A 10-minute procedure
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By MEL HUFF Staff Writer - Published: January 6, 2008
Electroconvulsive therapy as it is practiced today is so different from the procedure of the 1940s and 1950s that "it actually should have been called something else," says Dr. Gregory Miller, the medical director of Retreat Healthcare in Brattleboro.
In Vermont, patients are given complete medical and psychiatric examinations when they enter the hospital. The attending psychiatrist reviews their records, consults with their other doctors, talks with the patient and the patient's family, discusses the risks and benefits of ECT and explains the specific technique that will be used. The night before treatment, an anesthesiologist talks with the patient to check for individual health risks.
The patient and family are given an informed consent packet that talks about the possibility of memory loss, and they can watch a video that shows the entire procedure and patients waking up from it.
Before treatment begins, the patient is given anesthesia and a muscle relaxant to prevent movement. The amount of stimulation needed to induce a seizure varies from patient to patient, so the psychiatrist calibrates the electrical charge on a device about the size of a stereo receiver. Then, with what looks like a pair of insulated bicycle handles, he holds the electrodes against the patient's scalp for several seconds. The current induces a seizure that lasts from 30 seconds to a minute. Only one charge is given per session.
Psychiatrists use different electrode placements, intensity of stimulus and waveforms to try to produce the most effective response with the least effect on memory. (Sine wave, which causes more severe cognitive side effects, is not used in Vermont.) "The science of it is that you want to produce the minimum amount of dosage of electricity that causes seizure activity in the brain for 30 seconds to one minute," Miller said.
During treatment, the patient is given oxygen, and the anesthesiologist and an ECT nurse monitor brain activity, heart function, blood pressure and the amount of oxygen in the patient's blood. The state requires facilities to have equipment at hand to deal with emergencies. ECT has a one in 10,000 risk of death – the same as other outpatient procedures that are performed with anesthesia.
The whole process, from the time patients enter and leave the treatment area, takes about 10 minutes. Afterward, they spend 30 minutes to an hour in the recovery area while their blood pressure, pulse and breathing are checked at 10-minute intervals. Patients can go home when they are completely awake, although they are not allowed to drive.
Most patients initially receive a course of between nine and 12 treatments, usually one treatment three days a week. Like medication, the effects of ECT are not always permanent, so after the initial course of treatments, patients go on a maintenance program, typically antidepressants.
"Even if they haven't responded to an antidepressant to get them out of the depression, a lot of times they will respond to taking an antidepressant to maintain the response to ECT," Miller explained.
When medications don't keep patients from slipping back into depression, they may be switched to "maintenance ECT" and have a single treatment at monthly or longer intervals. Sometimes maintenance ECT keeps patients free from depression for years, Miller noted.