Electroconvulsive Therapy

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Electroconvulsive Therapy – How Is The Procedure Done?

Posted on August 11, 2011 in ECT Therapy

As a definition, electroconvulsive shock therapy is a psychiatric procedure used to induce in the patient’s brain controlled small amounts of electricity in order to treat a number of affective diseases – acute depression, bipolar disorder, or schizophrenia. The small electric shocks produce short convulsions which ameliorate the symptoms of the mental illness.

Electroshock therapy is another approach used instead of drug medication in treating mental disorders. That is because there are patients who manifest allergy to drugs; some other patients display side effects to anti-psychotics; some of them are unable to self-medicate, while others need fast improvements in their states because they are refusing to eat or drink. Major depressions seem to have too, their best cure with ECT. Severely depressed pregnant women may undergo the procedure. Finally, there is one more instance when ECT is the first recommendation: antipsychotic drugs manifest their effectiveness not until two to four weeks and in cases where the patient has suicidal tendency.

New medical standards have been set in 2000 and a series of steps has been established that have to be taken before the electroconvulsive shock treatment. First of this is to take the patient’s written consent.

In preparation for the ECT procedure, patients need to be thoroughly examined, as hidden medical conditions might [prove to be harmful to them. The physician conducting the procedure has to check with the detailed medical file, perform a physical examination, complete the lab tests, EKG, radiography of the chest and spine, CT of the brain, in order to observe any abnormality that would disqualify the patient (heart attacks, strokes, brain tumors, etc.).

The medical team has to be made up of a number of specialists in different fields: the anesthesiologist, the respiratory therapist, the cardiologist, the psychiatrist – of course, and the assistants.

Before performing the ECT, the patient is given an intravenous injection containing two components: one of them induces muscle paralysis, the other puts them to sleep. Both doses are calculated for rapid and short-term effect, because the session lasts for, at most, 30 minutes. The muscle paralyzing substance prevents dangerous convulsions. However, a tourniquet is applied on one of the patient’s hands or feet before the injection, in order to observe muscular reaction during ECT. Additionally, a piece of rubber is placed into the patient’s mouth, to prevent tongue bites or loss of teeth. A breathing tube is also inserted into the patient’s respiratory system.

The electroconvulsive therapy unit is then connected to the head of the patient, together with the EEG. The electrodes of the ECT apparatus are usually placed bilaterally, on the temples, while the electrodes of the EEG are stuck to the front. The patient is also connected to a EKG unit.

The menu on an electroconvulsive therapy machine permit setting up of different durations, voltage, and amperage electrical discharges.

As a general rule, the electrical shocks are of very low power and duration. Usually, therapists use currents of 70 – 120 or 150 Volts, but there are occasions when they raise tension up to 400 volts. The amperage ranges between 0.1 to 0.6 Amps, sometimes up to 1.5 Amps. The current might be discharged in doses between 5 to 15 seconds, rarely more.

The limb which is not paralyzed witnesses for the neuronal activity during ECT. In the first phase, the muscles will contract for a longer period about 10 to 15 seconds, then they will show spasmodic contractions. This second stage might last anywhere from 10 seconds to 2 full minutes.

The contractions are a sign that the electroshocks really work, and that they will be effective in the shock treatment for mental illness. If the contractions are too short in both phases, the electrical current parameters or the duration of the discharge have to be increased, until the desired outcome is obtained. A second shock is not to be released sooner than one minute after the preceding shock. If, after a third discharge, no effect is noted, the session must end because the patient is irresponsive due to different causes and may be harmed if further shocks are administered.

The therapy will seldom show effectiveness within a single week. However, most of the cures take two to six weeks with one session conducted every other day. In some isolated cases, notable results might be seen only after longer periods of time, sometimes up to six months.

ECT practitioners proudly estimate their rate of positive responses to therapy at 90% of the patients, while common antidepressant medication rates somewhere around 50%. They also say that the rate of relapse is less frequent, if therapy sessions are taken twice a year.

Despite these figures, ECT in itself has not proven to be sufficient. Most of the psychiatrists prescribe antipsychotic medication after the electroconvulsive therapy. The combined effect of the two methods is told to have given very good results.