal patients, elderly patients, and pregnant women.
It is not as easily accessible as other treatments and can be expensive for those that aren’t insured.
You may have to choose between having a good memory and being happy. I’m sure for severely depressed people for whom everything else has failed its an easy choice.
Now where did I put my keys?