Before your first treatment of electroconvulsive therapy, there are a number of things to keep in mind. Though this might not be everything you should know about ECT before your first treatment, the research that you do will be helpful in the steps you take when working with your doctor.
When treating major depressive disorder (MDD), standard treatments such as antidepressants and psychotherapy may fall short. In cases like these, patients and doctors may consider electroconvulsive therapy (ECT). Due to highly problematic early forms of the practice, representations in popular culture, and the question of proper informed consent, ECT is an often-misunderstood treatment. At the same time, patients should be made aware of the common warnings and legitimate controversy alive today.
The nature of the procedure itself, which triggers a brief seizure through electrical current, can lead to side effects such as cardiovascular complications, blood pressure concerns, and even memory loss. In contrast with early use, however, ECT is now performed under general anesthesia, so the patient is unconscious during the procedure. Anesthesia comes with its own risks, however.
TMS, or transcranial magnetic stimulation, is a modern, safe and highly effective treatment without the electroconvulsive therapy side effects. Magnetic pulses reconfigure activity in certain areas of the brain associated with MDD. TMS is a helpful alternative for those seeking the effectiveness of a treatment like ECT, while avoiding the side effects and intensity.
In cases of severe MDD, as well as cases with complications like comorbid schizophrenia and catatonia, ECT is often introduced as an option. If left untreated, catatonia can quickly become life threatening so timely intervention is essential.
If ECT is considered to be the most appropriate treatment for a patient, doctors will inform the patient and family of all possible risks. Only when a patient is considered to be in prime physical health is ECT therapy appropriate, as side effects can be worsened by pre-existing conditions. Side effects of ECT can include slight memory loss, adverse reactions to anesthesia, hyper- and hypotension, and ongoing heart issues throughout life. Though these side effects are rare and can often be prevented through proper pre-diagnosis, they do add to the controversy of ECT therapy. Additionally, the recovery process often requires additional care and treatment. Additional treatments, such as antidepressant medication and/or talk therapy, may be necessary to address the underlying issues and aid the patient through any other related issues.
ECT has been used to treat patients with severe depression or mania for almost 80 years. Known more colloquially as electroshock or shock therapy, this process gained a negative and controversial status due to its extreme side effects and the debate of patient consent. ECT has stood the test of time by being effective and adapting to public outcry and moral controversy.
Through the late 1980s, debates brought to light by literature and major news outlets forced the early ECT issues into mainstream conversation. Many argued that this therapy was being abused in cases of extreme mania or catatonia, in which patients were unable to make independent decisions. Patients were also receiving the therapy while fully conscious and without ways to ensure relaxed muscles, often leading to a traumatic patient experience or possible damage to the bones, muscles, and spinal cord. Mentions of the therapy in famous works of literature and pop culture have presented early ECT treatments as nonconsensual and even torturous, leading to decades of protest against the procedure.
The practice of ECT adapted with the outcry. As early as the mid-20th century, doctors administered proper muscle relaxants and anesthesia, to prevent the aforementioned electroconvulsive therapy side effects of trauma or broken bones. These adjustments did not become commonplace right away. Instances of the practice being carried out without muscle relaxants continued in many parts of the country. Over time, however, anesthesia and muscle relaxants became common practice and later a requirement for all facilities.
Controversy continued as patients reported long-term side effects of ECT, particularly memory loss. Sustained memory loss occurred in certain people over time; some even experienced memory loss long after their major depressive disorder had subsided. Negative connotations related to the therapy followed it through the 1970s, branching across politics and modern literature. A 1975 New Yorker article famously reported the story of a woman with extreme ECT memory loss who eventually lost her ability to pursue her prominent career and even complete basic job tasks. By the end of the century, an extensive survey of medical, moral, and efficacy concerns were compiled and debated, opening both ECT’s short- and long-term side effects up to professional scrutiny. The results of the report ultimately showed ECT had demonstrable value as a treatment.
ECT treatment is recognized as effective by American and worldwide health organizations. Still, doctors must make patients aware of the risks of ECT, including those that may become exacerbated by prior health issues.
Once a patient and doctor agree that ECT treatment is best for their particular care, they will discuss ECT side effects and what to expect from the appointment itself. Before therapy, doctors will closely assess the muscular, cardiovascular, and neurological health of the patient. Doctors will also examine specific medical records, such as the patient’s dental history and history of drug interactions. Full blood work and an ECG, or electrocardiogram, may be ordered.
At the beginning of the appointment, doctors will administer muscle relaxants as well as general anesthesia to the patient, ensuring they will not feel, remember, or react to the electrical pulses. Doctors then place small electrode pads on one or both sides of the head, depending on the diagnosis and targeted area of the brain.
Once the medication has relaxed the body, the medical team administers a controlled stream of electrical impulses to induce a seizure in the brain. The body only slightly responds to the seizure due to the muscle relaxants, which protects muscles and bones from any self-injurious movement. A twitch of the hand and foot, as well as data from an EEG machine, alert the medical team to when, and for how long, the seizure occurs. Some patients experience slight confusion after therapy is over, and many others express not remembering the procedure itself.
Depending on the severity of the given case, ECT is administered 2-3 times per week for several weeks. Each session lasts about fifteen minutes, with approximately an hour of time on either side of the therapy for preparation and recovery.
Though positive outcomes from ECT therapy develop quite soon after treatment, patients should be aware of the risks of ECT and the long-term side effects that still exist.
Headaches and General Pain: Pain and discomfort vary by patient, but often remain mild to moderate. Oral analgesics can be used to offset this level of pain.
Adverse Reaction to Anesthesia: As with any use of anesthesia or other neuromuscular agent, doctors must be aware of any past reactions to anesthesia. Long-term use of anesthesia is associated with increased risk.
Skin Burns: Though patients rarely experience burns on their skin, poorly placed ECT electrodes can lead to slight marks and burns on the head and face.
Cardiovascular Problems: The nature of ECT treatment itself can lead to arrhythmia and other cardiovascular issues. Studies have found that those with pre-existing cardiovascular disease are far more likely to see complications during ECT treatment.
Dental and Oral Trauma: Though uncommon in modern practice, due to the controlled use of muscle relaxants, some patients experience trauma to their dental prostheses, teeth, and gums during the process. For this reason, many doctors will use a bite plate during treatment as well as making the pre-treatment dental assessment.
Blood Pressure Fluctuations: Mild to moderate hypotension and hypertension are relatively common ECT side effects. Medical centers will closely monitor blood pressure before and during the procedure to track any significant changes.
Continuous Seizures: A thorough assessment of neurological health before ECT treatment can prevent the rare yet severe complication of prolonged seizures.
Stroke: Medical advancements and pre-ECT assessments have largely made ECT-related strokes less common than they were historically.
Memory Loss and Confusion: A continuous concern for many patients and patient advocates is the loss of memory, usually of the events immediately leading up to treatment, and post-therapy confusion. More extensive and long-term memory loss is also possible and quite difficult to predict or diagnose on a patient-to-patient basis.
Due to this list of complications, ECT is generally considered after other therapies have been deemed unsuccessful.
Transcranial magnetic stimulation (TMS) uses alternating magnetic fields to “reset” specified areas of the mind. TMS can stimulate targeted areas of the brain, specifically in the prefrontal cortex, where issues related to MDD often occur.
This non-invasive option does not involve the inducement of seizures, cutting out the need for anesthesia or muscle relaxants. Though seizure is an extreme, and rare, side effect of TMS, a physician will always complete a thorough medical examination to assess any potential interactions with medications, implanted medical devices, or history of seizures and brain damage from illness or injury.
During the appointment, the patient remains awake and relaxed, often completely unaware of any effects of the magnetic pulses, other than a light tapping on the head or very slight hand twitches. Doctors will offer earplugs to offset the rare potential hearing disturbance from the treatment. Mild side effects such as tingling of the skin or scalp may occur, as well as mild to moderate headaches, all of which are treatable with over-the-counter medications. Unlike ECT, which can cause significant confusion and even memory loss, the TMS treatment process is so mild that patients can drive themselves home after therapy. Sessions last around thirty minutes and are repeated several times per week, which is convenient for patients who may need to return immediately to usual daily activities after the session. Additionally, the TMS treatment also acts as a viable alternative or second-line option to antidepressant medications, which carry side effects of their own. While antidepressant medication is often prescribed to sustain the effects of ECT, TMS can be effective without any additional accompanying treatments. TMS is an ideal treatment option for those whose negative reactions to antidepressants outweigh any benefits.
Understanding the side effects of ECT, as well as its background and development, can inform the best path forward when discussing treatments with your doctor. If the severity of both the experience and the lasting side effects of ECT are discouraging to a patient, TMS provides an effective and noninvasive alternative for lasting effects.
ECT stands for electroconvulsive therapy. The treatment induces a seizure and muscle relaxants and anesthesia are used. Patients experience confusion and short term memory loss and need to be monitored post treatment.
The most common side effects of ECT are confusion, short term memory loss and muscle aches.
Treatment is determined on a case by case basis but it’s likely to be delivered 2-3 times a week over a period of several weeks.
ECT has been portrayed in media and films negatively often because historical ECT treatments were non consensual and didn’t include the use of anesthesia and muscle relaxants to minimise trauma and side effects.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Recovery TMS website is solely at your own risk.