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ECT is often effective in cases where antidepressant medications do not provide sufficient relief of symptoms or in cases where the side effects, caused by antidepressant, are not tolerable. ECT is done under brief general anesthesia in an operating room setting. After general anesthesia is induced, a muscle relaxant is given before ECT electric stimulus.
Two electrodes are placed at precise locations on the head to deliver electrical impulses.
The stimulation causes a brief about 30 seconds seizure within the brain. The patient does not consciously experience the electrical stimulus. For full therapeutic benefit, at least six-nine sessions of ECT are typically given at the rate of three per week. The actual procedure itself lasts only a minutes and the patient wakes up from the effects of anesthesia within 5 to 10 minutes. It is a well-controlled and highly successful treatment option. Side effects may result from anesthesia, ECT treatment or both. Common side effects include temporary short-term memory loss, such as recent events, dates or recent meals.
Other side effects could include confusion, nausea, muscle aches and headache, mostly on the day of the ECT procedure. Due to epileptic, parasympathetic, and sympathetic responses, control of the patient's muscular sphincters can be altered. The patient can experience defecation bowel incontinence as a result of the ECT procedure. Being compliant with "Nothing Taken by Mouth" 8 hours prior to ECT procedure decreases the incidence of this potential side effect.
We will prompt patients to void before ECT so that bowel and bladder incontinence will be very unlikely. I often wonder what treatment I would receive for my depression if I had been born into a different generation. At the turn of the 20th Century, I might have been institutionalised in one of the many mental hospitals that dotted the British countryside.
In the s, I would have been prescribed amphetamines, the class of drugs that includes ecstasy and were marketed as the first antidepressants. And in the s — the decade when my grandparents would have been my age, in their late 20s or early 30s — I would have received electroconvulsive therapy.
At this time, shock therapy was so popular that it was often performed on an out-patient basis. View image of In the s, shock therapy was so popular it could be done on an outpatient basis. The idea to induce convulsions to treat mental illness originated with Ladislas von Meduna, a neurologist at the University of Budapest. Like other doctors working in mental hospitals, he had noted how patients with schizophrenia who suffered from a convulsion — which was normally a result of the powerful drugs they were taking — seemed to recover.
Electroconvulsive therapy (ECT) - Mayo Clinic
Their hallucinations, nonsensical speech, and delusions appeared to vanish. Although the symptoms would, in time, return, his observation opened a new vista of possibility for psychiatric treatments. Find a way to induce convulsions, Meduna thought, and perhaps the most stubborn forms of mental illness would vanish in their wake. In , Meduna used a drug called cardiazol marketed as Metrazol in the US that induced convulsions within seconds or a couple minutes after its injection into muscle.
After regaining consciousness, once-catatonic patients began to get out of bed, dressing themselves, and — in some cases — talking for the first time in years. This new therapy created a buzz of excitement. Were once incurable conditions soon to be cured? After hearing about cardiazol, Ugo Cerletti, the chair of the Department of Mental and Neurological Diseases at the University of Rome La Sapienza, thought he knew of a better way to induce convulsions. He had been using short, sharp bursts of electricity to induce epileptic-like fits in his study animals for years.
It was instantaneous, cheap, and highly controllable. Unlike cardiazol, which varied in its potency, electricity was split into two basic variables: number of volts and fractions of a second. A dial controlled the voltage, while an automatic stopwatch could reduce the shock to a tenth of a second. View image of Doctors in a hospital place the electrodes in a simulation of an ECT session.
Teeth would clamp down on a piece of pipe as air hissed out of the lungs. Legs and arms might thrash wildly, and faeces, urine, and for men, even semen could be ejected from the body as a result of straining every sinew. Bones could be fractured, especially those in the spine and around the shoulders and hips. These were hairline fractures often only seen in X-rays and which healed quickly, but obviously still undesirable.
Electroconvulsive therapy (ECT)
Then there were reports of memory loss. After regaining consciousness, some patients wondered where they were, how they got there, even to whom they were married. Although their memories would normally return days or weeks after the treatment, some patients seemed to lose memories forever.
The surgeon does not refuse a necessary operation because of its impending risks — Lothar Kalinowsky. Risks are therefore justified. Indeed, for all its drawbacks, ECT was incredibly effective at treating some of the most stubborn mental illnesses — especially, as it soon turned out, severe depression. At least two of their patients had suffered with their condition for 10 or 15 years, only to find it lift for the first time after six or seven sessions of ECT performed over a few weeks.
Like a forest fire vital in liberating the seeds from inside tough pinecones, a quick burst of electricity — and, more importantly, the convulsion that it caused — seemed to reanimate a person from the thick psychological armour in which they were encased. From its earliest days, ECT was misused and sometimes abused. In , Emil Gelny, a psychiatrist at two mental hospitals in Lower Austria and a member of the Nazi Party, modified an ECT machine for use in the T4 euthanasia programme of the mentally ill.
At Baton Rouge General, we promote a healthy lifestyle to address your needs, discussing all options available before deciding on any treatment. ECT often works when other treatments are unsuccessful and can benefit pregnant and lactating women, seniors, people with limited tolerance to psychiatric medications and those who are at a high risk of suicide.
ECT is a safe and effective option for psychiatric disorders.