Electroconvulsive Therapy

Information on Electroconvulsive Therapy

Home - ECT Therapy - Electroconvulsive Therapy Modes And Procedures

Electroconvulsive Therapy Modes And Procedures

Posted on August 18, 2011 in ECT Therapy

In the 1850’s, a French physician by the name of Duchenne, using tiny electrical discharges emitted by a Leyden jar, managed by chance, to induce muscular activity and blood circulation improvement into the paralyzed hand of a locksmith. This was the first important step in a journey that still continues to this day. During the 1930’s, an Italian psychiatrist, Ugo Cerletti noticed that patients with schizophrenia do not suffer epilepsy and vice versa. He supposed that the seizures and the convulsions characteristic to epilepsy would cure schizophrenia and tried to find a procedure to replicate the convulsions. Electroshocks proved to be the easiest manner, and this is the way electroconvulsive therapy treatment was born.

Electroconvulsive therapy definition

Electroconvulsive therapy (ECT) is the process of using small quantities of electrical current administered to the patient’s brain, producing seizures that would ameliorate mental disorders. ECT is mainly used with depression, bipolar disorder and schizophrenia – known together as affective disorders.

The method was, in the beginning, rather cruel and fraught with many dangers. This was due to the violent and uncontrolled convulsions. Many patients who underwent the primitive method of ECT suffered fractures in limbs, ruptures in the muscles and problems in the spine. For a time in the 1950’s, there was a public campaign started against the use of electroconvulsive therapy. In time, along with the better understanding of the process and technological advancements, the therapy was refined to what it is today. Muscle relaxants began to be dispensed to control the convulsions. The dangers that accompanied the process of old no longer exist in electroshock therapy today.

What are ECT treatments?

In lieu of using medical drugs to treat mental disorders, electro shock therapy is another approach. That is because there are patients who manifest allergies to some drugs; other patients display side effects to anti-psychotic drugs; many patients on account of their conditions cannot medicate themselves, while still others need quick improvements because they are refusing food and water. Major depressions have their best cure with ECT.

Technically, the ECT procedure is rather simple, and international medical standards have made it safe. There is required the presence of a whole specialist team attending to the patient: their physician, the anesthesiologist, psychiatrist, respiratory therapist, and a cardiologist, each with a precise role in the process.

In preparation for the procedure, patients have to go detailed medical diagnostic examinations. The physician-in-charge will check the results of the physical examination, complete lab and blood tests, EKG, radiography of the chest and spine, and computer tomography of the brain. This is done to check for abnormalities that may present risks to the patient for heart attacks, strokes, or brain lesions during the procedure. If the standards are not met, the patient is disqualified for the electroconvulsive therapy treatment.

Also prior to the ECT itself, the patient is given an intravenous injection containing two elements. One of these drugs induces paralysis in the muscles to prevent convulsions and the other puts the patient in a sedative state. The effect of the doses is calculated to last for some 30 minutes, which is the average duration of a session. A tourniquet is applied, a rubber mouthpiece placed into the patient’s mouth and a respiratory apparatus attached to the patient, all safety precautionary measures.

The patient is then wired to the EKG and EEG. The electrocardiograph’s sensors placed on the chest track the heart rate, while the electroencephalograph’s electrodes placed on the forehead track brain activity.

There are two modalities to connect the subject to the electrotherapy unit: either on the temples or other symmetrical parts of the cranium (bilateral ECT), or over one single lobe (unilateral ECT). Positioning is important because of one single factor. The left hemisphere of the brain is responsible for cognitive activities, while the right hemisphere deals with emotions. The symmetrical placement of electrodes causes electroshocks to flow through both hemispheres. This way, the cognitive side is also affected. This is why more and more of the psychiatrists do unilateral therapy, applying electroshocks only to the affected lobe of the brain.

The electrical shocks are intentionally weak and applied in quick bursts. The range of current used is 70 – 150 volts. Rarely, it can climb up to 400 Volts. The intensity ranges from 0.1 to 0.6 amps and rarely up to 1.5 Amps. The discharges take 5 to 15 seconds, rarely more.

One of the best advantages of electroconvulsive therapy is its high recorded effectiveness rates. ECT experts estimate that 90% of the patients exhibit positive responses, compared to antidepressant medication success rates at only 50%. Another advantage is that while antidepressants can cause addiction which is another problem altogether, ECT does not. ECT is also a supervised procedure and the doctor is able to monitor its conduct while a patient’s medication outside of the hospital or clinic cannot be checked for the patient’s compliance to the dose and frequency.