Which of the following are some of the benefits of using electroconvulsive therapy to treat?
Why does ECT work?No one is sure how ECT helps certain psychiatric disorders. It may promote changes in how brain cells communicate with each other at synapses and it may stimulate the development of new brain cells. ECT may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in conditions like depression and schizophrenia. Show
When is ECT used?People with major depression typically first receive antidepressant medication and psychotherapy. These treatments, though often effective, take time to work. This delay can be dangerous for patients whose depression is accompanied by delusions (false beliefs) or intense suicidal thoughts. ECT can work much more quickly than antidepressants and is useful when patients are at immediate risk for self-injury or suicide. ECT may also be prescribed when antidepressant medications have not worked. It can be useful for older patients who are unable to tolerate antidepressants and for pregnant women in whom medication might damage the fetus. People suffering from bipolar disorder and schizophrenia may also benefit from ECT. What happens during an ECT procedure?Before ECT, patients are asked not to eat or drink from midnight the night before treatment. During the procedure, the patient receives a short acting anesthetic agent which puts the patient to sleep for approximately 5-10 minutes. A muscle relaxant is also used during the procedure to stop the patient’s muscles from moving during the seizure. Cardiac monitoring pads are placed on the patient’s chest to check on the cardiac status during and after the procedure. Four electrodes are placed on specific areas of the patient’s head. Two of these electrodes are for monitoring the brain waves. The other two are for delivering a short, controlled set of electrical pulses for a few seconds. The electrical pulses must produce a generalized seizure to be effective. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current. Patients awaken about 5 to 10 minutes after the end of the treatment. Patients are then moved to the recovery room and remain there until their blood pressure, pulse and breathing return to their pre-treatment levels. Usually this takes about 20 to 25 minutes. Patients who are given ECT on an outpatient basis must have someone drive them home after the procedure and stay with them until they go to sleep at night. People should not drive in the 24 hours following ECT. How long is an ECT procedure?A single ECT session usually lasts one hour. This includes the time the patient will be in the treatment room (approximately 15-20 minutes) and the time spent in the recovery room (approximately 20-30 minutes). Typically, ECT (whether inpatient or outpatient) is given two to three times a week for a total of six to twelve sessions. Some patients may need more or fewer treatments. These sessions improve depression in 70 to 90 percent of patients, a response rate much higher than that of antidepressant drugs. Although ECT is effective, its benefits are short-lived. For this reason, patients take antidepressant medication after ECT or may continue receiving ECT periodically to prevent relapse. What are the side-effects of ECT?The immediate side effects of the procedure which may last for about an hour include:
Patients may also develop memory problems. Memories formed closer to the time of ECT are at greater risk of being lost while those formed long before ECT are at less risk of being lost. The ability to form new memories is also impaired after a course of ECT treatments but this ability usually makes a full recovery in the weeks and months following the last treatment. How can families help patients who will be receiving ECT?The treatment team will enlist the family’s help in assessing a patient’s progress. Families can help by providing a gentle reminder of the day and date and that feeling confused is to be expected. Family members should inform the nurse of any concern they have about their loved one. View a Powerpoint Presentation for Families about ECT Electroconvulsive therapy (ECT) is a procedure used to treat certain psychiatric conditions. It involves passing a carefully controlled electric current through the brain, which affects the brain’s activity and aims to relieve severe depressive and psychotic symptoms. Modern day ECT is safe and effective. It can relieve symptoms of the most severe forms of depression more effectively than medication or therapy, but because it is an intrusive procedure and can cause some memory problems, ECT should be used only when absolutely necessary. Feedback was collected from members of blueVoices – Beyond Blue’s national reference group – who have received ECT treatment, their families and carers to help develop the information below. "I don't think I would be here today if it was not for the treatment that I received, including ECT."Carleen, 54
"I had ECT and it definitely turned me around and out of a severe depressive condition.''Andrew, 40''I did actually feel better for a few months, but I felt respite had been gained at too great a cost."Anne, 51When is ECT used and why?ECT is used for fast treatment of severe depressive, manic or psychotic symptoms (e.g. catatonia). It may be used when the situation is thought to be life-threatening or after all other treatment options have failed. How is the decision to use ECT made?Decisions to use ECT are always made very carefully. Together with the person wherever possible, a mental health specialist (e.g. psychiatrist) considers whether the procedure may be necessary to reduce life-threatening symptoms. Following a psychiatric and physical examination the person/family member/carer is provided information about the procedure and their legal rights. The decision is made by weighing the risks for the person against the potential danger of leaving the condition untreated. It is important to remember the person can seek a second opinion from another doctor. Informed consent must be gained by the person, if able to do so. If the person is not able to consent (for example is unresponsive or is severely delusional), the psychiatrist will seek independent authority from the mental health authority in that state (often called the Guardianship Board) to proceed in the person’s best interests, in consultation with family or carers – and taking any advance directives (e.g. the person’s previously stated wishes) into account. If the person has been able to provide informed consent, they can withdraw consent at any stage in the process. Who administers ECT?ECT is administered by a medical practitioner (usually the treating psychiatrist) and an anaesthetist in a hospital environment. What happens during ECT?Before the ECT procedure, the person is given a general anaesthetic and a muscle relaxant. Electrodes are placed on one (unilateral) or both (bilateral) sides of the scalp and a small electric current is passed between these until a brief generalised seizure occurs. The person does not feel anything due to the anaesthetic, and does not convulse due to the muscle relaxant. The person wakes up five to 10 minutes after treatment and is usually clear headed within 30 minutes. Often, people do not clearly recall the time around the ECT treatment and, at first, may have little memory about the period of illness around the treatment. Often, memory of these events gradually returns (see below for more information on side-effects). If ECT is done on an outpatient basis, a family member or friend must drive the person home after the procedure (driving is not allowed in the 24 hours following an ECT session) and stay until he or she goes to sleep that night. Typically, treatments are given two to three times a week for three to six weeks, although the exact course of treatment depends on the nature of the illness and the person’s response to treatment. The person should be re-assessed after every session of ECT. Generally, symptoms start to improve after two sessions. The treatment should be stopped as soon as the person has responded adequately, if there are adverse effects, or if he/she withdraws consent. It is not understood exactly how ECT works to treat depression and the outcomes may vary from person to person. What are the risks and side-effects of ECT?RisksThe greatest risk with ECT is associated with the anaesthetic, which has a very small risk of death (often quoted as one in 100,000). Like any procedure involving an anaesthetic, ECT involves this small amount of risk, but overall, it is regarded as a very safe treatment. Despite the myths about ECT causing brain damage, MRI studies have shown that it does not change the brain anatomy in any way, as the strength of the electrical current is too low to harm brain tissue. Side-effectsImmediate effects of ECT may include:
Generally, these resolve within a few hours, although some memory loss may persist. Some people who have undergone ECT recommend writing down passwords, PINs, phone numbers and special dates, and keeping them in a safe place in case they cannot be recalled in the period after the treatment. A common and significant side-effect is difficulties with memory – this is reported by at least one in three people1 who have ECT. It can be hard to work out which memory changes are caused by ECT and which by the mental health condition itself – but ECT may lead to both loss of memories or difficulty in creating new memories. Most research demonstrates that memory loss is very restricted and usually temporary. However, memory changes may last for some weeks after treatment and a few people experience long-term or even permanent loss of memories. People differ in the amount of memory loss they report from ECT and how they feel about it. The more treatments a person has, the greater the effect on their memory and, if the ECT is bilateral rather than unilateral, is likely to affect a person’s memory more as well. While some people find ECT to be a beneficial and lifesaving treatment, others find their memory loss distressing and for them, this outweighs any benefit from ECT. What is the evidence for the use of ECT?There is strong evidence that ECT is effective in treating severe depression in the short term. ECT can also be effective as a treatment for severe depression and/or mania in bipolar disorder.2 However, as with other therapies for depression, relapse is common. Repeated courses of ECT may be considered for individuals with severe depressive illness who have previously responded well to ECT. ECT is not effective in all cases. Where this occurs, it is the treating health professional’s role to look at different treatment options and develop a new treatment plan. Key points
Sources and further information1 Rose D, Fleischmann P, Wykes T et al (2003) ‘Patients’ perspectives on electroconvulsive therapy: systematic review.’ BMJ 326:1363 (21 June), doi: 10.1136/bmj.326.7403.1363. 2 UK ECT RG 2003 The UK ECT Review Group. 'Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis.' Lancet 2003; 361 (9360):799–808 Fink M, Taylor MA (2007) ‘Electroconvulsive therapy: evidence and challenges.’ JAMA Jul 18; 298(3):330-2. Jorm, AF, Allen NB, Morgan AJ, Purcell R (2009) A Guide to What Works for Depression. beyondblue: Melbourne, August 2009. National Institute for Clinical Excellence (2003) Guidance on the use of electroconvulsive therapy. Technology Appraisal 59 April 2003: 1-37. Pagnin D, de Queiroz V, Pini S et al (2004) ‘Efficacy of ECT in depression: a meta-analytic review.’ J ECT 20(1):13-20. Sane Australia fact sheet Electroconvulsive therapy http://www.sane.org/factsheets/electroconvulsive_therapy_(ect).html beyondblue is grateful to our blueVoices participants for sharing their experiences. Stay in touch with usSign up below for regular emails filled with information, advice and support for you or your loved ones. Sign me up Who may benefit the most from electroconvulsive therapy?Between 70 and 90 percent of patients experience a rapid improvement in symptoms. It may also help people who are acutely ill with mania, psychosis, catatonia, agitated dementia, post-traumatic stress disorder (PTSD), and suicidal thoughts.
Which of the following are components of DBT?There are four components of comprehensive DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.
What are the three things that cognitive behavioral therapist are advised to do?There are a number of techniques your therapist might use during a session, but some of the most popular involve: setting achievable goals. practicing cognitive restructuring. journaling.
Which of the following is a side effect of administering electroconvulsive therapy?Risks and Side Effects
Memory loss is the most common side effect of ECT. Patients may experience some mild short-term memory loss and forgetfulness during the treatment. This side effect, however, usually ends shortly after the treatment course has ended.
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