ECT

The National Institute of Mental Health reports that approximately 17.3 million American adults suffer from major depressive disorder. Electroconvulsive therapy can help patients with severe depression that have been unresponsive to other forms of treatments.

Sadness and melancholy are normal human emotions, which usually disappear after a short period of time. But for many, the down feeling lingers and depression is affecting their everyday life in every aspect.

Depression is a diagnosable condition and classified as a mood disorder. Besides the down feeling, long-lasting symptoms can include low energy, lack of interest and loss of appetite.

Depression affects how the individual feels, acts and interacts. While milder cases can often be treated with psychotherapy, antidepressants or a combination of both, severe depressed patients are often unable to find relief.

Left untreated, depression can lead to serious health complications and even put patients at a high risk for suicide.

According to the National Institute of Mental Health, approximately 17.3 million American adults suffer from major depressive disorder. This is about 7.1% of the U.S. population over the age of 18.

However, electroconvulsive therapy, or ECT, has been an effective approach in many cases of major depression and gives severely depressed patients hope.

“ECT is considered to provide significant response in 80% of cases, which is many times the expected outcome for treatment of individuals with medications after prior lack of response,” said Dr. Paul B. Hicks with the Department of Psychiatry at Baylor Scott & White in Temple.

The success rate makes ECT the most effective and rapidly working treatment for severe depression cases.

During the procedure, an electrical stimulation is delivered to the brain to cause a short, medically controlled seizure. Since ECT is performed during general anesthesia, the patient does not feel pain or discomfort.

Although experts don’t completely understand the results, this seizure helps relieve the symptoms of depression.

“While no one knows for certain how it works, it appears to provide the same neurochemical changes in the brain that antidepressants provide but more effectively,” Hicks said. “The common endpoint neurochemically appears to be an increase in brain derived neurotrophic factor, which allows improvement in connections between neurons and an overall healthier brain.”

Despite the high success rate, ECT, also known as electroshock therapy, is often associated with a bad reputation.

Reasons for its bad reputation are plentiful but mostly based on misunderstandings and outdated practices.

“Very negative stories have been passed along over the years about events which would be highly unlikely to occur today,” Hicks said. “Today, the treatments are much better tolerated with fewer cognitive side effects.”

To better tolerate the invasive treatment, patients require general anesthesia and complete muscle relaxations.

“In the early days of ECT, it was performed without anesthesia or muscle relaxation,” said Hicks. “It also was often administered in non-private rooms. Watching someone receive treatment without the patient being given muscle relaxation would be a very anxiety provoking experience.”

But the stigma attached to ECT still remains, making patients fear permanent memory loss and lasting confusion.

Confusion immediately after the treatment and short-term memory impairment is possible, Hicks said. However, ECT is considered a generally safe procedure if conducted correctly by a health professional.

“In early days of ECT, the stimulus parameters of the ECT machines resulted in far more cognitive impairment then we now observe,” he said.

Modern ECT is a therapy that is associated with a very rapid recovery. Most patients need between eight to 12 sessions, which are usually held three times a week.

The effects of the therapy generally last between eight and 12 months. Hicks mentioned that health care professionals usually try to sustain and prolong the benefits with the use of other medications.

Generally, everyone with major depressive disorder is a potential candidate for ECT.

“ECT should be considered in anyone with severe depression, especially if they have failed prior medication trials and/or are acutely suicidal,” said Hicks.

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