Electroconvulsive Therapy

Definition

Electroconvulsive therapy, or ECT, is a medical procedure performed to relieve symptoms of severe depression, bipolar disorder, schizophrenia and some other mental illnesses. The treatment sends small electric currents through the patient’s scalp, creating a controlled seizure in their brain, which is believed to alter brain chemistry and alleviate or reverse symptoms. ECT is performed in a series of sessions in a safe, controlled environment and is used when other treatments, such as medication and therapy, have not been effective.

The UF Health difference

At UF Health, we are proud to be leaders in the field of neuromodulation, including electroconvulsive therapy. We want to help all patients with psychiatric illnesses, including those who have not benefitted from previous treatments. In our facility, ECT is performed by a team of highly trained and experienced medical professionals consisting of an ECT credentialed psychiatrist, an anesthesiologist and nursing staff. Your comfort, care and a successful treatment plan are of utmost importance to our ECT psychiatrists, including the chief of ECT, Brent Carr, MD, and Louis Solomon, MD, specifically trained in the delivery of ECT. For more information, please call 352.265.5481.

Benefits

ECT is a highly effective treatment for mood disorders, such as severe depression or bipolar disorder, and has a high response rate even when previous medication and therapy trials have been unsuccessful. Treatment-resistant depression, mood disturbance with delusions and psychotic symptoms, depression during pregnancy and depression with severe suicidal thoughts usually respond rapidly to ECT. Many patients can tolerate ECT better than multiple medications.

What happens during ECT?

Electroconvulsive therapy is available for hospitalized patients and as an outpatient procedure. ECT is typically performed at the UF Health Psychiatric Hospital. Your ECT physician may opt for your procedure to be performed at UF Health Shands Hospital if it is determined to be medically necessary. General anesthesia is typically administered to ensure the patient is asleep and pain-free during the procedure, which usually only lasts a few minutes.

The following can be expected before, during and after your ECT treatment:

Preparation

Prior to the procedure, you will receive a thorough evaluation, including a physical exam, psychiatric assessment and potentially blood tests or imaging if needed. You should not eat or drink anything after midnight the day prior to your treatment.

Treatment procedure

• An IV is started with anesthesia to put you to sleep, at which point muscle relaxers are administered, ensuring you feel no pain.
• Patient safety is of utmost importance, so your vital signs are continuously monitored including your heart rate, blood pressure and oxygen levels.
• Electrodes are placed on both sides of your scalp to monitor your brain activity.
• A brief, mild and carefully controlled electrical pulse is delivered through the electrodes to your brain to induce a seizure. This usually lasts less than a minute and doesn’t cause any pain or damage to your brain, head or skin. If a seizure lasts longer than 60 seconds, medication will be administered to stop the seizure.
• Once the procedure ends, the anesthesia will start to wear off and you’ll wake up in a recovery room where you will continue to be closely monitored by post-anesthesia care nurses. They will watch your blood pressure and check for any immediate side effects. You will have no memory of the treatment.
• During the final phase of treatment, you will be given a light refreshment and your blood pressure will be monitored for another hour by our exit nurse.
• Outpatients will be discharged and need to be driven home by a pre-determined designated driver.

How long will I need ECT?

An initial series of ECT is usually given three times a week with a minimum of six treatments, but most patients will need eight or nine treatments. This initial series is required to achieve improvement for a patient with severe mood disorders. Patients with very resistant disorders may require 15 or more ECT treatments, but this is less common. Your improvement will be monitored regularly to determine the number of treatments needed.

Once symptoms are adequately controlled, many patients enter a tapering phase where ECT treatments are given less frequently, which helps prevent a relapse and may eventually be stopped.

Patients who have experienced resistance to other treatments may request to be placed on a maintenance ECT program to prevent recurrence. The maintenance program treatment frequency varies from patient to patient but could be one treatment every few weeks or every few months.

Medication use

Specific instructions will be given to you about the medications you’ll take before your treatment. Blood pressure medications are usually taken the morning of treatment with a sip of water.

During the course of the ECT treatment period, some patients are able to reduce the number of medications they need to take for their mental health diagnoses. The ECT team will work with your primary psychiatrist to discuss any recommendations or adjustments for your medications.

Potential side effects

While we understand there is some stigma associated with electroconvulsive therapy, we hope to resolve any misconceptions of this highly effective treatment. The procedure is pain-free and you will be fully asleep with anesthesia and muscle relaxers. You won’t have any memory of the procedure and it won’t cause any damage to your brain, head or skin.

As with any medical procedure, ECT treatment can cause some potential side effects, including:

• Confusion right after the procedure that generally only lasts a short period of time.
• Headache.
• Blood pressure changes, including low or high blood pressure.
• Memory loss, mostly surrounding the time of the procedure. Occasionally patients experience longer memory loss with details from the past, but this typically begins to clear after the ECT treatment frequency is reduced.
• Muscle soreness or nausea from the anesthesia can sometimes occur at the onset of treatments but is usually mild. If nausea occurs, anti-nausea medication is given at the time of the procedure.
• Rapid heartbeat or other heart problems.

Further reading

• The American Psychiatric Association’s website has an overview of ECT for patients.
• You can also find a great deal of information about ECT on the website of the International Society of ECT and Neurostimulation. Here you can find patient testimonials, books on ECT, videos about ECT and ECT provider lists.

References

• Kerner N, Prudic J. Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry. 2014;4(1):33-54. doi:10.2217/npy.14.3.
• Baghai TC, Möller H-J. Electroconvulsive therapy and its different indications. Dialogues in Clinical Neuroscience. 2008;10(1):105-117.
• Geduldig ET1, Kellner CH2. Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression.
• Curr Psychiatry Rep. 2016 Apr;18(4):40. doi: 10.1007/s11920-016-0674-5.
• Welch CA. Electroconvulsive therapy. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA