Name of the Procedure:

Electroconvulsive Therapy (ECT); also known as Electroshock Therapy

Summary

Electroconvulsive Therapy (ECT) is a medical procedure where small electric currents are passed through the brain, intentionally triggering a brief seizure. This is done under controlled conditions and is typically used for treating severe mental health conditions that have not responded to other treatments.

Purpose

Electroconvulsive Therapy is primarily used to treat severe depression, treatment-resistant depression, bipolar disorder, and certain forms of schizophrenia. The goal is to relieve persistent and severe symptoms of these mental health conditions, often resulting in rapid improvement.

Indications

ECT may be recommended for:

• Severe depression not responsive to medications or therapy
• Bipolar disorder with severe manic or depressive episodes
• Severe agitation or catatonia
• Schizophrenia with prominent symptoms
• High risk of suicide where immediate improvement is necessary

Preparation

Patients are advised to:

• Fast (no food or drink) for 8-12 hours before the procedure
• Adjust medications as directed by their healthcare provider
• Undergo necessary pre-procedure assessments, which may include blood tests, an electrocardiogram (ECG), and a thorough medical evaluation to ensure they are fit for anesthesia and ECT

Procedure Description

1. The patient is administered general anesthesia and a muscle relaxant.
2. Monitoring equipment is set up to track the patient's heart, brain activity (EEG), and vital signs.
3. Electrodes are placed on the patient’s scalp.
4. A carefully controlled electrical current is passed through the brain to induce a brief seizure.
5. The procedure typically involves multiple sessions, administered several times a week, until symptoms improve.

Duration

Each ECT session lasts about 5 to 10 minutes, though the total time including preparation and recovery is approximately 1 hour.

Setting

ECT is performed in a hospital or specialized outpatient clinic equipped with necessary monitoring and anesthesia facilities.

Personnel

The procedure is conducted by a team that includes:

• Psychiatrist with expertise in ECT
• Anesthesiologist
• Nurses
• Support staff

Risks and Complications

Common risks:

• Short-term memory loss
• Confusion upon waking from anesthesia
• Headaches

Rare risks:

• Long-term memory problems
• Cardiovascular complications
• Prolonged seizures

Management of complications involves supportive care and adjustments in the therapy regimen.

Benefits

ECT is highly effective for severe cases of depression and other psychiatric conditions. Many patients experience significant improvement within a few sessions, often within a few weeks.

Recovery

Post-procedure care includes:

• Observation until the anesthesia wears off
• Instructions to avoid driving or operating heavy machinery for at least 24 hours
• Regular follow-up appointments to monitor progress and side effects
• Gradual return to normal activities as tolerated

Alternatives

• Pharmacotherapy (medications)
• Psychotherapy (e.g., Cognitive Behavioral Therapy)
• Transcranial Magnetic Stimulation (TMS)
• Vagus Nerve Stimulation (VNS)
• Pros and cons of each alternative vary based on individual patient conditions and responses.

Patient Experience

During the procedure, the patient will not feel pain due to anesthesia and muscle relaxants. Post-procedure, they may experience some confusion, memory issues, or headaches, which are usually temporary and manageable with appropriate care.