Barry Alan Kramer, M.D.
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Information About ECT

The topic of electroconvulsive therapy has sparked feelings of fear and barbaric machinations since its introduction in 1938. Bad press and an inaccurate portrayal in the media have fueled this misconception. In fact, electroconvulsive therapy  (ECT or shock treatment) is an extremely safe and effective treatment for certain psychiatric disorders. Today ECT is most commonly used to treat patients with very severe depression. ECT is often the safest, fastest, and most effective treatment available to treat this illness. ECT is also occasionally used in the treatment of patients with manic illness, schizophrenia, catatonia, and severe symptoms of Parkinson's Disease. 

When it was first introduced, ECT was the only effective treatment available for severe psychiatric disorders. Hence, it was at times given to patients in the hope that "something that might work is better than doing nothing!"  While today many of these patients are treated differently, there were no other options available at that time. The techniques of administering the treatment have also changed very much since its introduction.

If your physician suggests that you be treated with ECT, You most likely have a disorder that (s)he believes will respond  to ECT Discuss this with your doctor.  Most ECT in the United States of America is given only with the consent of the patient. If you do not want to have ECT, it is highly unlikely that you will receive it against your will. You must sign an informed consent form that specifically conforms to requirements set out by this State. In addition, another psychiatrist or neurologist must see you in consultation and agree that ECT is the best treatment for you and that you are capable of giving informed consent. ECT is given as a course of treatments.

The average number needed to successfully treat a severe depression is between 6 and 12. It is highly unusual to feel better after only one treatment. In fact, most people don't begin to notice any change until they have had at least 4 treatments.

If you agree to have ECT, the treatments are usually given 3 times a week — usually Monday, Wednesday, and Friday  (Although the specific days and frequency may vary — consult your Doctor). You must not eat or drink anything after midnight prior to your scheduled treatment. Do not take your usual morning medicine before ECT unless your doctor tells you to. It is important that you do not eat or drink anything. Please try to refrain from smoking on the morning prior to your treatment.

Although you will be asleep during the treatment, it is necessary to begin to prepare you while you are still awake. An intravenous line will be started shortly before you are treated.  Electrodes are placed on your head for administering the treatment and also for recording your EEG (electrical measure of brain activity).  Electrodes are placed on your chest for monitoring your EKG (cardiogram). A blood pressure cuff is wrapped around your arm for monitoring your blood pressure during the treatment. A monitor is placed on your finger to measure the oxygen in your blood. When everything is connected, the machine is tested to insure that it is set properly for you.

Much of what is described above you will not remember. Next, a medicine (such as Brevital®, methohexital) is injected through the intravenous line that will cause you to sleep for 5 to 10 minutes. When you are asleep, a muscle relaxant (Anectine®, succinylcholine) is injected. This will prevent you from moving during the treatment. It may give you a mild amount of muscle soreness, but this will pass. During this time, you are being assisted in your breathing with 100% oxygen. When you are completely asleep and your muscles are completely relaxed, the treatment is given. 

A small amount of electrical energy is applied to your head for a few seconds. It is off more than it is on. If you were watching the treatment instead of receiving it, you would notice your toes wiggling — but little else. You continue to receive oxygen until you awaken.

When you awaken, you will be very confused. This is partially due to the anesthesia and partially due to the treatment. With most people the confusion passes in a few hours. Occasionally, someone may be confused for the entire day. This cannot be predicted. You may have a headache from the treatment.  This is generally caused by the muscles of your forehead contracting very tightly—like a tension headache. Tylenol® or aspirin usually relieves this.  If you have a headache after one treatment, you will probably have it after each treatment. Please remember to tell your doctor if this happens. 

You will also most likely experience some memory loss following the completion of the treatments. Recent events, dates, names of friends, public events, addresses, telephone numbers, and computer passwords may be forgotten. This memory loss should gradually reverse itself over the course of several weeks or months, but you may never remember many things that happened to you during your hospitalization. A very few people report some memory problems for years. Please — Use your memory! — Read! — Ask questions! — Write things down! — Watch continuing stories on TV! — Ask Questions!  "Exercising your memory" like this is the best way for you to help your memory return.  You may have read about brain damage with ECT. The scientific evidence concerning ECT as it is done today has not demonstrated evidence of brain damage.  

ECT is an extremely effective form of treatment. It is often safer and more effective than the available medications for the treatment of depression.  It is without a doubt safer than no treatment at all. If you have any questions about ECT, please discuss them with your physician.

You may also wish to read the following book. It was written by a psychologist who was against people having ECT–until he had a severe depression and needed the treatment himself. His book, which describes his illness and also the experience of having ECT, is often reassuring to people who read it:

HOLIDAY OF DARKNESS
by Norman S. Endler
Wiley-Interscience, New York
1982.
Thompson Educational Publishing, Inc.
Toronto, Ontario (paperback)

This next book also is written by a psychologist. It describes her depression and treatment, including ECT:

UNDERCURRENTS: A LIFE BENEATH THE SURFACE
by Martha Manning
Harper San Francisco
1995

This next book is written by the most widely known neuropsychiatrist in the field of ECT. It is
specifically meant for patients and their families.

ELECTROSHOCK: RESTORING THE MIND (hardcover)
by Max Fink
Oxford University Press
1999

or

ELECTROSHOCK: HEALING MENTAL ILLNESS (paperback)
by Max Fink
Oxford University Press
1999

COPYRIGHT ©1989, 1996, 2002, 2004 BARRY ALAN KRAMER, M.D.

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