Introduction[edit | edit source]
The indications for treatment with ECT are numerous, including for severe depression and treatment-resistant depression, bipolar mania/depression, schizophrenia, catatonia and suicidal patients who are unable to wait for antidepressants to take effect. Informed consent is a vital and essential part of the procedure
History[edit | edit source]
Convulsive therapy was introduced in the 1930's and used extensively and indiscriminately in the first three decades of it discovery. In movies and media, it is often depicted as an horrific treatment, both frightening and threatening, which has created a stigma. For many years, ECT was not as highly regulated as it is today, with it now being a much more comfortable procedure. One benefit of ECT is speed, in that it can work more quickly than medication.
Mechanism of Action[edit | edit source]
Despite decades of research, the exact mechanism of action of ECT remains elusive.
In 2020 a new hypothesis proposed that the antidepressant effect is caused by a change in sleep architecture, triggered by the events induced by ECT. This change in the basic pattern of normal sleep (a profound change in the neurophysiological and neurochemical state of the organism) is what causes the therapeutic effects of ECT and not any simple change in the release of neurotransmitters, neurotrophic factors and/or hormones.
Technique[edit | edit source]
ECT is commonly performed in a dedicated suite, a post-anesthesia care unit, or an ambulatory surgery site, most frequently on an outpatient basis. ECT delivers an electrical stimulus, which induces an action potential in the neurones in the brain. The ECT stimulus is either a brief pulse (0.5 to 2.0 milliseconds) or ultra-brief pulse (less than 0.5 milliseconds) waveform. While the brief pulse is considered standard, the ultra-brief is considered more tolerable.
During a course of ECT treatment, the seizure threshold commonly increases as the patient develops tolerance. Although most therapeutic ECT seizures last from 15 to 70 seconds, EEG recording lasts about 25 percent longer than the motor seizure. Seizures lasting less than 15 seconds may not be clinically effective, while prolonged seizures may cause cognitive impairment.
Physiological Effects[edit | edit source]
- Cardiac: ECT affects autonomic nervous system activity, causing rapid hemodynamic changes. Heart rate goes down (as ECT causes a parasympathetic drive). The effects of ECT on the heart is similar to a brief period of “vigorous exercise.”
- Brain: cortical blood flow increases by up to 300%; Cerebral oxygen demand also increases up to 200%; Brain volumes and Brain Derived Neurotrophic Factor (BDNF) levels increase; GABA is released (to suppress seizures), release of GABA possibly playing a role in the antidepressant effect of ECT.
Benefits[edit | edit source]
The benefits of ECT are seen after several sessions and the results are lasting. Education provided to the patient and family is vital, as the procedure has been associated with many false and illogical beliefs. The antidepressant effect is seen relatively quickly and may last up to a few years. Overall, the mortality rate is very low with ECT administered in a controlled setting, but it continues to cause mild memory loss in the long term.
Physiotherapy[edit | edit source]
Physiotherapists need be aware of
- Falls risk after electroconvulsive therapy (ECT). In older people it is a recognized major clinical care issue. The risk factors for falls after ECT are vast and complex in nature, especially considering existing comorbid medical conditions.
- Inpatients with a mental illness are at a high risk of falling both in the acute phase of their illness, and when the patient gets well and becomes more independent with their activities of daily living.
Today[edit | edit source]
Today ECT is now frequently used to treat a variety of mental health disorders besides depression. The procedure is relatively safe, and does work. However, the delivery of ECT requires an interprofessional team that includes a nurse, anesthesiologist, psychiatrist and a neurologist.
References[edit | edit source]
- Psych DB ECT https://www.psychdb.com/brain-stimulation/ect (accessed 19.3.2022)
- Very well health ECT Available: https://www.verywellhealth.com/electroconvulsive-therapy-5215450 (accessed 19.3.2022)
- Tsoukalas I. How does ECT work? A new explanatory model and suggestions for non-convulsive applications. Medical Hypotheses. 2020 Dec 1;145:110337. Available:https://www.sciencedirect.com/science/article/abs/pii/S030698772032692X?via%3Dihub (accessed 19.3.2022)
- Salik I, Marwaha R. Electroconvulsive Therapy. StatPearls. Available:https://www.ncbi.nlm.nih.gov/books/NBK538266/ (accessed 19.3.2022)
- Brown AM. Reducing falls after electroconvulsive therapy: a quality improvement project. Journal of Psychosocial Nursing and Mental Health Services. 2017 Jul 1;55(7):20-9. Available:https://pubmed.ncbi.nlm.nih.gov/28671238/ (accessed 23.3.2022)
- Health WA gov. Falls prevention and mental health for inpatients Available:https://ww2.health.wa.gov.au/Articles/F_I/Falls-prevention-and-mental-health-for-inpatients (accessed 23.3.2022)