What is electroconvulsive therapy?

ECT is an effective medical treatment for certain mental health problems. A very small amount of
electricity is applied to the scalp and this produces a seizure (a fit) in the brain under control. The
procedure is painless because you will be asleep under general anaesthesia.

Why is ECT used?

ECT is given for a range of reasons. Your consultant may recommend to be treated with ECT if:

1. You have suffered from severe depressive illness for some time and a number of different drug
treatments have been tried without success.
2. You have tried several different anti-depressants but your doctor had to stop them because of
their side-effects
3. You are suffering the manic phase of Bipolar disorder (manic depressive illness)
4. You are suffering one of the less common forms of schizophrenia for which ECT is indicated.
5. You have responded well to ECT in the past
6. Your life is in danger because the severity of your mental health problem is preventing you from
eating and/or drinking sufficiently
7. Your mental health problems are putting your life in direct danger.

How does ECT work?

Nobody is certain how ECT works and there are a number of theories. The essential element in ECT
treatment is the seizure (fit). Many doctors believe that severe depression is caused by problems with
certain brain chemicals. It is thought that ECT causes the release of these chemicals and probably more
importantly, makes the chemicals more likely to work and so help recovery. Recent research suggested
that ECT can stimulate the growth of new blood vessels in certain areas of the brain.

What are the benefits, risks and side-effects?

Benefits:

1. The main benefit of ECT is the speed of recovery from a depressive episode when compared to
drug treatment alone
2. Although you might not see the improvement immediately, you many notice an improvement in
your mood after 3-4 treatments. This varies from person to person and you will be given only as
much treatment as you need to get better and stay well.

Risks:

1. ECT is one of the safest procedures done under general anaesthesia.

2. Complications rarely occur but – as with all procedures- if you suffer from serious heart or lung
problems, your doctors will need to assess your fitness for ECT. People with heart disease can
 still receive ECT safely, with special precautions such as heart monitoring. Depending on the
severity of any medical condition you might have, your doctor may ask another specialist for
advice before starting a course of ECT.

Side-effects:

1. Some clients may be confused just after waking up from the treatment but this generally clears
up within a few minutes to an hour.
2. Your memory of recent events may be upset and some factors may be temporarily forgotten
(such as dates, telephone numbers, etc). This memory loss, in most cases, goes away in within
few days of weeks, although some patients continue to experience memory problems for a
number of months.
3. ECT has not been proven to have any long-term effects on your memory or your intelligence.
4. Some people have headaches or feel sick when they wake up, but we can alleviate these
symptoms with medication should this happen.
5. Many people wake up with no side-effects t all and they simply feel very relaxed or sleepy

Before the procedure:

Patient:

Can’t eat or drink after midnight on the day of treatment, able to wear ordinary day clothes throughout
the procedure. Wear loose garment. Keep make-up to a minimum without nail polish. Remove any
dentures, jelwelry, contact lenses and hearing aids, dr will instruct what medications not to take , if not
get the medications with themselves.

Medical:

1. Medical History
2. Authorization by consultant signed to do ECT
3. Recent blood results
4. Physical check up
5. ECG
6. Authorization by consult signed to do ECT
7. CXR if smoker
8. Consent form signed by patient or respective relative

What will happen?

1. Greeting of patient and preferably relative by one of the ECT nurses

2. Wait for a short while in the waiting area until it will be your turn.
 3. A member of the ECT staff will carry out routine physical checks – taking blood pressure, and
other parameters
4. Bathroom before procedure
5. Acccompanied to treatment area
6. Anaesthetist and anaesthetic nurse will connect to monitoring equipment to ccheck heart rate,
oxygen levels and blood pressure.
7. Cannula insertion
8. ECT given under anaestheisa
9. Wakes up in recovery area assisted by nurse till fully awake
10. Nurse asks simple questions
11. Monitor and a mask might be attached
12. May take a while for pt to recover completely and not know where he is at first. May feel sick at
first.
13. Leave suit when u are ready to go.

Outpatients

 Responsible adult assistance for first 24hrs. No strenuous activity, nod riving and no alcohol first
24hrs.
 No follow up required but assessment by consultant to assess progress and prescribe next two ect
treatments
 Normal activities resumed within 24hrs. Delay any major decisions or official business – such as
signing contracts until your condition has stabilized.

Other relevant information:

 Patient receives 6-12 bouts – 2x week outpatients MDH or inpatient in MCH

 Need a course to see an effect
 3 stages:
o ECT
o Recovery
o Food
 Intra-operative monitoring of – BP, pulse and PO 2. An increase in BP, when giving an anaesthetic,
initially it will decrease but then it will increase at a higher rate.
 Mainly used for depression and stupor (may be considered as life saving, if patient is not eating)
 IV cannula for thiopentone, short acting muscle relaxant, atropine (strengthens heart beat and
prevents bradycardia)
 ECT can be unilateral or bilateral. Bilateral more effective and preferred most effective in
depression.
 Bilateral movement are the only relevant ones. Facial twitches are considered as bilateral
 Movements >15 bilateral – If more than 60-70, need for valium to stop seizures
 Tonic-clonic activity is essential to determine effectiveness of ECT
  Benzodiazepine and valium should be reduced the night before the ECT so that the tonic-clonic
activity can be visualized more clearly (not masked by drugs)
 The room for ECT is equipped with suction and oxygen. Should O2 stop  ambuback. They also
have portable sucker.
 Patient needs to be starved and asked to go to the bathroom before to avoid incontinence
 When airway starts annoying patient  first sign that patient is emerging from anaesthesia,
recovery of reflexes

Tuesdays and Fridays at MDH

Monday and Thursdays at MCH

Extension: 6920 ask for Joseph or Martin