Electroconvulsive therapy (includes necessary monitoring); multiple seizures, per day (Deprecated)
CPT4 code
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
- The patient is administered general anesthesia and a muscle relaxant.
- Monitoring equipment is set up to track the patient's heart, brain activity (EEG), and vital signs.
- Electrodes are placed on the patient’s scalp.
- A carefully controlled electrical current is passed through the brain to induce a brief seizure.
- 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.