Electro-Convulsive Therapy

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Electro-Convulsive Therapy

Question:

After a recent suicide attempt, I was diagnosed with major depression. I also have dissociative episodes that last from a couple of hours to a week or more. My antidepressants are causing severe side effects (irregular heartbeat, migraines, nosebleeds, vomiting), which are increasing in frequency and severity. I was told to consider ECT. How effective is this treatment? What are the risks?

Answer:

It's good you're working hard to get the help you need. You know that there are no simple answers for treating the problems you have.

ECT, which stands for electro-convulsive therapy, is an excellent treatment for people who have major depression. It is called "electro-convulsive" because electric current is used to induce a seizure. It is the seizure (not the electricity or "shock") that seems to restore the brain's functioning in the domain of mood, while decreasing symptoms of serious mental illness.

It is hard to predict how well someone will respond to ECT if they have an added problem like dissociation. I'll leave it to you and your doctor to sort out the diagnosis issues.

About 80% to 90% of people who receive ECT for the classic form of major depression get at least some relief. Contrary to popular belief, the risks compare favorably with other antidepressant treatments. People who have received ECT are most often satisfied with the results. The overwhelming majority would have the treatment again if their depression were to return.

The discomfort of ECT is about equivalent to a minor surgical procedure. The patient is under anesthesia and receives medicine to relax the muscles. The person does not feel a seizure and the body remains relaxed.

The most common side effect is temporary memory loss. Usually, there is some memory loss for the events that occurred just before and soon after treatment. This memory loss is temporary. Some people have trouble remembering events that happened during the full course of their treatment. (Treatment can last two to three weeks.) But relatively few people have long-lasting memory problems. People who already have a memory problem may find the problem made worse by ECT.

There are no medical conditions that make ECT impossible, but because the procedure briefly makes the heart work harder — heart rate and blood pressure go up temporarily — people who have heart disease face a small increased risk.

Other side effects are short-lived. Some people feel a bit sedated or fatigued on the day of the procedure. There may also be a mild headache or nausea. Some of these symptoms may be related to the anesthesia rather than the ECT itself.

The relapse rate for depression after ECT is significant. It is common to start an antidepressant medication or mood stabilizer after successful ECT to help prevent the return of the depression. When this does not work, some people receive periodic "maintenance ECT." This can be done on an outpatient basis. Some people with severe depression have done well with this approach.

It's a good idea to educate yourself fully before agreeing to ECT. In addition to your doctor's explanations about the procedure, you may want to talk to other people who have received the treatment. Any medical procedure, even if it is minor, is anxiety-provoking. Knowledge can help you deal with your apprehensions.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

Last updated:	July 20, 2009