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Copyright 2006 www.stopdepressiontoday.com
Electroconvulsive Therapy (ECT)
It seems quite barbaric in this day and age, but in the experience and judgment of many physicians (and patients with severe depressions who have received ECT and other antidepressant treatments), electroconvulsive or “shock” therapy is the single most effective treatment for severe depression and has a number of advantages over other treatments.
ECT works rapidly so that patients can quickly return to productive living. It has a higher success rate for severe depression than any other single treatment approach.
ECT is the treatment of choice when a depressed person is making dangerous suicide attempts, because attempts are exceedingly rare after a course of treatment has started.
It seems quite barbaric in this day and age, but in the experience and judgment of many physicians (and patients with severe depressions who have received ECT and other antidepressant treatments), electroconvulsive or “shock” therapy is the single most effective treatment for severe depression and has a number of advantages over other treatments.
ECT works rapidly so that patients can quickly return to productive living. It has a higher success rate for severe depression than any other single treatment approach.
ECT is the treatment of choice when a depressed person is making dangerous suicide attempts, because attempts are exceedingly rare after a course of treatment has started.
In psychotic depression
where a person has lost contact with reality and has delusions and/or
hallucinations, ECT is actually more effective than most antidepressant
medications (an exception may be amoxapine (Asendin), which has been
shown to be useful for psychotic depression).
Depressed patients who are also severely medically ill usually tolerate ECT very well and with fewer complications than when treated with antidepressant drugs. Contrary to the common fears and dramatic misconceptions often associated with the term “shock treatment”, the actual physiological stress and risk from the minimal electrical stimulus employed are very low. ECT is administered after the patient is put to sleep with a short acting anesthetic and after the patient’s muscles are relaxed, so that muscle contractions from the treatment will not damage muscles or bones. Patients do not remember or feel the treatment.
After most treatments, there is a brief period of confusion and memory loss for recent events. This usually lasts from 20 to 60 minutes. Temporary memory loss increases with the number and frequency of treatments but can be lessened by increasing the interval between treatments and by “unilateral” or one sided treatment. A new technique called brief-pulse ECT uses the minimum amount of electricity needed to produce an effective treatment and substantially reduces memory loss after each treatment and over a course of treatments.
Contrary to scare stories and subjective reports of lasting memory loss, repeated studies have failed to find any permanent effect on memory. In fact, memory is sometimes improved after ECT, probably because depression itself can have an adverse effect on memory. After the usual series of 6 to 12 treatments at intervals of 2 to 3 days, some decreasing memory loss may persist for as long as several months. Occasionally, patients complain of more persistent memory impairment, which may not be apparent when tested objectively. Whether this is a reflection of insensitive testing procedures and whether this is truly a consequence of ECT continues to be investigated. Once patients are given information about the great effectiveness and safety of ECT, they may prefer ECT to alternative treatments.
Depressed patients who are also severely medically ill usually tolerate ECT very well and with fewer complications than when treated with antidepressant drugs. Contrary to the common fears and dramatic misconceptions often associated with the term “shock treatment”, the actual physiological stress and risk from the minimal electrical stimulus employed are very low. ECT is administered after the patient is put to sleep with a short acting anesthetic and after the patient’s muscles are relaxed, so that muscle contractions from the treatment will not damage muscles or bones. Patients do not remember or feel the treatment.
After most treatments, there is a brief period of confusion and memory loss for recent events. This usually lasts from 20 to 60 minutes. Temporary memory loss increases with the number and frequency of treatments but can be lessened by increasing the interval between treatments and by “unilateral” or one sided treatment. A new technique called brief-pulse ECT uses the minimum amount of electricity needed to produce an effective treatment and substantially reduces memory loss after each treatment and over a course of treatments.
Contrary to scare stories and subjective reports of lasting memory loss, repeated studies have failed to find any permanent effect on memory. In fact, memory is sometimes improved after ECT, probably because depression itself can have an adverse effect on memory. After the usual series of 6 to 12 treatments at intervals of 2 to 3 days, some decreasing memory loss may persist for as long as several months. Occasionally, patients complain of more persistent memory impairment, which may not be apparent when tested objectively. Whether this is a reflection of insensitive testing procedures and whether this is truly a consequence of ECT continues to be investigated. Once patients are given information about the great effectiveness and safety of ECT, they may prefer ECT to alternative treatments.