Electroconvulsive Therapy

Definition

Electroconvulsive therapy, or ECT, uses an electric current to treat depression and some other mental illnesses. During ECT, the electric current triggers a seizure in the brain. Doctors believe that the seizure activity may help the brain "rewire" itself, which helps relieve symptoms. ECT is generally safe and effective.

The UF Health difference

At UF Health, ECT is performed by a team of medical professionals consisting of an ECT credentialed psychiatrist, an anesthesiologist and nursing staff. ECT psychiatrists include Brent Carr, MD, the chief of ECT, Laura Rodriguez-Roman, MD, and Louis Solomon, MD, all specifically trained in the delivery of ECT. For more information, please call (352) 265-5481.

The procedure

ECT is a highly effective treatment for mood disorders, such as depression or bipolar disorder. The response rate is high even when previous medication and therapy trials have failed. Depression that is treatment resistant, mood disturbance with delusions and psychotic symptoms, depression during pregnancy, depression with severe suicidal thoughts usually respond rapidly to ECT. Many patients can tolerate ECT better than multiple medications.

ECT is also used in cases of mania, catatonia and psychosis that are not improving with other treatments.

Where is ECT done?

ECT is performed at the UF Health Psychiatric Hospital. Your ECT physician may opt for your procedure to be performed at UF Health Shands Hospital if it is determined to be medically necessary.

ECT is available for hospitalized patients and also as an outpatient procedure. Patients are asleep for the procedure (under general anesthesia), and ECT is pain-free.

What will happen during ECT?

The morning of ECT you will not take anything by mouth (NPO) after midnight. On the treatment morning you will be seen by the ECT doctor, anesthesiologist, nurse and occasionally, also by a social worker.
An IVis started and you receive medicine to put you asleep briefly (for about 10 minutes). Once asleep, you are given muscle relaxants.
Electrodes are placed on your scalp to monitor your brain activity. Then, electrodes are applied to deliver a brief electrical current to induce a seizure. This mild, brief electrical pulse does not cause any harm, pain or damage to your skin, head or brain.
The seizure that is induced is carefully monitored and usually self terminates before 60 seconds. Medication will be given to stop a seizure if it continues much longer, as this does not improve the response further.
The sleeping medication wears off and about 15 minutes after you started the procedure you will be awake and in the recovery room, having your blood pressure monitored by post-anesthesia care nurses. You will have no memory of the treatment.
In our final phase, you will be given a light snack/drink and blood pressure is monitored by our exit nurse for about an hour. Outpatients will then be discharged home to family.
A responsible adult will need to drive you home, so a designated driver has to be identified ahead of time.

How long will I need ECT?

An initial series of ECT is usually given three times per week, for a minimum of six treatments. Improvement is monitored regularly and most patients need eight or nine treatments. Patients with very resistant disorders may require 15 or more ECT treatments; but this is less common.
This initial, intense ECT series is required to achieve marked improvement for a patient with severe mood disorder.
Once symptoms are adequately controlled, many patients will enter a tapering phase, where ECT treatments are given less frequently, to help prevent a relapse and may eventually be stopped.
Other patients who have experienced marked resistance to other treatments may request to be placed on a maintenance ECT program to prevent recurrence. The required frequency of such a maintenance program varies from patient to patient, and may be one treatment anywhere from a few weeks to every two or three months.

Risks

Of importance, ECT was performed before anesthetics became commonly available. As with any medical procedure administered in the early 1900s without anesthesia, fear became associated with the procedure and has contributed to the unfortunate stigma against this highly effective treatment.

However, despite the pain-free nature of modern ECT, the treatment can still cause some side effects, including:

Confusion right after the procedure that generally lasts for only a short period of time.
Headache may occur, and medication will be given at the time of the procedure.
Blood pressure changes, including low or high blood pressure.
Memory loss, mostly about or surrounding the time of the procedure.
Occasionally patients experience longer memory loss, concerning autobiographical details from the past. This memory problem typically begins to clear after the ECT treatment frequency is reduced.
Muscle soreness from the anesthetic can occasionally occur at the onset of treatments, but is usually mild.
Nausea from the anesthesia. If this occurs medication is given at the time of the procedure.
Rapid heartbeat or other heart problems. Cardiovascular problems are screened before the procedure.
Some medical problems make ECT a higher risk. The physician will discuss these with you prior to deciding whether ECT is right for you.

Medication use

Specific instructions will be given to you about the medications that you will take before the treatment. Usually blood pressure medications are taken the morning of the treatment with a sip of water.

During the course of the ECT treatment period, some patients are able to reduce the number of medications that will need to take for their mental health illness. The ECT team will work with your primary psychiatrist if there are any recommendations for your psychiatric medications.

References

Kerner N, Prudic J. Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry. 2014;4(1):33-54. doi:10.2217/npy.14.3.
Baghai TC, Möller H-J. Electroconvulsive therapy and its different indications. Dialogues in Clinical Neuroscience. 2008;10(1):105-117.
Geduldig ET1, Kellner CH2. Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression.
Curr Psychiatry Rep. 2016 Apr;18(4):40. doi: 10.1007/s11920-016-0674-5.
Welch CA. Electroconvulsive therapy. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA

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