by Donna Ecklesdafer, MSN, RN
When you think about a defibrillator, most people think about an up to the date, state of the art and life saving treatment. When you think about Electroconvulsive Therapy (ECT), do you think about the 1940’s and the movie “One Flew Over the Cuckoo’s Nest”? The stigma of mental illness and ECT is still prevalent.
ECT is a safe and effective treatment in treating the debilitating symptoms of major depression, bipolar disorder (mania and depression), some forms of schizophrenia, dementia with an underlying mood disorder, among other diagnoses. It can be a life saving treatment if a rapid response is needed.
Major depression affects many people. Nearly 15 million adults in the United States deal with major depression each year. Major depression is the leading cause of disability for individuals ages 15 – 44.
Many people respond to medication and talk therapy. Some, however, do not. ECT is a lifeline for these individuals.
ECT helps to improve or even eliminate the depression symptoms an individual is experiencing. The benefits of ECT include: improved mood, increased pleasure, more restful sleep, better appetite, more positive attitude, less agitation, increased sexual interest, more energy, clearer thinking and more hope.
ECT is similar to medications, however it works faster. A series of 6 – 12 treatments is given three times each week over a period of 4 – 5 weeks. The national average for a series is 10 treatments. Each person is assessed for their response to ECT.
People begin to see an improvement after 4 – 6 ECT treatments or in about 1½ to 2 weeks. Others tend to see improvement before the patient does. When the patient first begins ECT, they may be isolative, have poor eye contact and say just a few words. After a few treatments, they may begin to smile. After a few more treatments, they may start laughing. It is wonderful to see the improvements people can experience with ECT.
A number of improvements and advancements have occurred in ECT just as they have in surgery over the years. A treatment team made up of an anesthesiologist, psychiatrist, and registered nurse (RN) will care for each patient. The patient receives a brief anesthetic medication to put them off to sleep.
Once the patient is asleep, a brief electrical stimulus is given to the brain which causes a grand mal seizure. Because a muscle relaxer is given, very little muscle movement is visible, typically just the hands and feet move. The seizure is monitored by an electroencephalogram (EEG). Once the patient wakes up from anesthesia, they are transferred to the recovery room. The patient’s vital signs are monitored throughout their stay in the ECT Clinic.
Seizure activity in the brain causes chemical changes to take place, not the electricity. These chemical changes improve the patient’s mood symptoms.
ECT is not 100% effective. Once the patient has gone through an acute series of treatments, they must remain on medications or in some circumstances maintenance ECT to keep the gains they made. There is an 80% chance of relapse if the individual does not follow up with either medications or ECT.
Side effects of ECT include headache, muscle aches (due to the muscle relaxant as it contracts muscles before relaxing them), nausea, confusion, short and/or long term memory. Many patients do not experience any of these symptoms. Medications can be given to treat some of the side effects. Typically, the patient may have gaps in their memory right around the time of treatments – right before, during and after.
Education about ECT is vital. Patients and their family are given a video to watch as well as education by an RN. Booklets and an article written on ECT are also given as part of the education packet.
ECT has been proven to be a safe and effective treatment, especially when medications have been ineffective. It is a great option for these individuals. For some, it can be a life saving treatment.
Pine Rest’s ECT Clinic is the only outpatient clinic in the area. For more information, please contact the Pine Rest ECT Clinic at 616-281-6341.
The National Institute of Mental Health (NIMH) latest statistics on suicide (2007):
- Suicide was the 4th cause of death in adults ages 18 – 65
- 34,598 cases reported
- Out of these cases, over 90% were diagnosed with Depressive Disorder or Substance Abuse Disorder
- The overall rate was 11.3 suicide deaths per 100,000 people
- An estimated 11 attempted suicides occur per every suicide death
Donna Ecklesdafer, MSN, RN, has been the Pine Rest ECT Clinic Manager for the past 16 years and certified in ECT since 2001.