Electroconvulsive Therapy (ECT)

Experts at UPMC Western Psychiatric Hospital are experienced in providing electroconvulsive therapy (ECT), which is considered the most common treatment for drug resistant depression.

ECT is a procedure under general anesthesia in which 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.

When do you use ECT?

ECT is an FDA-approved treatment for treatment resistant depression. If a patient is diagnosed with clinical depression and is not responding to at least two different antidepressants then they are considered treatment resistant. Typically the antidepressants must be from two different classes of antidepressants (that means they can't all be Selective Serotonin Reuptake Ihibitors 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 result in complete resolution of depressive symptoms. It is much refined procedure now as compared to the past and is done under brief general anesthesia.

ECT may also be performed for a condition called catatonia (caused by various other conditions leading to mutism, posturing, limited movements. Patients eat little, so they are at risk for bed sores and other complications). This is a very serious condition and ECT can be lifesaving in these patients. ECT can also help when all other treatments fail for mania or schizophrenia.

How is ECT performed?

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 (usually Methohexital- a short acting anesthetic to make the patient sleep; and then Succinylcholine-a short acting muscle relaxant to temporarily paralyze the patient once they fall asleep). EKG, a BP cuff and pulse oximeters are connected to the patient and these are monitored throughout the procedure. Typically, a cuff is inflated in the right ankle, usually to prevent the Succinylcholine from reaching that foot so the seizure can be observed in that foot.

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 or 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, oxygenation, 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 the treatment, patients are typically monitored in the recovery room for about 30 to 45 minutes and then will either return to their hospital room or are sent home with another adult.

ECT is typically administered two to three times a week for about 10 to 15 treatments, depending on the response and tolerance.

How do I prepare for ECT?

Typically you should not eat or drink for at least six to eight 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 a medicine before the procedure, please take it with a sip of water.

What are some of the side effects of ECT?

ECT, as it is done currently, is much safer than in the past, though it still can cause some side effects. Most common side effects are 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. So typically you can 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 they are rare. Each patient is assessed for risk of side effects based on their other medical needs.

What if ECT doesn’t help me? Do I have any options?

There are still several options available if you fail medications and ECT.

Transcranial Magnetic Stimulation or TMS is a non-invasive, FDA-approved treatment for depression which uses a magnet placed close to the left front area of the patient’s head (left dorsolateral prefrontal cortex). This is performed while the patient is awake and sitting in a comfortable dentist-like chair. Generally, the treatment is well tolerated, but it is not highly effective for many patients. TMS is performed five days a week for four to six weeks.