Treating depression with Electroconvulsive Therapy (ECT)

What is ECT

Electroconvulsive therapy (ECT) is an invasive type of brain stimulation that’s sometimes recommended for severe depression if all other treatment options have failed, or when the situation is thought to be life threatening, (NHS).

ECT, given to depressed patients under anaesthesia, sends electrical pulses to the brain through electrodes applied to the head. The electrical stimulation triggers a seizure, which seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. Repeated a few times a week for a short period, ECT eliminates depressive symptoms for an extended time in many patients, Brainwise, 2018.

“ECT is the most effective treatment available for severe and treatment-resistant depression, but it requires anaesthesia and can cause side effects like memory loss,” says Irving Michael Reti, M.B.B.S., M.D., director of the Brain Stimulation Program.

Who invented ECT

There’s much written about the invention of ECT but I love and have used excerpts from this article written by Robyn Wilson for the Independent, 2017 — Once upon a time in April 1938, a team of Italian medical researchers got ready to do one of the most controversial things that medicine had ever seen. They’d attempt to heal a mentally ill patient by applying a jolt of electricity through his brain. They didn’t know if he’d live or die but it was a risk they were willing to take.

Leading the team was 61-year-old Ugo Cerletti, and his assistant, Lucio Bini who, together had been working on the intriguing new medical machine they were soon to put to use.

In a large, secluded room they shaved the patient’s head and stretched him out on a bed. They attached two electrodes to his temples, placed a rubber tube in his mouth as a bite-bloc and flicked the switch of Cerletti and Bini’s device.

The team braced themselves as the electrical current coursed through the man’s head. He let out a small spasm and then bizarrely burst into animated song. Interesting, amusing certainly, but it wasn’t a seizure.

They tried again, increasing the voltage, until finally the patient went into what was a rather dramatic convulsion; face purple, mouth clenched, fists balled, heart racing. The medical staff all nervously watched on, fearing his death. Until suddenly the man slumped back, still. His breathing was steady, regular.

Right then, they knew they had completed what they had set out to do. After two years of research, they had proven that an electrical current could be used to induce a seizure without it resulting in the patient’s death; a seizure that, as they had hoped, would go on to relieve the patient’s symptoms.

They had just given birth to electroshock therapy and psychiatric medicine would never be the same again.

Modern day ECT

Today’s ECT involves going to a general hospital, where the patient is given short-acting anaesthesia (including a muscle relaxant) before ECT is administered. The targeted (and very low-level) electric jolts, it’s said, stimulate the brain to address everything from depression to dementia-related outbursts of anger (something I haven’t seen it used for).

In my first post as a mental health nurse I’d developed a good therapeutic relationship with a lady who had bipolar disorder and during the depression phase she felt hopeless and suicidal — it was pitiful to see. Over the years she had been treated with several courses of ECT and this time, she requested more. When it was agreed she could have ECT she asked if I, as her nurse, would accompany her.

I’d only ever seen Jack Nicholson in One Flew Over The Cuckoo’s Nest — and I cried watching that — so I wasn’t looking forward to observing Lyn having ECT. Oh my word, I thought I was going to have a panic attack as they pressed the button and she went into a seizure which lasted around 80 seconds. The ECT nurse must have noticed as she gave me a comforting shoulder rub and a smile that said she understood.

I waited for Lyn to come round in the recovery room with another nurse who took regular observations (obs) i.e. blood pressure, temperature and pulse to ensure Lyn wasn’t experiencing any unusual side effects. When she woke from the mild anaesthesia Lyn was drowsy but able to get into a waiting wheelchair with support from me and the other nurse.

Once back on the mental health ward I was to observe Lyn throughout my shift, taking hourly obs and asking her how she felt; documenting everything in her notes and on charts. She remained drowsy and confused for a few hours and her memory lapsed, she was unable to concentrate and complained of a headache, for which she was given paracetamol.

Shock and horror

I was about 15 and terrified when my mum went into hospital — well, an asylum actually. I later learned she’d been suffering with clinical depression which was treatment resistant. When I became a mental health nurse, I was telling mum about ECT when she confessed that she’d been in an asylum once before, when I was about 4-5, and on both occasions, she’d had ECT.

I’m glad I had more awareness and insight into ECT when mum told me because I would have thought, like most people, it barbaric, inhumane. She said she didn’t remember too much about it all — long-term memory loss? Or perhaps she just shut it out for all those years? Still, it had relieved the depression and her mood had improved.

My conclusion on ECT

I’d accompanied Lyn on six more occasions and my anxiety lessened each time as I saw how much her mood improved — and I realised that ECT is actually more civilized than I’d been led to believe.

I’m not sure it would be my choice of treatment but then again, I’ve been lucky that medication and talking therapies were, and still are, beneficial to me — they’ve helped me out of a massive black hole — on more than one occasion.

Would you be able to explain what ECT is to other people now? What do you think of ECT? Is there anything I missed? I am happy to answer your questions. In the meantime, you might like to read more about depression here.

This article was first posted on the Blogger Community here – thanks to Saumya and Niki; authors on this blog. Why not drop in and say hi to some fellow-bloggers.