Brain Stimulation Services

ECT may work in several ways. For example, it may work by changing the brain cell network communications that can be over connected in depression. ECT appears to increase neurotransmitters, such as serotonin and dopamine. ECT also increases BDNF (Brain Derived Neurotrophic Factor), which can help the brain cells grow.

ECT is used with patients with severe depression, mania or psychosis or with those unable to tolerate medications. Most patients receive ECT for treatment-resistant depression, when antidepressant medication and psychotherapy have not worked. Sometimes ECT is administered on an inpatient basis when patients have severe suicidal thoughts and cannot be safe outside the hospital or do not have time for medications to work. ECT is commonly administered on an outpatient basis to patients with treatment-resistant conditions who do not require inpatient care for safety.

Patients are instructed not to eat or drink anything after midnight the night before treatment. The morning of ECT, patients arrive at the waiting area and complete a clinical survey. The patient enters the ECT suite and meets with the ECT nurse, psychiatrist and anesthesiologist. Monitors are placed on the chest and head, and an IV is placed in the arm. During the procedure, patients receive a brief-acting anesthetic, which puts them to sleep for approximately seven minutes. Electrodes are placed on the temples or other areas of the head to allow brief electrical currents to be sent to the brain. A muscle relaxant is given shortly after the anesthesia to loosen the muscles so there are no motor convulsions during the therapeutic seizure that follows. Patients are not awake for the actual seizure as they are under anesthesia. The seizure itself typically lasts from 20 to 60 seconds, but can last as long as three minutes. Patients wake up several minutes after the therapeutic seizure ends. They are then transferred to the recovery area, where they remain until they are alert and ready for discharge, usually about 20 minutes.

From start to finish an ECT appointment takes about one hour. Generally, ECT is administered three times a week for three to four weeks (a total of eight to 12 sessions). Some patients may need more or fewer treatments.

ECT eliminates depression in more than 55 percent of patients, with a marked reduction in depression in another 20 to 30 percent of patients. ECT remains the most effective antidepressant treatment, with a greater response rate than antidepressant medication. Although ECT is effective in the short term, patients can relapse quickly, sometimes within weeks or months, if they are not taking antidepressant medication during and after ECT. For this reason, we request that patients do so. Some patients may continue receiving ECT periodically to prevent relapse.

An acute series of ECT involves a patient receiving ECT three times a week for two to four weeks (six to 12 treatments) for treatment-resistant depression or other conditions that respond to ECT. Maintenance ECT is for patients who have recurrence of symptoms or have responded well to prior ECT treatment. Generally, we will offer an acute series of ECT only. Many patients remain well while staying on antidepressant therapy, such as Nortriptlyline and Lithium. For patients who relapse into severe depression within a year, we commonly will offer another acute course of ECT followed by maintenance ECT. The maintenance schedule is a tapering of ECT sessions, the goal being to continue once-a-month ECT to maintain benefits. The ECT taper from an acute series to a maintenance schedule is generally once a week for four treatments; every two weeks for four treatments; every three weeks for four treatments; then, every four weeks. There is no limit on how long a patient can receive maintenance ECT provided the treatment is effective.

Patients are not allowed to drive during the entire ECT course and for two weeks after the last treatment in an acute series of ECT. An acute series is usually three treatments a week for two to four weeks (six to 12 treatments). Patients who receive maintenance ECT can drive, except on the day of ECT, unless otherwise instructed by their physician.

The immediate side effects of the procedure may include:

• Headaches/Muscle Aches: Over-the-counter medications like Ibuprofen (Motrin, Advil) or Acetaminophen (Tylenol) are usually effective in treating aches and pains. Ibuprofen may cause stomach discomfort, so it is helpful to eat as soon as possible after treatment. After eating, take either Ibuprofen or Acetaminophen as directed on the bottle. If headaches are severe enough to affect eating, two Acetaminophen tablets may be taken with a sip of water one to two hours prior to and following treatments.
• Confusion: Confusion will usually clear within several hours of the treatment. Family and friends can be most helpful by frequently reminding the patient that he or she had an ECT treatment. It is not unusual for this confusion to become slightly worse with each treatment. Please call if confusion persists longer than six hours.
• Nausea/Vomiting: This is usually related to the anesthesia. If this occurs, please call to discuss possible interventions. A medication will be added during subsequent treatments to prevent nausea.

The ECT treatment team relies on the family's feedback in assessing a patient's improvement. Families commonly are able to see progress in the patient's activity before the patient actually feels better. Families can also assist with transportation and supportive care after ECT and can let the ECT nurses and physicians know of any concerns they may have about the patient's care.