Depression is common and impacts quality of life, relationships and health. Severe depression can become life threatening. For various reasons, medication and talk therapy may no longer help some patients.
Your psychiatrist at this point may recommend electroconvulsive therapy (ECT). Most people have heard about ECT, but unfortunately, ECT has not always been mentioned in a positive context. The way media has portrayed ECT — the movie One Flew Over the Cuckoo’s Nest invariably comes to mind — has not done the public any favors, and patients may suffer for it. In fact, ECT as we administer it today, is quite different from when it was first invented, and can be dramatically effective for those patients who are severely ill.
ECT is a simple procedure done under general anesthesia and with a muscle relaxant to prevent movement. A psychiatrist and anesthesiologist supervise each treatment, and psychiatric and recovery nurses assist. The patient, once anesthetized, receives a small electrical current, delivered across the scalp. The resulting controlled brain seizure produces positive changes in brain chemistry, connection and function. This improves depressive symptoms. About an hour after treatment the patient can go home.
ECT is also available as an inpatient, but most patients opt for outpatient ECT. Usually six to 12 treatments are necessary, given three times a week, and can lead to complete remission of depressive symptoms in many patients. Some patients benefit from maintenance ECT, which is usually given on a much less frequent basis, sometimes once monthly.
For most patients, the benefits of ECT greatly outweigh the small risks, such as temporary confusion, memory loss, nausea and muscle pain. ECT is generally well tolerated and patients are often surprised about their positive response to ECT. Depressive symptoms and negative thinking improve, giving them a reinvigorated ability to connect and communicate with other people. This is also helpful for treatment that follows ECT, because patients can engage much more effectively in talk therapy and obtain rewarding experiences from social interactions, which can reduce reliance on medication.
Dr. Martin Strassnig is a psychiatrist at UHealth — the University of Miami Health System. To learn more, visit umiamihospital.com/