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Electroconvulsive therapy (ECT) is a procedure in which a brief
application of electric stimulus is used to produce a generalized
seizure. It is not known how or why ECT works or what the
electrically stimulated seizure does to the brain. In the U.S.
during the 1940�s and 50�s, the treatment was administered mostly
to people with severe mental illnesses. During the last few
decades, researchers have been attempting to identify the
effectiveness of ECT, to learn how and why it works, to understand
its risks and adverse side effects, and to determine the best
treatment technique. Today, ECT is administered to an estimated
100,000 people a year, primarily in general hospital psychiatric
units and in psychiatric hospitals. It is generally used in
treating patients with severe depression, acute mania, and certain
schizophrenic syndromes. ECT is also used with some suicidal
patients, who cannot wait for antidepressant medication to take
effect.
How is it
administered?
ECT treatment is generally administered in the morning, before
breakfast. Prior to the actual treatment, the patient is given
general anesthesia and a muscle relaxant. Electrodes are then
attached to the patients scalp and an electric current is applied
which causes a brief convulsion. Minutes later, the patient awakens
confused and without memory of events surrounding the treatment.
This treatment is usually repeated three times a week for
approximately one month. The number of treatments varies from six
to twelve. It is often recommended that the patient maintain a
regimen of medication, after the ECT treatments, to reduce the
chance of relapse.
To maximize the benefits of ECT, it is crucial that the patient�s
illness be accurately diagnosed and that the risks and adverse side
effects be weighed against those of alternative treatments. The
risks and side effects involved with the use ECT are related to the
misuse of equipment, ill-trained staff, incorrect methods of
administration, persistent memory loss, and transient
post-treatment confusion.
Why is ECT so
controversial?
After 60 years of use, ECT is still the most controversial
psychiatric treatment. Much of the controversy surrounding ECT
revolves around its effectiveness vs. the side effects, the
objectivity of ECT experts, and the recent increase in ECT as a
quick and easy solution, instead of long-term psychotherapy or
hospitalization. Because of the concern about permanent memory loss
and confusion related to ECT treatment, some researchers recommend
that the treatment only be used as a last resort. It is also
unclear whether or not ECT is effective. In some cases, the numbers
are extremely favorable, citing 80 percent improvement in severely
depressed patients, after ECT. However, other studies indicate that
the relapse is high, even for patients who take medication after
ECT. Some researchers insist that no study proves that ECT is
effective for more than four weeks.
During the last decade, the �typical� ECT patient has changed from
low-income males under 40, to middle-income women over 65. This
coincides with changing demographics. The increase in the elderly
population and Medicare, and the push by insurance companies to
provide fast, �medical� treatment rather than talk therapy.
Unfortunately, concerns have been raised concerning inappropriate
and even dangerous treatment of elderly patients with heart
conditions, and the administration of ECT without proper patient
consent.
Is ECT an option?
The patient and physician should discuss all options available
before deciding on any treatment. If ECT is recommended, the
patient should be given a complete medical examination including a
history, physical, neurological examination, EKG and laboratory
test. Medications need to be noted and monitored closely, as should
cardiac conditions and hypertension. The patient and family should
be educated and informed about the procedure via videos, written
material, discussion, and any other means available before a
written consent is signed. The procedure should be administered by
trained health professionals with experience in ECT administration
as well as a specifically trained and certified anesthesiologist to
administer the anesthesia. The seizure initiated by the electrical
stimulus varies from person to person and should be monitored
carefully by the administration team. Monitoring should be done by
an EEG or �cuff� technique. The nature of ECT, its history of
abuse, unfavorable medical and media reports, and testimony from
former patients all contribute to the debate surrounding its use.
Research should continue, and techniques should be refined to
maximize the efficacy and minimize the risks and side effects
resulting from ECT.
For more information contact:
National Mental Health
Association
2001 N. Beauregard Street
12th Floor
Alexandria, VA 22311
Phone 800-969-6642
National Institute of
Mental Health
Public Inquiries
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892
Phone 866-615-6464
American Psychiatric
Association
1000 Wilson Blvd., Suite 1825
Arlington, VA 22209
Phone 888-357-7924
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