ECT

Electroconvulsive Therapy (ECT) is a lifesaving medical procedure performed under general anesthesia in which a small electric current is administered through part of the brain, intentionally triggering a brief, controlled and closely monitored seizure. ECT causes changes in the brain chemistry and connections that can quickly reverse symptoms of depression, mania and other conditions, and often works when other treatments have been unsuccessful.

"The physicians at SeattleNTC are wonderful and I felt they really listened to my needs as a patient. I never knew how much I could enjoy the quality of my life as I do now that I’m depression-free." —Kari

Why Choose ECT?

ECT can provide rapid, significant improvement in severe depression, suicidality, mania and other conditions. ECT is often used as an urgent life-saving treatment when medications aren’t tolerated, or other forms of therapy haven’t worked. ECT works particularly well in older adults. ECT may be used to treat:

Severe depression, particularly when accompanied by suicidality, psychosis or refusal to eat or drink
Severe mania
Catatonia

In some cases, ECT is used:

During pregnancy, when medications can’t be taken because they might harm the developing fetus.
For older adults who can’t tolerate drug side effects.
For people who prefer not to take medications.
As a follow-up treatment when ECT has been successful in the past.

SeattleNTC is one of the largest providers of ECT in the nation. We understand that the decision to have ECT is an important step for patients and so we make every effort to educate our patients and their families about ECT before, during and after this decision is reached.

What Can I Expect With ECT?

Most people require twelve to fifteen treatments, which are generally given two to three times weekly for four to five weeks. The number of treatments needed depends on the severity of symptoms and how rapidly they improve. Some patients take longer to respond to ECT and have a longer overall course. After improvement, most patients taper off of ECT slowly rather than stopping abruptly, to help prevent relapse.

To get ready for the ECT procedure, a patient should expect the following:

No eating or drinking of non-clear liquids for 8 hours before the treatment.
- Clear liquids allowed up to 3 hours prior to your ECT treatment.
- Take morning medications with a sip of water on the morning of a treatment unless otherwise instructed.

A nurse will insert an intravenous (IV) line into the patient’s arm or hand through which medications or fluids can be given.
The ECT nurse places electroencephalogram (EEG) leads on the patient’s head. These allow the medical team to monitor the seizure.
An anesthetic is administered so the patient will be unconscious and unaware of the procedure.
A muscle relaxant helps minimize movement.
Once the ECT team is sure the patient is asleep and muscles are relaxed, the SeattleNTC psychiatrist places the treatment electrodes on the patient’s scalp. Each electrode is about the size of a sliver dollar. They may be placed on only one side of the head or both. The specifics of electrode placement will be decided during a discussion between patient and doctor.
Recovery takes place over about 20-30 minutes with one-to-one nurse care in our recovery room. A patient cannot drive home after ECT, so a responsible driver is necessary.

Side Effects

ECT is considered a low-risk procedure and is among the safest procedures done under general anesthesia. However, patients should be aware that ECT may cause some side effects, including:

Confusion
- Post-treatment confusion: Immediately after an ECT treatment, a period of confusion can last from a few minutes to several hours before improving.
- Between treatment confusion: It’s possible that processing speed, attention and other areas of thinking are more affected with the more ECT treatments given. These changes in cognition may last for a few weeks up to a few months after ECT but are not expected to be permanent.
Memory loss
- Anterograde amnesia: This is the inability to recall newly learned information during and up to a few weeks after the ECT course. During this time, any information may not be remembered. Important strategies are to write down instructions/passwords and make sure that family members are informed of the need to repeat things and monitor how the patient is doing. Anterograde amnesia is expected to resolve within weeks to months after ECT.
- Retrograde amnesia: This refers to the forgetting of personal life events and general knowledge about the world. Usually, the memories that are “wiped out” by the treatments are some events from up to a few months before the treatments begin to about a month after the treatments are done. More remote memories may be forgotten as well, though this is uncommon. Unlike the other types of ECT-induced memory impairment, retrograde amnesia may be long-lasting.

Physical side effects
- On the days of an ECT treatment, nausea, vomiting, headache, jaw pain, muscle ache or muscle spasms are possible. We can treat these symptoms with medications and for most patients, these are not ongoing problems during treatment.

Medical complications.
- As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. Most patients, even those with multiple medical conditions, can safely receive ECT. Our physicians, in conjunction with a patient’s primary care provider, can help determine whether ECT is right for someone.

More Information About ECT

SeattleNTC will need each patient to complete the following items in the thirty days before the first ECT procedure.

1. Labs:

CBC (complete blood count)
Comprehensive Metabolic Panel
TSH (thyroid stimulating hormone)

2. EKG (electrocardiogram, or heart rhythm tracing) – we need a copy of the full EKG tracings, not just the text of the interpretation.

3. A note from a patient’s primary care provider re: “pre-operative clearance” – that is, is the patient’s chronic medical problems under control such that the procedure can be tolerated? ECT is very low risk, but it does result in brief elevations in blood pressure, heart rate, and intracranial pressure.

Most primary care providers will ask a patient to schedule an appointment for this evaluation so they can do a targeted physical exam and review cardiac and other medical history. If that is the case, a copy of the chart note from this checkup is sufficient.
If a primary care provider is seen relatively frequently, she or he might be willing to submit a note attesting to the patient’s medical fitness for ECT, without a separate appointment. The provider’s note to this effect is fine, or we also have a brief form that she or he can complete, sign, and return to us for this purpose.

The following restrictions and considerations must be heeded while a patient is undergoing ECT:

The patient must refrain from driving while receiving ECT more than once weekly due to the confusion and cognitive side effects that can occur during ECT.
The patient must be accompanied by a responsible adult when leaving the hospital after each ECT treatment.
Since ECT involves the carefully controlled induction of a seizure, some medications with antiseizure properties require dose or timing adjustments while undergoing ECT.