Title: Exploring ECT for Depression: Advantages, Drawbacks, and Procedure
Electroconvulsive therapy (ECT) serves as an alternative treatment for individuals grappling with depression that hasn't responded positively to typical medication. Despite its controversial history, the method has shown promising outcomes in terms of its antidepressant effects.
Depression is a mental health condition that causes individuals to experience chronic feelings of sadness and guilt, a persistent low mood, and a lack of interest in activities they once enjoyed.
A variety of treatments exist for individuals living with depression, such as medication and psychotherapy. For those who encounter a relapse of symptoms, brain stimulation therapies like ECT may also be considered.
The application of electric currents to stimulate the brain and induce a controlled seizure is the basis of ECT. The goal is to alleviate severe depression.
This piece delves into ECT, its benefits and drawbacks, what to expect prior to ECT, the procedure itself, recovery, and alternative treatment options.
What Is ECT for Depression?
ECT utilizes electric currents transmitted by medical professionals through the brain while the patient is under anesthesia. This results in a brief surge of electrical activity in the brain, which people often refer to as a seizure.
Doctors frequently employ ECT to treat severe major depression cases. Research has shown that induced seizures have been effective in addressing psychiatric disorders since the last century. ECT has been proven to be more effective than medication at stabilizing mood during depressive episodes.
Understanding Depression
Depression is a mood disorder that drastically affects an individual's emotional and behavioral well-being.
Doctors use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision, to diagnose depression. Symptoms normally persist for at least 2 weeks and may include:
- a depressed or irritable mood
- weight loss not intended
- sleep disturbances
- fatigue or low energy
- suicidal thoughts
Depression manifests in various forms, such as:
- major depressive disorder
- persistent depressive disorder
- postpartum or perinatal depression
- seasonal affective disorder
- situational depression
Suicide Prevention
If you or someone else is in an immediate crisis, take the following steps:
- Ask the tough question: "Are you considering suicide?"
- Lend an ear without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 for assistance from a trained crisis counselor.
- Stay with the person until professional help arrives.
- If it's safe, remove any harmful objects from the environment, such as weapons, medications, or other objects that could pose a risk.
If you or someone you know needs help, you can always reach out to the 988 Suicide and Crisis Lifeline or access local resources for support.
Explore more about ECT.
Advantages of ECT
The American Psychiatric Association has reported that ECT is highly effective in easing major depression. Clinical evidence suggests that ECT improves approximately 80% of cases.
Experts have observed the benefits of ECT after several sessions, and these results typically last for an extended period.
Swartz found that ECT rapidly alleviates depressive symptoms, even when alternative treatments have failed.
Research has identified the specific effects of ECT, such as:
- changes in the brain's blood flow
- temporary disruptions in the blood-brain barrier
- alterations in electrical activity in certain parts of the brain, rearranging brain chemistry related to depression
- modifications in gene expressions and reductions in inflammatory mediators
- growth of nervous tissue
- stimulation of hormones and neurotransmitters, notably increasing dopamine
- alterations in brain structure and components
A study by Loo et al. disclosed that ECT swiftly abolished suicidal thoughts in 38% of patients after one week, 61% after two weeks, and 81% of patients by the completion of the ECT treatment session over several weeks.
The research conducted in 2022 also implies that ECT might be safer than antidepressants or antipsychotics in certain high-risk groups, including those with debilitating conditions, older individuals, pregnant women, and nursing mothers.
Disadvantages and Controversies
Electroconvulsive therapy is one of the most contentious methods of treatment in psychiatry. Depending on the country, it is either a crime or a common practice.
However, psychiatrists have worked to make ECT as safe as possible. They introduced muscle relaxation and anesthesia prior to administering ECT to reduce side effects.
On the other hand, the American Psychiatric Association has linked ECT treatment to temporary memory loss. Some people have reported experiencing memory loss related to events before or even weeks prior to treatment. While memory improvement generally occurs within a couple of months, some individuals have experienced persistent memory gaps.
General anesthesia carries risks, similar to those encountered during surgery. These risks include:
- nausea
- headaches
- fatigue
- confusion
Participants can discuss potential risks with their psychiatrist to determine the best strategy for managing effects.
More Severe Risks
ECT poses more severe risks for those with:
- a pheochromocytoma or an adrenal tumor
- increased pressure within the skull
- slowed heartbeat
- high-risk pregnancies
- aneurysms in the aorta and cerebral arteries
Preparing for ECT
Before beginning ECT treatment, individuals undergo a thorough psychiatric assessment to evaluate its safety. Before treatment, a medical examination, blood tests, and an EKG will be conducted to examine heart conditions.
Medication and supplement histories will also be assessed, as certain substances can impact ECT. A written informed consent process will take place before ECT is administered. In certain situations where a patient is too ill for the procedure, state law shall regulate the decision to appoint a legal guardian prior to ECT.
The person receiving ECT, their guardian, and their family should discuss the treatment options with a trained professional, receiving information about the procedure's benefits, risks, and side effects.
Normally, patients receive ECT two to three times a week for six to twelve treatment sessions. The frequency depends on the severity of symptoms and a person's response rate.
ECT Procedure
The procedure occurs in an outpatient unit, but individuals with severe illness may require inpatient treatment.
Before ECT, anesthesiologists administer general anesthesia and a muscle relaxant to ensure the patient remains asleep during the procedure. Trained staff continuously check vital signs, including blood oxygen saturation and heart activity.
Doctors place electrodes at specific locations on the scalp. They stimulate the brain with a controlled series of electrical pulses to induce a temporary seizure within the brain.
Recovery and Aftercare
Patients are usually asleep during the procedure, but they may wake up five to ten minutes later and be in a recovery room. Doctors will check blood sugar levels before the procedure and during recovery, as ECT may affect these levels.
Individuals will need to recover from general anesthesia and ECT before being discharged.
Summary:
Electroconvulsive therapy (ECT) involves sending an electric current through the brain while the person is under anesthetic. This procedure induces a controlled seizure, which research has shown to be effective in relieving depression. Benefits have been observed after a series of sessions, and these results tend to last in the long term.
Research considers ECT one of the most controversial methods of treatment. However, professionals have attempted to make it safe by administering muscle relaxants and anesthesia alongside ECT.
Once the procedure has finished, individuals will need to recover from both the anesthetic and ECT. However, ECT treatment may cause temporary memory loss in some people, but this usually improves within a few months.
Alternative methods for treating depression include medication, psychotherapy, and natural remedies.
Despite the temporary memory loss associated with ECT, it has been proven to be more effective than medication in stabilizing mood during depressive episodes for about 80% of severe major depression cases. Individuals living with depression who encounter a relapse of symptoms may consider brain stimulation therapies like ECT as an option.
