Electroconvulsive Therapy (ECT)

What is electroconvulsive therapy (ECT)?

ECT is a non-invasive way to treat refractory major depression.  A therapeutic seizure is caused by an ultra brief amount of electricity applied to the scalp.

Etiology

Despite the profound antidepressant effects of ECT, the exact etiology is unclear but researchers feel a series of treatments restore normal biologic function of the brain.

Indications for ECT

• Severe, life threatening depression that is refractory to current antidepressants
• Mania
• Psychosis
• Schizophrenia not responding to medications

Ideally, patients being considered for our ECT program have had poor response to at least four antidepressants that have been from at least 2 drug classes.

ECT vs. antidepressants

• ECT works faster than medications.  Most patients have a clinical improvement in mood within 2-3 weeks but can take as long as four weeks.  Most anti-depressants target dopamine or norepinephrine but take 5-6 weeks to reach therapeutic levels.
• ECT has a success rate of 80-90% vs. pharmacologic therapy.  Response rates to first agent can be as low as 50% and remission rates can decline even further with successive drug trials.

During initial course of therapy patient will receive treatments three times a week.  Our clinic operates on a Monday, Wednesday, Friday schedule.

Pregnancy and postpartum women

• Although ECT is no longer considered a first line intervention, it can be one of the treatment options.  Research findings indicate fetal/infant toxicity to antidepressants is much less than previously supposed.
• ECT poses no risk to the fetus and general anesthesia is well tolerated.

Potential cognitive side effects

• Confusion immediately following treatment.  This is related to anesthesia and the post- ictal phase of the seizure and resolves within an hour.
• Memory loss can be experienced several ways: Retrograde amnesia:  No recollection of events weeks or months before treatments. No memory of events during the weeks of therapy.  Some patients have problems that persist once ECT is completed but usually improve over the next several months.

Potential medical complications

• Cardiac:  Irregularities in rhythm, heart rate, elevated blood pressure at the most severe cardiac ischemia or asystole.  The electricity causes a strong cholinergic response and the seizure causes a profound sympathetic response.
• Oral or dental injury from patients clenching their jaw during the seizure.
• Long bone or spinal fractures

These issues are dramatically diminished by our pretreatment work ups and the use of general anesthesia.

Contact us

If you or a loved one might benefit from ECT, please contact us at (412) 858-2707.