A Guide to Electroconvulsive Therapy (ECT)

 

What is Electroconvulsive Therapy (ECT)?

• ECT is a painless, safe and effective procedure that triggers a brief seizure in your brain.  During these treatments, small electric currents are passed through your brain. These currents are what trigger (or induce) a brief seizure.  
• ECT is a well-established therapy. Please note that this treatment has improved greatly over time. Today it is safer than ever and better tolerated by patients.

• ECT is an effective treatment for severe symptoms of certain mental health conditions. Most patients improve greatly with ECT. It may also be an effective option in patients who have not responded to other treatments.
• Experts do not fully understand how ECT works. However, research shows that ECT results in chemical changes to the brain during and after the induced seizure. These changes allow the brain cells to work better. It reverses symptoms of some mental health conditions.

 

Who receives ECT?

ECT is used the most in patients having an acute depressive episode or in treatment-resistant depression. Treatment-resistant depression is when symptoms do not improve with medication or therapy.

 

ECT is also used to treat patients with:

• Bipolar Disorder
• ECT can be useful for treating patients having a bipolar depressive episode.
• ECT is used less often to treat a bipolar manic episode. A manic episode is when patients feel a wide range of emotions, sleep less, have more energy and engage in risky behaviors.
• Psychosis     
• ECT helps treat patients experiencing psychosis. Psychosis is when a person loses touch with reality, forms stubborn false beliefs, or hears or sees things that are not there. Psychosis can be a feature of various mental illnesses, including depression.
• Catatonia
  • • • ECT is used to treat catatonic patients. Catatonia can happen along with schizophrenia and other psychiatric disorders. It can also result from a medical condition.
      • Signs and symptoms of catatonia are: moving or speaking very little or not at all, or making fast or strange gestures. These signs happen along with other symptoms that place a patient at risk for poor health.
      • ECT may also be a good choice for certain patients who may have bad side effects from medications or cannot take medications:
      • ECT is useful in older adults who cannot tolerate the side effects of medications.
      • ECT is a possible treatment option for people who are pregnant or who recently gave birth. These people may not be able to take certain medications because of possible risks to the baby.

 

How many ECT treatments will I need?

The number of treatments you will need usually depends on how you are responding to them. We measure your response by how your psychiatric symptoms improve. For this reason, we cannot know ahead of time how many ECT treatments you will need. Please note the following:

 

• Most patients usually need 6 to 12 ECT treatments.

• Most patients usually have 3 ECT treatments a week. These treatments are scheduled for Monday, Wednesday and Friday mornings.

• We sometimes recommend outpatient ECT to maintain recovery. This reduces the risk of symptoms returning.
• If you are having outpatient ECT, your ECT psychiatrist will decide how many treatments you need and how often. They will look at your specific case and your needs.

 

What medical tests will I need to have ECT?

• Your treatment team wants to make sure that ECT is a safe treatment option for you.  Before starting ECT, they will ask about your medical history, including all medications you have taken. They will talk with you about the risks of anesthesia. Then they will ask that you have the tests listed below.
• The treatment team will explain the reason for these tests and when to take them:
• Physical exam
• Psychiatric assessment
• Blood work
• Electrocardiogram (ECG)
• Chest x-ray (CXR)
• Head CT or MRI

 

Where will I have my ECT Treatments?

Patients have their ECT treatments on the 10^th floor of Tisch Hospital (Ambulatory Surgery).

Who is on the Treatment Team?

• ECT Psychiatrist
• Anesthesiologist
• ECT Coordinator: Psychiatric Mental Health Nurse Practitioner (NP).
• Registered Nurses (RNs)
• Patient Care Technician (PCT)

How do I prepare for ECT Treatments?

• Do not eat or drink anything after midnight on the night before your treatment.
• Our HCC 10 nursing staff will wake you up on the morning of your treatment. They will prepare you for the treatment.
• You will change out of your own clothing and into a hospital gown. We will also give you non-skid socks.
• You will not take most of your routine medications until after treatment.
  • Your nurse may give you specific medications if you need them before treatment. You can have them with a sip of water.
• Your hair should be dry. Do not put hair spray or any other products on your hair.
• Please let us know about any changes in your health, including your teeth and mouth.
• Remove jewelry, watches, contact lenses, glasses, dental appliances, and hearing aids.
• We will have you secure any valuables on the unit. 
• A patient transportation staff member will arrive about 30 minutes before your scheduled ECT. They will take you by wheelchair to the Tisch 10 Ambulatory Surgery Department. 

 

What happens in the Procedure Prep Area?

• A nurse will go over your medical history and medications with you. They will take your vital signs (your temperature, heart rate, blood pressure, oxygen level, and body weight.)
• The ECT psychiatrist and treatment team will speak with you before the procedure. They will see how your treatments are going and address any questions or concerns.
• The nurse or anesthesiologist will place a small needle called an intravenous (IV) line into a vein in your hand or arm. This allows them to give fluids and medications you need during treatment.
• You will have a chance to use the bathroom before the procedure.  We recommend that you do so.

 

What happens in the ECT Treatment Area?

• An RN will take you into the Treatment Area. You will be there about 20 minutes.
• First, the treatment team will have you will lie on a hospital stretcher. Then they will connect you to the following equipment so they can safely monitor you during the procedure:
• Electrodes:
• Electroencephalogram (EEG)
• Staff will apply small electrodes to specific places on your head. This way we can measure electrical activity in your brain and monitor seizure activity. A machine connected to the electrodes records this activity.  
• Electrocardiogram (ECG)
• Staff will apply electrodes to your chest. This way we can monitor your heart rate and rhythm during the treatment.
• Pulse Oximeter
• A small device called a pulse oximeter will be placed on one of your fingers. It measures how much oxygen is in your blood. This helps us make sure you are breathing normally.
• Oxygen Mask
• Staff will put a clear mask on your face. It will cover your nose. We use this mask to give you oxygen during the entire procedure. 
• Blood Pressure Cuff
• Staff will wrap a blood pressure cuff around one of your arms. They will use it to check your blood pressure during the procedure.
• Mouth Guard
• Staff will put a mouth guard in your mouth after you are under anesthesia. The mouth guard protects your teeth and tongue from any injury during the ECT. 

 

What medications will I have during ECT Treatments?

• We will give you a short-acting general anesthetic medication. This will put you to sleep so you will not feel any pain or discomfort.
• We will give you a medication to help relax your muscles and keep you from moving during the procedure.
• We may give you other medications. This depends on your overall health or past experiences with ECT.  

 

How is the seizure induced?  

• Once you are asleep and your muscles are relaxed, a brief electric current will be applied to your brain. It will be applied either on one side only or on both sides.
• After the electric current is applied, you will have a brief seizure. The physical effects of the seizure will be milder than they normally would be because of the medications we give you to relax your muscles.
• The treatment team will observe seizure activity by watching your toe and hand movements. 
• Please note that your toes wiggle and other parts of the body will move a little but not much else.
• The team will also observe seizure activity by examining your brain waves on the ‘electroencephalogram’ or EEG monitor.
• The procedure takes only a few minutes.
• Since you are receiving general anesthesia, you will be asleep. You will not feel any pain or discomfort from the seizure.

What will happen in the Recovery Area?

• A few minutes after the procedure, the effects of the short-acting anesthetic and muscle relaxant will begin to wear off.
• When you are more awake, the treatment team will move you to a recovery area where an RN will closely monitor you.
• Most patients spend about 30 to 45 minutes in the recovery area.
• The RN will ask you if you are having any pain, nausea, or other symptoms of physical discomfort.
• The RN will encourage you to eat or drink something.
• Be sure to tell your treatment team about any treatment side effects you are having. This way we can try to ease them.
• After your recovery period, we will take you back to the inpatient psychiatric unit (HCC 10) by wheelchair.

 

What are the common side effects of ECT?

Physical Side Effects:

• Stiff Muscles
  • Stiff muscles can be a result of having a seizure. They could also be a side effect of the medication that relaxes your muscles.

• Headache
  • Headache can be caused by anesthesia, by the treatment, or possibly from not eating or drinking

• Nausea
  • Nausea or dry mouth can be caused by anesthesia or from possibly from not eating or drinking

• Confusion
  • You may have temporary confusion right after treatment. If you do, this could be due to the effects of treatment. Please remember that this confusion is temporary. It can last from a few minutes to several hours.
  • Rarely, confusion may last several days or longer.
  • Confusion is usually more obvious in older adults.

• Memory loss
  • Temporary memory loss is a common side effect of ECT.
  • Some people have trouble remembering events that happened right before treatment or in the weeks or months before treatment. And, in rare cases, from previous years.
  • For the most part, these memory problems usually improve within a couple of months after treatment ends.
  • Some patients may have longer-lasting memory problems.
  • These memory effects usually improve once the ECT treatments are completed.

 

When will I notice improvements?

• Patients vary in how long it takes them to feel better. Everyone is different.
• Mood symptoms improve with time. Other symptoms such as poor sleep, poor appetite and lower energy may begin to improve after less than 6 treatments. However, depressed mood may take longer to get better.
• People around you may notice subtle improvements before you recognize them yourself.
• Some people show a response to ECT in the hours after the procedure. However, it may fade as the day goes by. This is normal and the response usually lasts longer as treatment continues.
• Your treatment team will work with you throughout your ECT treatments. They will monitor your symptoms and response. They will also watch for any side effects you may have such as memory loss.

 

©2022 NYU Langone Health. All rights reserved. Reviewed for health literacy. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.