Introduction

When various medical therapies have failed to improve a patient's severe major depression or bipolar illness, electroconvulsive therapy, or ECT, is frequently utilised.

When a patient is under anaesthesia, ECT involves briefly stimulating the brain electrically. A group of skilled medical experts, usually consisting of a psychiatrist, an anesthesiologist, a nurse, or a physician assistant, administers it.¹

When medication and psychotherapy have failed to produce the desired results, ECT is usually utilised. ECT is also utilised for patients who, due to the severity of their disease, need a quick reaction from their treatment provider, such as those who are suicidally unstable.¹

The American Psychiatric Association, the American Medical Association, the National Institute of Mental Health, as well as comparable organisations in Canada, Great Britain, and numerous other nations, acknowledge the efficacy of electroconvulsive therapy (ECT) in treating severe mental diseases.¹

These days, ECT is far safer. To maximize benefits while minimizing risks, ECT currently employs regulated electric currents, albeit certain adverse effects may still occur.²

Procedure

You will require a thorough evaluation before receiving your first ECT therapy, which often entails:

• Medical background
• Thorough physical examination
• Psychiatric evaluation
• Simple blood tests
• An ECG is used to monitor the health of your heart
• Talking about the dangers of anaesthesia

These tests aid in ensuring that you are safe using ECT.²

Precautions taken before the procedure

• Removal of jewellery, medical equipment, accessories, or prostheses
• Discontinuation of medicine⁴
• Pre-surgical fasting

Pre-procedure

There will be general anaesthesia for you. Therefore, before the procedure, be prepared for dietary limitations. This usually entails having nothing to eat or drink after midnight and perhaps a small sip of water to take any morning prescriptions. Before your operation, you will get detailed instructions from your healthcare team.

There can be a quick physical examination. This is to examine your lungs and heart.

An intravenous (IV) line will be inserted for you. An IV tube, used to administer fluids or medication, is inserted into your arm or hand by a nurse or another team member.

Electrode pads will be applied to your head. The size of each pad is comparable to a silver dollar.²

Placement of electrodes

Right unilateral: Both electrodes are positioned on the right side of your head in this placement. Between your temple and the tip of your eyebrow will be one electrode. The location of the other electrode will be just above your right ear, close to the top of your head.

Bifrontal: This arrangement places electrodes just above the tips of your eyebrows, on opposing sides of your forehead.

Bitemporal: In this arrangement, one electrode is positioned on each side of your head, aligning with the temple region.⁴

The procedure

Your foot's muscles aren't affected by the muscle relaxant drug when it's wrapped around one ankle like a blood pressure cuff. When the process starts, your doctor can keep an eye out for movement in that foot to track seizure activity.

Your heart, brain, blood pressure, and oxygen consumption are all monitored.

Oxygen may be administered to you via an oxygen mask.

To protect your teeth and tongue from harm, you might also be offered a mouth guard.²

Inducing seizure

The doctor pushes a button on the ECT machine once the anaesthesia has taken effect and your muscles are relaxed. This results in a brief seizure that typically lasts less than 60 seconds by sending a tiny quantity of electric current via the electrodes and into your brain.

You stay relaxed and don't realize you're having a seizure because of the anaesthetic and muscle relaxant. If you have a blood pressure cuff around your ankle, the only obvious sign that you're experiencing a seizure could be a rhythmic movement of your foot.²

Your brain's internal activity grows significantly. An electroencephalogram, or EEG, is a test that measures the electrical activity in your brain. The start of a seizure is indicated by abruptly elevated EEG activity, followed by a levelling off that indicates the seizure has ended.

The effects of the muscle relaxant and short-acting anaesthetic wear off within a few minutes. You're brought to a recovery area and kept under observation in case anything goes wrong. You could go from being confused for a few minutes to several hours or longer after you get up.²

Indications

• Depression (particularly in those over sixty)
• Schizophrenia (includes psychotic illnesses and other ailments on the schizophrenia spectrum)
• Bipolar disorder as well as other manic disorders

Contraindications

• Myocardial infarction, a recent heart attack, or another unstable cardiac condition
• Disorders that cause the pressure inside your skull to rise (such brain tumors or intracranial hypertension)
• A recent cerebral haemorrhage, aneurysm, or other cause.
• Severe respiratory conditions, such as COPD (chronic obstructive pulmonary disease)
• Other potentially fatal illnesses or those who fit the criteria for levels 4 or 5 of the American Society of Anesthesiologists physical categorization system⁴
• Pregnancy⁵

Risks

There has been evidence linking ECT treatment to

• Transient memory loss
• Transient learning challenges
• Some patients experience memory problems related to things that happened a few weeks before the treatment or even earlier. memory issues typically go better in a few months. Certain patients might have more persistent issues, such as irreversible memory loss

The hazards associated with general anaesthesia, which is required for ECT, are comparable to those associated with other procedures including minor operations that also need anaesthesia.

On the day of treatment, the most frequent side effects of ECT include headaches, nausea, exhaustion, confusion, and mild memory loss. These symptoms can linger for a few minutes or several hours.¹

Patient experience

With electroconvulsive therapy, many patients start to see relief in their symptoms after roughly six treatments. Even while ECT may not be effective for everyone, full recovery might take longer. In contrast, antidepressant medication response may take a few weeks or longer.

The exact mechanism by which ECT treats severe depression and other mental diseases is unknown. It is recognised, however, that a variety of chemical facets of brain activity are altered both during and following seizure activity. It's possible that these molecular alterations compound one another to lessen the symptoms of severe depression and other mental diseases. Because of this, ECT works best for patients who undergo a comprehensive course of several treatments.²

Alternative treatments

Although ECT is frequently more beneficial for really severe illnesses, transcranial magnetic stimulation (TMS) is used to treat depression that has not responded to previous therapy. It entails stimulating particular brain regions with quickly switching magnetic fields. TMS, in contrast to ECT, is a non-invasive procedure that keeps the patient awake and doesn't induce seizures.

Although it was first designed to treat seizure disorders, vagus nerve stimulation (VNS) can also be used to treat depression which has not improved with other forms of therapy. The procedure entails implanting an electrical pulse generator beneath the patient's skin in the chest, which stimulates the vagus nerve in the neck intermittently.¹

Ongoing research

In addition to treating depression, ECT is also widely utilised to treat other mental health conditions. The process is effective and quite safe. However, to administer ECT, a multidisciplinary team of a neurologist, anesthesiologist, psychiatrist, and nurse is needed. After multiple sessions, ECT is beneficial, and the effects last. The most important thing is to inform the patient and their family about ECT because it has been linked to a lot of myths and irrational assumptions. The antidepressant effect manifests itself soon and might persist for several years.³

Summary

In conclusion, electrical currents are used in electroconvulsive therapy (ECT), a psychiatric treatment, to cause controlled seizures. ECT has developed into a safe and useful therapeutic option for several mental health issues, particularly in cases where other therapies are unsuccessful, despite its contentious past. 

Research is still being done to improve its use and lessen the stigma attached to it. Of course. Major depressive disorder, bipolar disorder, and schizophrenia are among the serious mental health conditions that are treated using electroconvulsive therapy (ECT). When further therapies, such as medicine and psychotherapy, have failed to yield the desired effects, it is frequently taken into consideration. The process is carried out under general anaesthesia to reduce pain, albeit its exact mode of action is still unknown. The effectiveness of ECT and improvements in its administration methods have made it a popular treatment option in modern mental medicine. But it's imperative to thoroughly consider the advantages and disadvantages while speaking with medical experts.