When should you not use ECT?
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The greatest risk with ECT is associated with the anaesthetic, which has a very small risk of death (often quoted as one in 100,000). Like any procedure involving an anaesthetic, ECT involves this small amount of risk, but overall, it is regarded as a very safe treatment. Despite the myths about ECT causing brain damage, MRI studies have shown that it does not change the brain anatomy in any way, as the strength of the electrical current is too low to harm brain tissue. Show Side-effectsImmediate effects of ECT may include:
Generally, these resolve within a few hours, although some memory loss may persist. Some people who have undergone ECT recommend writing down passwords, PINs, phone numbers and special dates, and keeping them in a safe place in case they cannot be recalled in the period after the treatment. A common and significant side-effect is difficulties with memory – this is reported by at least one in three people1 who have ECT. It can be hard to work out which memory changes are caused by ECT and which by the mental health condition itself – but ECT may lead to both loss of memories or difficulty in creating new memories. Most research demonstrates that memory loss is very restricted and usually temporary. However, memory changes may last for some weeks after treatment and a few people experience long-term or even permanent loss of memories. People differ in the amount of memory loss they report from ECT and how they feel about it. The more treatments a person has, the greater the effect on their memory and, if the ECT is bilateral rather than unilateral, is likely to affect a person’s memory more as well. While some people find ECT to be a beneficial and lifesaving treatment, others find their memory loss distressing and for them, this outweighs any benefit from ECT. ECT today is a sophisticated procedure – nothing like how it’s portrayed in that old movie. Today, ECT is performed under general anesthesia. Patients are monitored continuously to reduce the risk of complications. Patients are asleep and unaware of the stimulation. 2. ECT is a miracle cure.It is an incredible therapy, but it is not a miracle cure. Depression is a chronic condition, and relapses can occur after ECT. If relapse occurs, we can offer maintenance treatments to patients who have previously completed ECT therapy to regain control of depression symptoms. 3. I’ll get injured during the seizure.Patients lie down while the medically controlled seizure is induced, and we will ensure they are stabilized. People who experience spontaneous seizures often fall down and risk head injury. That won’t happen during an ECT treatment. In fact, most patients don’t move or jerk their limbs at all; those who do move only minimally. There is a risk of shoulder dislocation or biting the tongue during the procedure, similar to during a non-medical seizure. However, because this procedure is medically controlled, we take precautions to reduce the risk such as giving patients medication to relax the muscles and placing bite blocks in their mouths during the procedure. 4. I’ll have permanent brain damage.For many patients, this is the most worrisome ECT myth. However, there is no evidence of structural brain damage in patients who have ECT. Some patients have slight memory loss of recent events, and in most patients, this resolves within a few months after treatment ends. MST is similar to ECT but uses magnets in place of electrical currents to stimulate the brain. We know that bilateral ECT (both sides of the brain are treated) is superior to MST and unilateral ECT (only one side is treated). Preliminary data suggests that right-unilateral ECT and MST are comparable, but MST carries fewer memory-loss symptoms. We are excited about this trial because we hope to, in the future, offer magnetic therapy as an alternative for patients who are concerned about cognitive side effects of ECT. Another therapy for treatment-resistive depression is repetitive transcranial magnetic stimulation (rTMS), which does not carry some of the side effects of ECT. While rTMS is not as effective as ECT, there is exciting research in progress that could lead to rTMS becoming a more effective option for patients in the future. Additionally, the drug ketamine was approved by the FDA in March 2019 as a therapy for treatment-resistant depression. Ketamine is still being studied for other major depressive disorders; clinical studies are currently being conducted at UT Southwestern. Today, no treatment is generally more effective for treatment-resistant depression than ECT. With this and other ever-improving therapies, we can achieve our continual goal in mental health care: Helping more patients and families have more good days together. Who is ECT Not recommended for?Not everyone is a candidate for treatment even if they believe ECT could help them. For example, children under age eleven cannot undergo ECT for mental health disorders. People with heart conditions and people who cannot handle short-acting sedatives or muscle relaxers should not undergo ECT treatments.
Can ECT make your disorder worse?Some people who had bipolar disorder described experiencing a 'high' after the ECT. John Z, who was catatonic when he had the treatment, went high and “off the scale” after his ECT treatment (see for more 'How effective did people find ECT'). Sometimes this was short lived and left them feeling worse than before.
What are the disadvantages of ECT?Immediate side effects. drowsiness (you may sleep for a while). confusion.. headache.. feeling sick.. aching muscles.. loss of appetite.. What condition has the best response to ECT?Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments.
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