Electroconvulsive Therapy
Educational Video on Electroconvulsive Therapy (ECT)
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Living Well: A Treatment Series
Modern Day ECT
This educational video is included in a five-part series of films on treatment options for depression. The films were developed by the Fuqua Center for the purpose of educating patients and care providers on available treatments for depression. This short video discusses the history of ECT treatment, medical concerns, general side effects, typical treatment course, and general guidelines after treatment. It features an actual ECT treatment and provides commentary from patients and caregivers.
Please browse the following links to the ECT information below:
A History of ECT
ECT was first developed in 1937 by Ugo Cerletti and Lucio Bini as way to induce seizures reliably. It had been previously observed that inducing seizures using chemicals that were given intravenously helped reduce psychotic symptoms such as hallucinations and paranoid ideas. At the time ECT was developed there were few medications to treat the sickest psychiatric patients. The only medications available were sedatives that left the patient asleep (such as barbiturates or opiates) but still psychotic.
The first antipsychotic and antidepressant were not available until the late 1950s. Lithium was not used in the United States until the 1970s. There were few effective treatments for psychiatric disorders and the underlying illnesses were poorly understood. Many of the patients classified as having psychiatric disorders in fact had medical disorders like syphilis and a vitamin deficiency called pellagra. The understanding of these medical disorders and the development of effective medical treatments was a major advance in psychiatric treatment.
The treatments available at the time ECT was developed were often quite dramatic and included frontal lobotomy, insulin coma therapy and malarial therapy. For example, in insulin coma therapy the patient was brought near death by administering insulin to the point where the patient went into a coma because of dramatic drop in blood sugar. As, perhaps, a sign of the times and how desperate physicians were to develop treatment strategies for psychiatric disorders, a neurosurgeon Moniz received the Nobel Prize in Medicine for the development of frontal leucotomy (also know as frontal lobotomy) for the treatment of psychosis. These were pivotal times in the understanding and treatment of psychiatric disorders.
In the twenty-first century, ECT is the only one of these procedures that remains in common use in psychiatry. The administration of ECT has been refined and advanced with the use of anesthesia, muscle relaxation, oxygenation and better seizure monitoring. The treatments done today have only a superficial resemblance to the treatments done at the time of Cerletti and Bini.
In the early days of ECT, the procedure was administered without anesthesia. The theory at that time was that patients got better when they were more confused and disoriented during the treatments. The treatments were often given with minimal medical supervision.
The modern ECT suite such as the one at Wesley Woods of Emory University is equipped to provide general anesthesia during the treatment, and monitoring and post-ECT care that is comparable to any outpatient surgical clinic found in any state of the art hospital in the United States. Patients are monitored during the treatment by a team of medical providers which (at Wesley Woods and most ECT centers) includes a psychiatrist, anesthesiologist, nurse anesthetist, nurse practitioner and postoperative nurses. Patients are asleep throughout the treatment and are monitored for their heart rate using a continuous electrocardiogram, blood pressure, oxygenation, and electroencephalogram (EEG) throughout the treatment. During the treatment, medications are administered to limit the amount of muscle movement and to control heart rate and changes in blood pressure.
These treatments are a far cry from the ones depicted in movies such as One Flew Over the Cuckoo's Nest!
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Frequently Asked Questions
What is ECT?
Electroconvulsive therapy (ECT), also known as electroshock therapy (EST), is a medical procedure used to treat various psychiatric disorders including depression, manic depressive illness and schizophrenia. The reputation of ECT often precedes it, bringing to mind negative images of an antiquated and barbaric treatment. Electroconvulsive therapy also has been touted as a "cure-all" for many psychiatric illnesses. The truth, as with many things, lies somewhere between the two extremes. ECT is one of the most effective treatments for depression, is usually well tolerated but does carry some potentially serious side effects.
How is ECT administered?
ECT is typically administered in the morning to patients with an empty stomach. The patient is asleep and electrodes are placed on his or her head. The electrical stimulus is then administered and the unconscious patient does not suffer pain or convulsions. The patient wakes up in the recovery area five to ten minutes after the procedure. After treatment, follow-up therapy is important and includes either medication or less frequent ECT given over a 6-month period.
Who should get ECT?
Usually, ECT is considered after a person has tried several antidepressant medication trials and still has significant depressive symptoms. ECT is considered earlier and may be the first line of treatment in situations when the patient is severely depressed, actively suicidal or not eating food and drinking fluids.
How does ECT work?
The exact mechanism of how ECT works is unknown. However, ECT is believed to effect the central nervous system (CNS) and change the levels of neurotransmitter receptors, such as those of serotonin, norepinephrine and dopamine, in the brain. The most widely accepted theory about how ECT works is that ECT acts as an anticonvulsant - that is, ECT actually raises the seizure threshold or decreases the tendency of the brain to seize. ECT may, therefore, quiet many of the overactive neurotransmitters in the brain. This theory is known as the anticonvulsant hypothesis. The anticonvulsant effects cause brain changes that lead to the antidepressant effects that are observed after ECT. More research in this area is needed before definitive statements can be made regarding the mechanism of ECT.
Is ECT a safe treatment?
Yes. Electroconvulsive therapy can be given safely to adults of nearly all ages. However, there are some risks, particularly if the patient has significant medical problems. The two most serious concerns regarding ECT are related to the heart and brain. Stoke, heart attack and even death are very rare but potential outcomes. The risk of death is approximately 1/10,000 or .001%, near the risk rate of just getting general anesthesia alone. However, the fact is that most modern medical facilities such as our own have not had an ECT-related fatality because of the intense medical monitoring before, during and after the treatments.
How effective is ECT?
Electroconvulsive therapy is between 60% and 90% effective in the treatment of major depression. The American Psychiatric Association, the American Medical Association, and the National Institutes of Mental Health recognize ECT as an effective treatment.
How often are treatments given?
Electroconvulsive therapy is given in a series of treatments. Usually it takes between 5 and 8 treatments before the benefits are observed. Treatment is given approximately three times per week. This treatment period is called the acute series of ECT. ECT can be given as an inpatient or an outpatient depending on the individual's specific situation.
ECT is discontinued after a sustained response is obtained. The patient then takes medications to help prevent a relapse of the depressive symptoms. Unfortunately, due many factors, there is high relapse rate after completing ECT. Individuals who have relapsed previously after completing electroconvulsive therapy or had an extremely severe depressive episode may be considered for a longer course of continuation ECT (C-ECT). C-ECT is given after someone completes the acute series of ECT. It is usually given weekly for four treatments, then every ten days for three treatments and then every other week for eight treatments. C-ECT helps reduce the recurrence of depressive symptoms.
What side effects can be expected from ECT?
Serious adverse effects are rare. However, patients can experience headaches and nausea, which can be effectively treated with medications. Short-term memory loss, particularly around the time of the treatments, is common. Patients also report that their "thinking is a little fuzzy" during the acute treatment phase. These cognitive deficits usually resolve a few weeks after the last ECT treatment. During the acute series of ECT, it is recommended that patients not drive a car or sign important documents until these effects resolve. Here at Wesley Woods Hospital, ECT is usually given by stimulating the right side of the brain only (rather than bilateral stimulation on both sides of the brain), in effort to reduce the cognitive side effects.
The risk of an ECT related fatality is increased, of course, if the patient has other significant medical problems. Increased risk is associated with brain tumors, recent strokes or heart attacks, unstable vascular disease and aneurysms. A very thorough medical exam, including evaluation of the heart and brain, are standard in the pre-ECT evaluation. The ECT treatment may be modified slightly depending on the medical conditions of the patient.
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Location and Contact Information
| Location: |
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Contacts: |
Wesley Woods Hospital
ECT Suite; 1st floor
1821 Clifton Road, NE
Atlanta, GA 30329 |
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Tom Maxwell, NP
ECT Services Coordinator
(404) 728-6469
Dawn Prettygar, RN
ECT Unit Charge Nurse
(404) 728-6542 |
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Information for Patients and Families
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Information for Physicians
Electroconvulsive Therapy Mini-Fellowship
The ECT Mini-Fellowship Course is structured for psychiatrists and their nursing staff who are interested in the therapeutic efficacy of ECT and procedures for the administration of ECT. The physician can select either the three-day intensive session or the five-day session. Please visit the Emory CME website through the above link for more information or call Tom Maxwell at (404) 728-6469.
Please follow these simple steps for a new ECT referral:
- Call Tom Maxwell, FNP at (404) 728-6469 to relay patient history and urgency.
- Send Tom Maxwell the psychiatric evaluation and recent progress notes including specifics of past treatment options and why ECT is necessary via fax at (404) 728-6912.
- Fax both the front and back of the patient's insurance card to Angie Barrett-Davis at (404) 728-4588. For reference, Ms. Barrett-Davis' phone number is (404) 728-4909.
- Have the patient ask any other doctor treating him or her for an ongoing medical problem to send notes to Tom Maxwell.
- Have the patient schedule an outpatient ECT evaluation at the Fuqua Center with Tom Maxwell and William McDonald, MD at (404) 728-6302.
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Additional Resources
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Suggested Reading
- Shock Therapy: No Longer Shocking By Daniel DeNoon, WebMD Medical News
- Holiday of Darkness: A Psychologist's Personal Journey Out of His Depression (Revised Edition). Endler, Norman S. Wall & Emerson, 1990.
- Undercurrents: A Therapist's Reckoning with Her Own Depression. Manning, Martha. HarperCollins, 1995.
- Case studies show benefit of ECT for dementia-related mania. (2001) Brown University Geriatric Psychopharmacology Update, 5:7, 1-4.
- Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging (A Task Force Report of the American Psychiatric Association). American Psychiatric Press, 2001
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