Commonly used to treat mental disorders such as severe depression, schizophrenia, bipolar disorder and catatonia (characterised by lack of movement, fast or strange movements, lack of speech, and other symptoms), Electro Convulsive Therapy (ECT) can be an effective and safe procedure. It is practiced worldwide as well as in the South African private and public sector. “ECT is usually considered as a treatment option where other treatment options like medication have failed, or where rapid results are crucial e.g. suicide risk. ECT also tends to work better in older people”, so says Dr P J Malherbe, a psychiatrist at Akeso Clinic in Arcadia.
Entailing a small electric current being applied to the scalp, ECT is used to induce a brief convulsion in the brain, he explains.
Some Akeso clinics have ECT licenses and facilities, and the ECT is performed by a psychiatrist along with an anaesthetist. “The procedure involves being taken to an ECT theatre, where an anaesthetist will administer an anaesthetic in exactly the same way as it would be done for any minor surgical procedure. Once the patient is under anaesthesia, two electrodes are held to the scalp - no cutting or shaving of hair is necessary - through which a small electric current is applied by an ECT machine.
“The duration, nature and strength of the current is carefully controlled and determined by the psychiatrist. The charge strength is measured in millicoulombs and is therefore extremely small. The resulting convulsion is measured with the use of a monitor attached to the patient, because the patient’s muscles are relaxed and visible features of convulsing are barely seen.
“The brief convulsion typically lasts 15 to 40 seconds and the whole procedure is completed within about 5 minutes after which the patient spontaneously regains consciousness. Six of these treatments are generally necessary over a two week period for suﬀicient improvement in symptoms, depending on each case. In most cases it is done while a patient is admitted to hospital, but it may in certain cases be done as a day procedure,” according to Dr Malherbe.
“Ever since the 1930’s seizures have been used to treat psychiatric ailments where it was observed that patients with schizophrenia would improve spontaneously after experiencing an epileptic fit or convulsion. Initially medications like insulin were used to induce a seizure. This practice was abandoned due to the risks and side eﬀects, and instead an electric current was used to produce a seizure - with less risk,” Dr Malherbe points out.
However, it was not until the 1950s with advances in anaesthesia, that ECT was widely practiced. A seizure could now be induced while a patient was under general anaesthesia, making the procedure much more tolerable and safe, according to Dr Malherbe.
“ECT can also be employed where medications are not advisable, for example a pregnant patient. It is safe for use in pregnancy in comparison to other medicines. The procedure is undoubtedly eﬀective with more than 70% of people with depression responding favourably, making it more eﬀective than other treatment options. The benefit is also rapid, with improvement sometimes seen within days, as opposed to medications that may take longer to start working.”
Risks, side effects
According to ECT information supplied by Mayo Clinic, ECT is generally safe, but there may be risks and side effects. While most patients who responded to ECT questions by the website healthtalk.org, confirmed that they experienced side-effects, others had very little, even none.
“Most people we spoke to had some side effects from the treatment. Side effects ranged from patient to patient.
“However, a few of the people we interviewed experienced little if any side effects of having ECT, and some pointed out the side effects of taking medication could be worse.” One respondent even said that he experienced no bad effects from ECT at all, and it was like having a cataract operation. As with most medical procedures, side effects are possible. In ECT, side effects can include headache, forgetfulness and muscle ache. Possible risks and side effects are always discussed with the patient prior to the procedure and informed consent obtained.
It is important to continue medication for maintenance of improvement after ECT. Periodic follow-up with a psychiatrist or medical practitioner is therefore necessary.
Unfortunately ECT remains stigmatised because of various misperceptions and archaic ideas,” says Dr Malherbe.
Indeed, “many depictions of ECT in film and television have portrayed the therapy as an abusive form of control. Most famous is the film ‘One Flew Over the Cuckoo’s Nest,’ in which an unruly patient (Jack Nicholson) is subjected to the procedure as a punishment. There is probably no fictional story that so haunts our consciousness of a medical treatment,” according to Prof Jonathan Sadowsky, in his article titled Electroconvulsive therapy: A history of controversy, but also of help.
Yet, “almost all of the controversy about ECT is anecdotal opinion, unsupported by evidence. In fact, there is a remarkably wide gap between what anti-ECT ideas claim and the very substantial body of clinical and scientific evidence supporting its efficacy and safety.
According to Mayo Clinic, “much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anaesthesia, leading to negative side effects memory loss, fractured bones and other serious side effects. ECT is much safer today. Although ECT still causes some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks.”
ECT is monitored by regulations within the Mental Health Care Act 17 of 2002. These regulations outline how facilities need to be authorised to offer ECT, and that ECT can only be conducted by a registered medical practitioner or psychiatrist, while the patient is under general anaesthetic and has been given a muscle relaxant.
“Many patients say that ECT has possibly helped to save their lives when they had given up all hope of finding relief from debilitating symptoms and pain, according to Sandy Lewis, Head of Psychological Services at Akeso Clinics”
Concludes Dr Malherbe: “The fact is that despite all the negative connotations, ECT can be – and is - an invaluable treatment for many people. Today many a patient who benefited from this treatment, can attest to its efficacy.”
What you will need before undergoing ECT treatment
Before having your first ECT treatment, you'll need a full evaluation, which usually includes:
- A medical history
- A complete physical exam
- A psychiatric assessment
- Basic blood tests
- An electrocardiogram (ECG) to check your heart health
- Anesthesiologist review to go over the risks of anesthesia
These exams help make sure that ECT is safe for you.
- Mayo Clinic https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894
- A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study. Kellner CH, Husain MM, Knapp RG, McCall WV, Petrides G, Rudorfer MV, Young RC, Sampson S, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Rosenquist PB, Raza A, Kaliora S, Latoussakis V, Tobias KG, Briggs MC, Liebman LS, Geduldig ET, Teklehaimanot AA, Dooley M, Lisanby SH, CORE/PRIDE Work Group. Am J Psychiatry. 2016; 173(11):1110. Epub 2016 Jul 15.
- Shorter, E, Healy, D. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness, Rutgers University Press, New Brunswick 2007
- Endler, N.S. 1988. The Origins of Electroconvulsive Therapy (ECT). Convulsive Therapy, 4(1): 5-23.
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