ECT is recommended for serious depression, some forms of bipolar states, schizophrenia that has affective mood symptoms, and catatonia. ECT is effective in 80-90 percent of the cases. Typically, ECT is administered after medication treatment has failed, or due to the inability to tolerate the side effects of medications. However, ECT should be considered as first line treatment when the severity of the psychiatric (suicidal) or medical condition (inanition) dictates the need for a rapid and definitive response. ECT can also be used as first line treatment if in the past the individual has responded favorably to this treatment, and additionally if it is what is desired by the person.
How does ECT work? It is believed that ECT enhances the chemicals (neurotransmitters; dopamine, serotonin and norepinephrine) that are lacking, or deficient in different areas of the brain. Another theory is that ECT causes the release of certain hormones within our brain that exert beneficial effects relative to our mood and even promote the growth of brain cells.
ECT treatment progress is measured by making use of different scales that monitor both mood and memory function. This is done throughout the course of the treatments and it is the guidepost in making adjustments along the way, from the strength of the stimulus, placement of electrodes, to even the choice in anesthetic agent.
Before undergoing ECT, the individual must have an independent psychiatric evaluation (ECT Second Opinion) to determine if this therapy is appropriate. This ensures that ECT will be used where it is clinically appropriate. The individual also has to be medically cleared, as anyone would prior to having surgery, to make sure that they are able to undergo general anesthesia.
As psychiatrist we know that ECT works and it is a very safe and effective treatment modality that often is underutilized. This procedure requires specialized training in its administration, as well as a facility with the appropriate medical staff.
As psychiatrists it incumbent upon us to educate the public on the misconceptions and myths about “shock treatment,” and discuss with out respective patients the option of ECT just as we would when we discuss the use of medication and other therapies. Thanks to the advances in technology there is no reason to endure and prolong the pain and suffering that often accompanies certain mental states.