Electroconvulsive therapy (ECT) is a safe, effective and sometimes life-saving treatment that is used to treat specific conditions related to mental health.
In the National Institute of Mental Health and Neurosciences (Nimance), located in Bangalore, from consultant psychiatrist Dr. Preeti Sinha , we sought help in understanding Electroconvulsive Therapy (ECT), talked about its benefits and disputes related to it.
Electroconvulsive therapy (ECT) is used in the treatment of serious types of psychiatry. It is also called shock treatment in Ampham language. People have some concerns about this method of treatment because they are not familiar with scientific information which is not easily available. For this reason, people’s perception about ECT is made from non-authentic sources such as movies, TV serials and the Internet.
This article is addressing such misconceptions about ECT and explaining the facts related to it.
What is Electroconvulsive Therapy (ECT)?
Electrical shock electroconvulsive therapy (ECT) is a safe, effective and sometimes life-saving treatment that is used to treat specific conditions related to mental health. It has been used for the last 75 years. During ECT, a small amount of electricity is passed to the forearm to stimulate or stimulate brain cells of a controlled current. From this there are shocks or trips for a few seconds. This method is applied to an individual by giving anesthesia, so the person does not know the electrical current and the shocks fall too. The whole process is a few minutes and the person comes to conscious after 15-20 minutes.
Who benefits from ECT?
Doctors consider ECT as an option for those people who suffer from serious psychiatric diseases, such as depression, schizophrenia, or hysteria. Doctors recommend this treatment only when they keep these things in mind that how important is this function to a person, what is the priority of the person and his family, how much rest is needed from the psychiatrist and when medicines are not effective Have been. ECTs are usually used in the following situations:
When psychiatric (especially depression) is very serious and there is strong apprehension that a person can commit suicide.
Due to serious psychiatric disease, when a person refuses to take food and juice, it can cause harm to his health.
When a person becomes so sick that he becomes stable and mute – a condition called “catatonia”.
When a person gets very excited or gets very disturbed so that he or other people can be in danger.
Even when medicines can not provide any relief in psychiatric symptoms.
The medicines that are being given are severe side effects and they can not be continued for this reason.
What is the consent of the person or his family before giving ECT?
When psychiatrists decide that a person needs to give ECT, they tell him and his family in detail about his whole process, its benefits and losses, and alternate methods. ECT is given only when the person and his family give their consent in writing. When the person is so ill, that he does not understand everything in detail and is not in a position to give a valid consensus, the consent of his family members is obtained. The person and his family can also refuse consent. They can withdraw their consent even before treatment starts or at any point during treatment. In such a case, they are provided with the next best treatment.
What is done if no one is ready for an ECT?
Psychotherapists respect the decision of the person and his relatives. They try to treat psychiatry from other available methods. It may take longer to treat those methods, and stay in the hospital for longer periods of time. The doctor may have to give more doses of medicines to control the person’s restlessness, anger and other symptoms.
Is ECT safe for old people and children?
ECT is also safe for elderly if necessary precautionary measures are taken. In fact, in some countries, most people who have ECT are elderly people. It is used as a last resort in children and it is used only after talking to doctors panel. More than one hundred children have been given ECT in Bangalore, and they have no side effects on them.
Can an ECT be given to a person born with hypertension or cardiovascular disease?
For such persons, psychiatrists make a detailed account of their medical condition and take opinions from various experts, including anesthesiologist. During ECT they also closely monitored the patient’s condition. Most patients with heart, nerve or breathing difficulties have been given ECT of any side effects.
Can pregnant women or feeding mothers be given ECT?
If precautions are taken, ECT is also a safe method for pregnant women or breastfeeding women. In fact, many of the psychiatric medicines are such that women with these conditions can not be given. In this case, if the immediate treatment of psychiatry becomes necessary, then those women are given priority of ECT only.
If ECT is given once, will the patient have to ECT every time he falls ill?
Many people have this misconception that once the person has got an ECT, he will have to do ECT after falling ill every time. This is not true. In many cases, after having ECT, psychiatrists treat the person with medicines so that his condition is not returned. If the disease also comes back and it is light, then it is treated with medicines only and ECT is not given. There are very rare cases where psychiatry is such that they can be better than just ECT and no other treatment works. In similar cases, ECT is given repeatedly.
Will ECT fix the disease? Do you need to take medicines during or after ECT?
There is no permanent effect of ECT. A person will also need medicines to maintain the ECT’s improvement. In rare cases it is seen that despite taking medicines, the improvement made by the ECT could not be sustained. In such cases, ECT may have to continue, though it will have to be reduced considerably – once in a fortnight or once in a month.
When a person is advised to take an ECT, what should he do?
It is important to tell the doctor about the old or current illness of the person. Especially those diseases which are heart, lung, blood pressure and bones. Under Anesthesia, if there is any surgery done earlier or broken teeth or fake teeth, all this information is also needed to give to the doctor. It is important for doctors to know which medicines are being given to the person. Usually doctors examine the patient’s condition in detail and do some blood test and electrocardiogram (ECG). The doctor can also ask for a scan of the brain.
What preparations are required before each ECT session?
The most important thing is that nothing should be eaten or drunk 6 hours before ECT. The doctor can ask the person to wash hair with shampoo and not to put oil on the hair. The patient is said to wear loose clothes. If there are jewelery, contact lenses, fake teeth and hearing machines, they have to first remove them. It is also important to urinate immediately before going to the ECT chamber. If the patient is undergoing medication, then the doctor can advise what medications should be taken before and after the ECT session.
What happens during ECT? How is ECT offered? Does it hurt?
Team of experienced psychiatrists, anesthetists and nurses together make an ECT of the person. The person is given the first sleeping injection. During this time, oxygen is given with the help of masks. After the person is unconscious, an injection is given to rest muscles so that the shocks remain light. After this, light lightning is given near the forehead for about two or four seconds. It starts shock or seizures, which last for about one minute from 20 seconds. As long as the person does not breathe on his own, the doctor retains his breath. Throughout this process, the doctor keeps a close eye on the person’s beating, blood pressure and oxygen intake. ECT does not cause pain because the person is in deep sleep while giving a slight blow to electricity.
What should be monitored after ECT?
A few hours after the ECT, the person usually becomes completely conscious. After getting the ECT, when the person has to give breakfast or when to give morning medicines, the nursing staff should ask about it. It is advisable to not run the vehicle for a few hours after getting the ECT. Apart from this, a person can continue doing his daily work as before. It is good till the ECT completes its entire course of time that no contract or trade agreement will be signed.
How often is the ECT given? Usually how many ECT sessions are required?
ECT is given two or three times per week. Most people have to give 6-12 treatment sessions. It depends on the benefits of ECT that doctors can decide to decrease or increase ECT sessions.
Where is the ECT?
ECT is usually given in a cell which is equipped with all the equipment through which the condition of the person can be monitored during Anesthesia and ECT treatment. Individuals have different rooms for waiting, treatment and improvement.
How long can the beneficial effects associated with ECT be expected?
Most people begin to see improvement after two or four sessions of ECT. But the course of treatment can be long till some people get a substantial benefit. Such cases have rarely been found where there is no improvement in the individual.
How does ECT work?
It is believed that ECT creates some chemical changes in the brain, creating new relationships and contacts between the various muscle cells. Scientists have found that after ECT, the levels of neurotransmitters in the brain also change. They are also considered to be contributing to the ECT related improvement. But the exact process of working ECT is still unclear and continues to be a subject of continuous research.
Is ECT safe? What are its side effects? Does memory go away after ECT?
ECT is a universally safe method, doctors take all necessary precautions. ECT usually has temporary types of side effects. Someone may have pain in the headache or body, for which painkiller can be given. For a few minutes the person may experience confusion. Memory related to some of these events may be partially degraded, which occurred just before or after treatment. Normally, ECT does not have any effect on long-term memory and general intelligence. Like any other medical treatment, the range and extent of the side effects vary from person to person. With proper medical supervision, serious side effects affecting the heart or nervous system are very rare and if done, the ECT team remains for their management. With the help of modern techniques, the potential hardness of tooth, bone and joint after ECT has become very rare.
Is there any way to reduce side effects?
The process of ECT is designed in such a way that side effects without compromising without effectiveness, such as decrease in memory. Selection of such refineries is done based on the desired rate of improvement, current physical illness, age and prior experience of ECT.