The Royal College of Psychiatrists
Patient Factsheet on ECT (Electroconvulsive Therapy)
Produced by: Republished on the SEAN web site by kind permission. |
Introduction
This leaflet will try to answer some of the questions you may have about ECT. You will probably want to know what it is, why it is used and what it is like to have ECT. You will also want to know the risks and benefits of ECT.
When you are depressed, it is often quite difficult to concentrate. Don't be concerned if you can't read through all of this leaflet - just pick out the sections that seem important at the time and come back to it later. You may wish to use it to help you ask questions of staff, relatives or other patients.
What is ECT?
ECT is a physical treatment for severe depressive illness. It started in the 1930's when it was noticed that people who had both epilepsy and mental health problems often became more settled after an epileptic fit.
During ECT a small amount of electric current is passed across the brain for usually 2-3 seconds. This produces an artificial epileptic fit which affects the entire brain, including the parts which control thinking, mood, appetite and sleep. Repeated treatments alter chemical messages in the brain and bring them back to normal. This helps you to recover from your illness.
ECT is only given under a general anaesthetic and with drugs to relax the body's muscles. This means that unlike a person experiencing a natural epileptic fit, you will usually be asleep before it starts. Your arms and legs will not thrash around, usually there will be just be a flickering of the eyelids. You should suffer no physical ill-effects and have no memory of the treatment itself.
A special machine is used to precisely control the amount of electricity used to make sure that you are given as little as possible.
For most people ECT is a short-acting treatment, but it does act more quickly than drugs. This can be life-saving. The improvements produced by ECT will usually need to be maintained with anti-depressant medication.
Why has ECT been recommended for me?
ECT is given for many reasons. If you are not sure why you are being given ECT, don't be afraid to ask. It's sometimes difficult to remember things when you are depressed, so you may need to ask several times. Your consultant may recommend that you be treated with ECT if:
- You have had a severe depressive illness for some time and a number of different drug treatments have been tried without success.
- You have tried several different anti-depressants but have had to stop them because of side-effects.
- You have responded well to ECT in the past.
- Your life is in danger because you are not eating or drinking enough
- Your life is in danger because you feel so bad you want to kill yourself.
- If your depression is so bad that you may die, ECT can literally be life-saving.
What will happen if I have ECT?
You will be asked to have nothing to eat or drink from midnight on the night before treatment because you will be having a general anaesthetic.
The treatment takes place in a separate room with special equipment. Other patients will not be able to see you having the treatment, which takes only a few minutes.
A nurse will take you in and you will be asked to lie down. The anaesthetist will ask you to hold out your hand so you can be given an anaesthetic injection. It will make you go to sleep and cause your muscles to relax completely. You will be given some oxygen to breathe as you go off to sleep. Once you are fast asleep a small electric current is passed across your head and this causes a mild fit in the brain. Unlike normal epileptic fits, there is little movement of your body because of the relaxant injection that the anaesthetist gives.
When you wake up you will be back in the waiting area and there should be a nurse with you to make sure that you feel as comfortable as possible. Once you are awake you should be offered a cup of tea before you go back to the ward.
Practical Points
- Wear loose clothes or nightclothes
- Remove any jewellery, hair-slides or false teeth.
How will I feel immediately after ECT?
Some people wake up with no side effects at all and simply feel relaxed. Others may feel somewhat confused or have a headache. The nurse will be there to help you through any problems.
How well does ECT work?
Over 8 out of 10 depressed patients who receive ECT respond well to it. In fact, ECT is the most effective treatment for severe depression. People who have responded to ECT report it makes them feel "like themselves again" or "as if life was worth living again". Severely depressed patients will become more optimistic and less suicidal. Most patients recover their ability to work and lead a productive life after their depression has been treated with a course of ECT.
How many treatments are usually necessary?
ECT is usually given two or three times a week. It is not possible to say exactly how many treatments you may need. Some people get better with as few as 2 or 3 sessions, others may need as many as 12 and very occasionally more.
What ECT can't do
The effects of ECT will relieve the symptoms of your depression but will not help all your problems. An episode of depression may be due to problems with relationships or problems at home or at work. It may also cause such problems. These may still be present after your treatment and you may need further help with these. Hopefully, because the symptoms of your depression are better you will be able to deal with these other problems more effectively. You may then find that you are able to make good use of counselling or psychotherapy.
What are the side effects of ECT?
Some patients may be confused just after they wake from the treatment and this generally clears up within an hour or so. Your memory of recent evens may be upset and dates, names of friends, public events, addresses and telephone numbers may be temporarily forgotten. In most cases this memory loss goes away with a few days or weeks although sometimes patients continue to experience memory problems for several months. As far as we know, ECT does not have any long term effects on your memory or intelligence.
Are there any serious risks from the treatment?
ECT is amongst the safest medical treatments given under general anaesthesia. The risk of death or serious injury with ECT is rare and occurs in about one in 50,000 treatments. For example this is much lower than reported for childbirth. Very rarely deaths do occur and these are usually because of heart problems. If you do have heart disease it may still be possible for you to have ECT safely as long as the doctors take specialist precautions, such as heart monitoring. Your doctor will ask another specialist to advise if there are grounds for concern.
What other treatments could I have?
Anti-depressant drugs may be available to treat your particular condition and it is possible that some of them may work as well as ECT. The advantage and disadvantages of other treatments should be discussed with you by your doctor.
Will I have to give consent?
At some stage before the treatment you will be asked, by your doctor, to sign a consent form for ECT. If you sign the form you are agreeing to have up to a certain number of treatments (usually 6). Before you sign the form the doctor should explain what the treatment involves and why you are having it, and should be available to answer any questions you may have about the treatment.
Can I refuse to have ECT?
You can refuse to have ECT and you may withdraw your consent at any time even before the first treatment has been given. The consent form is not a legal document and does not commit you to having the treatment. It is a record that an explanation has been given to you and that you understand to your satisfaction what is going to happen to you. Withdrawal of your consent to ECT will not in any way alter your right to continue treatment with the best alternative methods available.
Very occasionally a person may become particularly seriously ill with depression. They may be suicidal, convinced that they are too wicked to be treated, or even eating and drinking too little to stay alive for much longer. In these circumstances ECT may be given to patients without their consent. For this to happen, two doctors and a social worker must agree that the person is so unwell that they need to be kept in hospital under a section (3) of the Mental Health Act. Then another independent psychiatrist, sent by the Mental Health Commission, must agree that the treatment is necessary. If you are detained in hospital under a section of the Mental Health Act and are uncertain about your rights, ask to speak to the Mental Health Act administrator for the hospital.
Are there any risks in not having ECT as recommended?
If you choose not to accept your doctors' recommendation to have ECT you may experience a longer and more severe period of illness and disability than might otherwise have been the case. The alternative is treatment with anti-depressant drugs. This also has risks and complications and may not be any safer than ECT.