ECT

Electric convulsive therapy (ECT) is used in psychiatry today to help lift major depression, and in some cases to reduce psychosis.  In the olden days ECT treatments were used only after medication therapy had been tried and the medication stopped working. I liked that rule because ECT is psychiatry’s heavy artillery. It was considered the last ditch effort to relieve depression.  

Research psychiatrists have no idea why or how ECT works. This is true in many situations in medicine. The bottom line is that ECT’s do work.  If any of you have watched the movie ‘One who flew over the cuck-coo’s nest’ you may have an unrealistic view of ECT. Poor Jack Nicholson had a bad time of it! In the movie, Jack would get an ECT for punishment. This simply does not happen today. Let’s go to the clinical stuff. 

The morning of your treatment you will receive Robinol either through your IV or by injection. Atropine dries up secretions and lessons the chance of aspiration. You will be transported to the ECT suite. You will be asked to lie down on the gurney. A cardiac monitor, an oxygen saturation monitor, a blood pressure and heart rate monitor, and the electrodes for the ECT will be placed on your body.  Your IV will be checked for placement. The first drug typically used is caffeine which some psychiatrists say will increase the seizure time. The next drug given through your IV is short acting anesthesia like Brevital. Once you are asleep you are carefully monitored by your anesthesiologist. He or she will be monitoring the important stuff like breathing and heart function. The next medication you will receive is Succinocholine. This medicine paralyzes your muscles including your diaphragm. The anesthesiologist will be breathing for you by using an ambu bag during your treatment. 

The caffeine causes your blood pressure to become too high. Often, Labatelol (a very strong blood pressure medicine) is given usually through your IV. You begin to wake up after about 15 to 20 minutes after the Brevital has been given. Typically you will stay in recovery for about 45 minutes.  The day of your treatment you will most likely be sleepy because of the Brevital. Also experiencing a headache is not uncommon. Some confusion may be present. The next day you will be more alert.  

The most talked about side effect due to ECT’s is short term memory loss. Memory loss does indeed occur. Your short term memory will return about 6 weeks after your last treatment.  Let’s go back to Jack! In the olden days that’s how ECT’s looked. No anesthesia was given. No paralytic agent was given, and no external monitoring occurred. The psychiatrist and the nurse would go room to room delivering electricity to patient’s brains. Back then, because no paralytic agent was used copious fractures occurred especially on the spine. This happened because the seizure was so strong. Fractures rarely happen today because of the use of Succinocholine. Anxiety has been reduced significantly because the patient is placed under general anesthesia for the treatment.  Now for my commentary! As a young nurse I thought ECT treatments were the most barbaric thing we could do to a patient. My mind was back with Jack! My nursing supervisor gave me the assignment to assist with ECT’s. I did this for about 5 years. During that 5 year period of time I saw miracles happen. I took care of an elderly woman who was unable to get out of bed because she was so depressed. She was not eating or caring for herself in any way. After 3 treatments this woman was up, dressed, eating, and taking care of her hygiene. She was completely animated and interacted well with others. I must admit after I saw her rapid recovery I was sold on ECT. Another patient I took care of was a young man who was diagnosed with Bipolar Disorder. He was manic and in a psychotic state. He was given one ECT and his psychosis was lifted. Once I saw that I was completely sold on the benefit of ECT.  Sometimes they do not work. If they don’t work don’t have them done. Some people especially the elderly will need another round of ECT for maintenance. This usually occurs 6 months to a year after the initial treatments.