You are here: Services > Allina Mental Health

Print

Send to a Friend

Transcript of video on electro convulsive therapy (ECT)

Elizabeth Sawinski, MD, psychiatrist: There are many myths and negative connotations involving the use of ECT.

Paul Goering, MD, psychiatrist: I think the most important question to ask if I was a patient would be, "Why do you chose ECT for me?"

Ramesh Sairam, MD, geriatric psychiatrist: One thing I want to be very clear about is…it is a treatment. It is not an action of desperation.

Michelle (patient): I really believe that – well, I know – it was the ECT that pretty rapidly pulled me out of the severity of my depression.

ECT: What it is and who it can help

Ramesh Sairam, MD, geriatric psychiatrist: ECT stands for electro convulsive therapy. It is a treatment where a controlled amount of electrical charge is administered to the front part of the brain. And this seems to specifically help certain kinds of depression. And it especially seems to help the depression that is more severe. The most severe kinds of depressions would be what we call catatonic depression – where somebody's mute and essentially not eating or speaking much – or psychotic depression. These are very severe forms of depression where ECT seems to be especially helpful.

Paul Goering, MD, psychiatrist: It can work for mania as well as for depression. In some kinds of schizophrenia it can be effective. And in reducing symptoms of suicide risk it can also be effective. Generally speaking the most common indication, though, is a form of depression, whether it's major depression or bi-polar depression.

Announcer: Although psychotropic medications have been used for many years to effectively treat mental illness, there are times when the use of medications is ineffective or unsafe, and ECT may offer a safer or more expedient treatment option.

Ramesh Sairam, MD, geriatric psychiatrist: Many patients, especially those who are experiencing depression for the first time, will find it uncomfortable consenting to a treatment that sounds strange, when there are medication options available.

But I do tell families - when the patients come with psychotic depression or catatonic depression, where they're not eating, they're not drinking, they're not communicating – in my elderly patients they can lose twenty pounds in a matter of a week or ten days. This can sometimes be a life-saving treatment.

Elizabeth Sawinski, MD, psychiatrist: A patient may not respond to medications quick enough. The medications may not be efficacious enough. There may be interactions with the psychotropic medications with the other medications this patient may be taking. In that case, ECT would be appropriate.

ECT myths and misconceptions

There are many myths and misconceptions regarding ECT. Among those are that ECT is very painful, that it's a violent procedure, that it changes a person's personality, that it causes permanent brain damage – these are myths.

Studies have shown that there are no structural changes that occur to the brain after a series of ECT.

It is not a painful procedure. We use anesthesia, we put the patient to sleep, the muscles are totally relaxed, so that the patient does not feel pain during the procedure.

Sue (patient): Well, I was in the hospital, and I wasn't coming out of my depression. When it all first started happening I didn't know what was going on with myself. You know, the up and down moods, and some of it was no reason for the mood swings. When it first started, I was married and I was going through a divorce. That was hard because my ex didn't understand what I was going through.

A lot of times I'd get suicidal and didn't want to live. So my family decided to try a series of ECT to see if that would bring me out of my depression.

Michelle (patient): I had lost almost 30 pounds. And I was in what was considered almost a catatonic state. I was totally unable to take care of myself in any way.

Mary (Michele's sister): My sister was in the hospital for four weeks prior to getting ECT. And they were trying different medications to see if that would help. She was severely, severely depressed. And there really was no response at all. She actually seemed like she was getting worse.

ECT: What to expect

Announcer: Once a patient chooses to receive ECT treatments, any questions or concerns the patient or family may have can always be addressed by the doctor and health care team before any treatments begin.

Reba, RN, ECT nurse: "Once you've made your appointment for ECT, one of the nurses in our department will give you a call and go through anything you need to know before your treatment, such as having nothing to eat or drink after midnight the night before your treatment, and if any medications that you're currently taking are indicated to be taken the morning of your treatment, or refrained from, the nurse will go over that information with you at that time.

You shouldn't drive yourself to your treatment – someone else needs to accompany you and drive you to and from the treatment.

Once you arrive here you'll meet with one of our nurses, and she'll do an intake interview with you. You may feel some anxiety, especially before your first treatment, and at that point there's still an opportunity to have your concerns addressed with either the nurses or the physicians.

Once the intake is done, we have a waiting room, and you'll wait, and when it's time for your treatment you'll go into the procedure room. There'll be an anesthesiologist and your psychiatrist as well as a registered nurse.

You'll lay down on a bed, and monitors will be applied to monitor your heart rate and EKG, your oxygen level and pulse oximeter, as well as blood-pressure monitoring cuff. And you'll also have an IV started. The general anesthesia is administered intravenously.

The psychiatrist will be placing the treatment leads and the monitoring leads for the ECT treatment on your head. Some other monitoring leads will be placed on your head by the psychiatrist so they can monitor your EEG, or your brain activity, while you're having your treatment.

Next, you're given the general anesthesia. And after the general anesthesia you're given a muscle relaxant, as well as any other medications you might need - for blood pressure or anything like that - through your IV. And you fall asleep. And we wait until your body is relaxed, and then the psychiatrist administers the treatment.

After the treatment is administered, we're still continuously monitoring all of your vital signs, as well as your brain activity. You stay in the treatment room a short while longer, and once the anesthesiologist and psychiatrist determine that you're stable enough, you go next door to the recovery room, where you're generally still sleeping.

So when you wake up, you'll wake up in a different place than you started out with your treatment – which can be a little bit frightening, but you'll be monitored continuously by a registered nurse in the recovery room, and they can re-orient you to where you are and what's happened.

Once you've gotten out of the recovery room, if you're an out-patient you'll come to our out-patient area. And you'll be given something to eat and drink, as well as a final check of your blood pressure and your pulse and your temperature, as well as your respiratory rate.

And at that point we will give you another appointment time, if it's indicated, as well as written instructions for your discharge, of when to call the doctor, when your next appointment is, as well as any other instructions that the psychiatrist or anesthesiologist might have given. That whole process takes about 30 minutes as well. Once the 30 minutes is up, you can go home – as long as you're escorted by someone."

Announcer: Although ECT is a safe and effective procedure, there are some possible side effects that fall into two categories – those side effects from the general anesthesia, and side effects from the ECT procedure itself.

Possible side effects from anesthesia include sedation, fatigue, nausea, and headaches. The most common side effects from ECT are headaches, jaw soreness, and short-term memory loss.

Ramesh Sairam, MD, geriatric psychiatrist: The patients may not remember events for a short time preceding the treatment and for a few hours following the treatment. And it usually abates with time. It's also related to the number of treatments they get. And, so, you know, if somebody needs ten treatments as part of the first course, you would expect expect them to have some more memory problems than somebody who gets well enough in four or five treatments. But even in somebody who's had ten or twelve treatments, the memory problems usually fade away in a matter of two to three weeks.

Maintenance ECT

Announcer: The patient's doctor will determine the number of treatments, depending on how well the patient responds to ECT.

Sometimes even if a patient responds very favorably to ECT – and the initial treatments are discontinued – additional outpatient treatments on an infrequent basis may be recommended, particularly if medications prove to be ineffective in the long-term treatment of mental illness. These periodic treatments are often referred to as "maintenance ECT," and their success-rate is often very high.

Sue (patient): I know some people don't understand why I still need treatments. They're always saying, "Well, you're fine. Why do you need all that?" But I keep saying that to continue to maintain this type of lifestyle you have to work at it, you have to want it.

ECT is there to help me but I have to want it. So I have to keep going, and doing it. Now, I work part-time. I do a lot of different projects. I volunteer a lot – to stay really involved because I want to. And before, I didn't want to do any of that stuff.

Michelle (patient): I come in every month for my maintenance treatments now, and I think of it like going to a dentist appointment or going to a doctors appointment. It's just as easy as that. And I continue to come in for maintenance treatments to guarantee that I continue to do as well as I feel like I am doing now.

Mary (Michelle's sister): "She was really sick – really sick. And within the first treatment, it was amazing. It was just incredible on how quick she responded to that treatment. I almost wonder if she's better than she's ever been. It's amazing. It's like a miracle. It's hard for me to understand it, but it worked.

Michelle (patient): I'm able to live a very functional, happy life because of this. I'm very grateful – very grateful – that this treatment is available. I look back and feel like it gave me my life back. It really saved my life at that time.

Announcer: ECT is an effective, safe, and quite often life-saving procedure. But ECT is only one option for the treatment of mental illness. The patient and family should examine all treatment options before making a determination about ECT. Do not hesitate to consult your doctor and health care team at any time for help in making your decision.

Paul Goering, MD, psychiatrist: You want to make sure that team of people who are making the decisions for your care have the best information possible – not only about your condition, but about the choices.

I think if I was to have one message it would be, consider it at an appropriate time. Don't consider it the treatment of last resort, consider it in the spectrum of your care. And talk to those people principle in your care. Ask them, "Should it be considered earlier? Should it be considered later?" But don't discard it as a treatment option.

Related Links

Electro convulsive therapy (ECT)

Depression inventory

Major depression

Allina Mental Health: Locations

First published: 12/15/2008
Last updated: 12/15/2008

Reviewed by: Paul Goering, MD, psychiatrist, medical director, Allina Mental Health; Ramesh Sairam, MD, geriatric psychiatrist, medical director, Geriatric Psychiatry Program United Hospital; Elizabeth Sawinski, MD, psychiatrist, Lakeside Psychiatric Specialists;