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Experts at UPMC Western Psychiatric Hospital have extensive experience in providing electroconvulsive therapy (ECT). It is considered the most common treatment for drug resistant depression.
ECT is a procedure performed under general anesthesia. Electric currents (delivered through paddles) are passed through the brain, intentionally triggering a brief seizure. ECT appears to cause changes in brain chemistry through yet unknown ways that can quickly reverse symptoms of certain mental illnesses, like severe depression. It often works when other treatments are unsuccessful.
ECT is an FDA-approved therapy for treatment-resistant depression. If a patient is diagnosed with clinical depression and is not responding to at least two different antidepressants, they are considered treatment resistant. Typically, these antidepressants must be from two different classes of antidepressants. (This means they can't all be selective serotonin reuptake inhibitors like Prozac®, Zoloft®, or Paxil®. There are other drug classes like serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, and more.)
ECT is still the most effective antidepressant and can dramatically improve or even completely resolve depressive symptoms. Done under brief general anesthesia, ECT is much safer today than it was in the past.
ECT may also be used to treat catatonia — a serious condition leading to mutism, posturing, and limited movements. Since patients eat very little and do not move, they are at risk for bed sores and other complications. ECT can be lifesaving for these patients. ECT can also help patients with mania or schizophrenia when all other treatments fail.
ECT is done under brief general anesthesia. Typically, an intravenous (IV) line is started and the patient is taken into the treatment room. An anesthesiologist administers two medications — a short-acting anesthetic to make the patient sleep and a short-acting muscle relaxant to temporarily paralyze the patient and minimize movement during treatment. The patient is connected to an EKG, blood pressure cuff, and pulse oximeter to monitor of vital signs throughout the procedure.
A nurse anesthetist provides oxygen throughout the treatment as the patient won't be breathing on their own. Once the patient is asleep, the psychiatrist delivers electricity through a set of paddles (either on the right side of the head on the right temple and slightly right of the top of head, or on both temples). This induces a seizure for about 30 to 60 seconds. During this time, the heart rate, blood pressure, oxygen levels, and other parameters are closely monitored.
After the seizure, the patient wakes up gradually and starts breathing as the anesthesia medications wear off. The full procedure takes about 15 to 20 minutes. Following treatment, patients are monitored in the recovery room for about 30 to 45 minutes. They then return to their hospital room or go home with another adult.
ECT is usually administered two to three times a week for about 10 to 15 treatments, depending on the response and tolerance.
Typically, you should not eat or drink for at least 6 to 8 hours before ECT due to the anesthesia given during the procedure. Since ECT occurs in the morning, we recommend that you take your morning medications after the procedure. If you are instructed to take medicine before the procedure, please take it with a sip of water.
ECT is a much safer procedure today than in the past, though it still can cause side effects such as headaches, body aches, confusion, nausea, and vomiting. These are temporary and can be treated effectively with common medications. ECT is known to cause short-term memory problems around the treatment itself. You might forget what happened the night before, the morning of, and the treatment itself. It does not typically cause other types of memory problems. ECT can cause problems with your heart, lungs, and other body parts, but that is rare. Each patient is assessed for risk of side effects based on their other medical needs.
We do not recommend driving at all during ECT, particularly when you are receiving treatments two or three times a week. When you receive ECT once a week, you can talk to your ECT doctor about driving again.
There are still several options available if you fail to improve with medications and ECT.
Transcranial magnetic stimulation or TMS is a non-invasive, FDA-approved treatment for depression. It uses a magnet placed close to the left front area of the patient's head (left dorsolateral prefrontal cortex). The patient is awake and sitting in a comfortable treatment chair. Generally, the treatment is well tolerated, but may not be effective for some patients. TMS is performed five days a week for four to six weeks.
For more information or to schedule an appointment with the Center for Interventional Psychiatry, please call 412-246-5063.
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