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Electroconvulsive Therapy - A Boon to Psychiatry

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Electroconvulsive therapy involves passing a small electric current through the brain. For more information, read the article below.

Medically reviewed by

Dr. Aneel Kumar

Published At December 7, 2022
Reviewed AtMarch 22, 2024

What Is Electroconvulsive Therapy?

Electroconvulsive therapy is carried out under general anesthesia and administering muscle relaxants to treat mental health disorders like depression, mania, and delusions, where other treatment modalities prove ineffective. Electroconvulsive therapy uses an electrical current passed through the brain and causes seizures and fits; these seizures or fits can be minor and last for a minute or two. Opting for the therapy is optional; if one does not wish to undergo the treatment, one can deny the therapy. However, a doctor can proceed without permission if the symptoms are severe and a physician feels an individual must undergo electroconvulsive therapy. The exact mechanism of how the therapy works remains unknown, but doctors believe that electroconvulsive treatment results in chemical changes in the brain, positively affecting mental health.

What Are the Types of Electroconvulsive Therapy?

Electroconvulsive therapy is considered to be of two types, which are as follows:

  1. Bilateral Electroconvulsive Therapy: In this type, the current is passed through both sides of the head.

  2. Unilateral Electroconvulsive Therapy: In this type, the current is passed through only one side of the head.

What Is the Mechanism of Action of Electroconvulsive Therapy?

Electroconvulsive therapy is based on the mechanism of inducting a generalized clonic seizure; this seizure is initiated or triggered when an electric current is passed through electrodes that are placed on the sides of the patient's head. This electric current is carried to a patient's brain and helps disrupt the electric current that flows through the human brain. This discontinuation in the brain's electrical current flow has proved effective in treating patients with severe depression and anxiety.

When Is Electroconvulsive Therapy Used?

Electroconvulsive therapy treats mental health conditions that are not improved by other treatment modalities like pharmacotherapy or counseling. Electroconvulsive therapy treats the following mental health disorders:

Severe Depression: This is mainly used in patients with suicidal thoughts and individuals who refuse to eat and are psychotic.

Uncontrolled Severe Mania: Patients with manic episodes include agitation, impulsive and risky behaviors, substance abuse, or threats to themselves or society.

Catatonia: When associated with other mental health disorders like schizophrenia that present with risky behaviors.

Schizophrenia: Bipolar behaviors and suicidal thoughts make other treatments ineffective. Thus, electroconvulsive therapy is implemented.

Patients with Dementia: Those who are very aggressive and are challenging to be treated with other treatment options are the ones preferred for electroconvulsive therapy.

What Are the Steps Involved When Getting Electroconvulsive Therapy?

Before a series of electroconvulsive therapy begins, the patient must receive a thorough psychiatric assessment, a medical examination, a few basic blood tests, and an electrocardiogram that will help to check heart health. Another important part of the process is informed consent. Before electroconvulsive therapy is administered, the patient must provide written informed consent, and before making a specific treatment decision, the patient should discuss all options for treatment with the psychiatrist. The electroconvulsive therapy is received two to three times a week for a total of six to twelve treatments based on the severity of symptoms and how quickly the symptoms respond to the treatment.

How Is Electroconvulsive Therapy Performed?

Before the first session of the therapy, a physician thoroughly investigates and discusses the following:

  • Medical history.
  • Complete physical exam.
  • Psychiatric assessment.
  • Basic blood tests.
  • An electrocardiogram (ECG) is used to check the heart health.
  • Discussion of the risks of anesthesia.

Electroconvulsive therapy is carried out under general anesthesia; patients are even given muscle relaxants before the procedure. The administration of general anesthesia and muscle relaxants causes a person to fall asleep.

Before the Procedure:

  • A general anesthetic is administered.
  • A physical examination is carried out.
  • Intravenous infusion is done to administer fluids.
  • Head pads are placed on the head.

During the Procedure:

  • A blood pressure cuff is applied around one ankle, which stops the muscle relaxant from entering the foot and affecting the foot muscles. When the procedure begins, the doctor monitors seizure activity by observing for movement in that foot.
  • Monitors check brain activity, heart, blood pressure, and oxygen use.
  • Oxygen is administered through the oxygen mask.
  • Mouth guards are provided to protect teeth and tongue and prevent injury.
  • The procedure usually takes five to ten minutes and additional time to prepare the subject for the procedure.

The procedure is carried out in multiple settings for better results. These settings can be about six to twelve sessions, with the duration being twice a week or once in two weeks, depending upon the individual's symptoms. Later, the therapy is carried out once a month to prevent a recurrence.

What Are the Advantages of Electroconvulsive Therapy?

Electroconvulsive therapy is the treatment option that can be used when other treatment options are ineffective, and that is one of the most significant advantages.

Other advantages include the following:

  • Less invasive.
  • Minimal side effects.
  • The time required is brief.
  • The duration of treatment is short.
  • A person is not awake during the procedure and thus does not experience any pain.

What Are the Side Effects of Electroconvulsive Therapy?

Electroconvulsive therapy is generally considered safe, but in rare cases, complications can occur due to the use of general anesthesia. However, electroconvulsive therapy can have side effects that can be noted immediately after the treatment, which include:

  • Tiredness and fatigue till the impact of general anesthesia wears off.
  • Headache.
  • Nausea and vomiting.
  • In some instances, electroconvulsive therapy can trigger prolonged seizures.
  • In rare cases, it can cause severe memory problems lasting over two months.
  • Muscle pain.
  • Temporary delirium and confusion, especially in the elderly.

The researchers have not reported any long-term or severe side effects of the therapy, but they should be discussed with the physician before the procedure.

How Are the Side Effects Monitored?

  • After every session of electroconvulsive therapy, healthcare professionals will monitor if the treatment is effective and if one is responding to it without any side effects.
  • On examination, if the physician notices the following, the electroconvulsive therapy will be discontinued.
  • If the goal of the treatment is fulfilled.
  • If any of the side effects mentioned above are noted.
  • If the patient does not want to continue the therapy.

When Is Electroconvulsive Therapy Contraindicated?

There is no absolute contraindication of ECT except for recent myocardial infarction and raised intracranial pressure.

Conclusion:

Electroconvulsive therapy is a treatment modality used in patients with mental health disorders who do not respond to other treatments. Electroconvulsive therapy uses a mild current that passes through the brain and causes chemical stimulation or chemical changes in the brain. The exact mechanism of the therapy remains unknown, but it has proved effective and gained positive results. Electroconvulsive therapy is effective in patients with depression, schizophrenia, catatonia, mania, and dementia.

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Dr. Aneel Kumar
Dr. Aneel Kumar

Psychiatry

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psychotherapyelectroconvulsive therapy ect
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