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Electroconvulsive therapy

Dr Ashish Sarangi

Sunday, February 12, 2017    

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Electroconvulsive Therapy (ECT), also known to lay persons as “shock treatment”, has come a long way since its early depictions of being cruel and barbaric.

Its portrayal in the media and popular movies has not done justice to this otherwise safe and effective treatment alternative for psychiatric conditions.

When most people think of ECT, they imagine a helpless person strapped to a table with leather bands on the arms and legs and a rolled up bandage shoved into the person’s mouth.

There is also the belief that the amount of electric current given to the patient is enough to sustain an entire Jamaica Public Service power plant. Sounds like the scene from a science fiction movie, right?


However, this couldn’t be further from the truth. The American Psychiatric Association, which has done extensive research in the field of ECT, actually states that it can produce substantial improvement in approximately 80 per cent of patients.

ECT’s effectiveness in treating severe mental illnesses is recognised by the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health, and similar organisations in Canada, Great Britain, and many other countries.

Indications

ECT can be an effective treatment for a range of psychiatric disorders and situations, including:

• Treatment-resistant major depressive disorder, especially with psychotic features;

• Bipolar mania;

• Catatonic schizophrenia;

• Neuroleptic malignant syndrome;

• Treatment of psychosis and depression in pregnancy;

• Patients with contraindications to particular psychotropics.

Procedure

Before beginning a series of ECT treatments, a patient should receive a thorough psychiatric assessment, including a medical examination and sometimes a basic blood test and an electrocardiogram to check heart health.

ECT basically involves inducing minute seizures by artificially giving the patient very small doses of electrical current and in turn activating target areas of the brain. Depending on the patient, the seizure will last anywhere between 20 and 40 seconds. There is a belief that this electrical charge hits a “reset” button in the brain, subsequently causing a relief of chemicals that allow neurons to form new connections. Patients are usually given muscle relaxants and are under anaesthesia so they don’t feel anything during the procedure.

The procedure has become more refined over the years with a better understanding of how smaller and smaller doses of current can have equal therapeutic effects. The amount of energy delivered is far less than it used to be at many centres.

Side effects

• Memory impairment: The memory side effects of ECT have reduced over the last two decades as the technique has been improved.

• Nausea

• Vomiting: May be prevented by giving antiemetics prior to procedure.

• Headache: Often responds to analgesics.

• Muscle ache or soreness

Barriers to treatment with ECT

• Lack of awareness among health care staff and patients.

• A lack of caregiver support or transportation after procedure.

• Cost

• Lack of availability locally and need to travel to centres abroad.

Contraindications

There are no absolute contraindications to ECT. however, increased need for close monitoring is necessary in cases of :

• Recent heart attack;

• Brain tumours;

• History of epilepsy;

• Patients with uncontrolled hypertension.

How often?

An acute course of ECT usually consists of six to 12 treatments (no more than 20) administered two to three times per week. Although this may not seem very feasible or cost-effective to many people, the cost must be weighed against debilitating illness and the cost of long-stay inpatient hospital, treatments and lifelong medication.

Both clinicians and the general public may differ in their opinions about the safety and efficacy of this treatment modality. However, we should all be able to come to a mutual agreement that patients have a right to know about treatments available for the management of their mental condition, even if the particular modality is not available locally.

Dr Ashish Sarangi MBBS is a resident in psychiatry at the University Hospital of the West Indies. He may be contacted via email at

aks_sarangi@hotmail.com

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