Electroconvulsive therapy (includes necessary monitoring)
CPT4 code
Name of the Procedure:
Electroconvulsive Therapy (ECT)
Summary
Electroconvulsive therapy (ECT) is a medical treatment that involves passing small electric currents through the brain to trigger a brief seizure. This induced seizure can help alleviate symptoms of severe mental health disorders when other treatments have not been effective.
Purpose
ECT is primarily used to treat severe depression, especially when other treatments have not been successful. It can also be used for other mental health conditions like bipolar disorder and schizophrenia. The goal is to provide rapid relief from severe symptoms, allowing patients to function better in daily life.
Indications
- Severe depression
- Treatment-resistant depression
- Bipolar disorder
- Acute mania
- Schizophrenia, particularly with catatonia
- Suicidal tendencies with immediate risk
Preparation
- Fasting for at least 6 to 8 hours before the procedure.
- Adjustments or temporary cessation of certain medications as advised by a doctor.
- Routine blood tests, ECG, and other necessary evaluations.
- Pre-anesthetic evaluation to determine fitness for the procedure.
Procedure Description
- The patient is placed on a bed or table in a specialized ECT treatment suite.
- Monitoring equipment for heart rate, blood pressure, and oxygen levels is attached.
- The patient receives general anesthesia and a short-acting muscle relaxant.
- Electrodes are placed on the scalp, either unilaterally or bilaterally.
- A controlled electric current is delivered, lasting about 1 to 2 seconds, inducing a seizure that typically lasts less than a minute.
- The patient is closely monitored throughout the procedure.
Duration
The ECT session itself lasts about 5 to 10 minutes, but the total time, including preparation and recovery, is around 60 minutes.
Setting
ECT is performed in a hospital or specialized outpatient clinic.
Personnel
- Psychiatrist
- Anesthesiologist
- Nurses specialized in ECT care
- Other trained medical professionals
Risks and Complications
Common risks:
- Confusion and memory loss
- Headaches
- Muscle aches
- Nausea
Rare risks:
- Cardiovascular complications
- Prolonged seizures
- Dental or tongue injury
Benefits
Patients often experience significant improvement in mood and function within a few sessions. Some individuals may notice improvements almost immediately after the first treatment.
Recovery
- Patients will be observed in a recovery area until the effects of anesthesia wear off.
- They may experience temporary confusion or memory issues.
- Normal activities can usually be resumed within a day, but driving and operating heavy machinery should be avoided until cleared by a doctor.
- Follow-up appointments and maintenance ECT sessions may be needed.
Alternatives
- Pharmacotherapy (medications for depression or other mental health conditions)
- Psychotherapy (counseling, cognitive-behavioral therapy)
- Transcranial Magnetic Stimulation (TMS)
- Vagus Nerve Stimulation (VNS) Pros and cons of alternatives:
- Medications and psychotherapy may take longer to show effects and may not be as effective for treatment-resistant cases.
- Non-invasive alternatives like TMS or VNS may offer fewer side effects but may not be as effective for severe conditions.
Patient Experience
During the procedure, the patient is under anesthesia and will not feel pain. Post-procedure, they may feel groggy, confused, and may experience temporary memory loss or physical discomforts like headaches. Pain management and comfort measures will be provided as needed.