Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a medical procedure that is used to treat a range of mental illnesses such as severe depression, catatonia and some forms of mania and schizophrenia. The treatment induces controlled seizures in the patient via small electrodes placed at specific locations on the head. ECT has been used for over half a century in many different countries, and its effectiveness is well documented. Approximately eight out of 10 patients who undergo ECT will experience dramatic improvement.

The reason why this treatment is so effective is still mysterious. The brain functions using electrochemical messages, and it is thought that ECT-induced seizures interrupt these messages and ‘reset’ the brain. ECT is generally used when other forms of treatment, including medication and psychotherapy, have failed. However, ECT is often the first treatment of choice in life threatening situations, such as a potential suicide, because of the rapid results. Sometimes, ECT is prescribed for older patients who can’t tolerate medications.

The procedure
Usually, ECT is performed under supervision by the prescribing psychiatrist.
The patient is anaesthetised and given muscle relaxants. The electrodes are placed at strategic points on the patient’s skull. Depending on the patient, one or both sides of the head will be stimulated, known as unilateral or bilateral ECT respectively. A series of brief, low frequency electrical pulses prompt a convulsion. The patient won’t feel the convulsion because of the anaesthesia, and won’t have muscle spasm or move because of the muscle relaxants. The patient wakes up after a few minutes. ECT is typically administered three times per week for six to nine treatments, but the exact course of treatment depends on the nature of the illness and the patient's response to treatment.

Risks and complications
Research has shown that ECT doesn’t cause brain damage because the amount of electricity used is too small to harm tissue. Like any operation involving anaesthesia, ECT carries a small degree of risk. Some of the immediate side effects of ECT (these tend to resolve within a few hours) include headache, sore muscles, queasiness and confusion. During the course of the treatment, many patients experience problems with short term memory, but this side effect only lasts a few days or weeks. A few individuals, however, experience long term difficulties with memory. This effect is more common in patients who undergo bilateral, rather than unilateral, ECT.

Patient rights
If your psychiatrist suggests that a course of ECT therapy may be helpful, you have certain rights under Victorian law. These rights include:

• A full explanation of the procedure and associated benefits and risks
• A second opinion
• Legal advice
• Representation by a friend or relative
• Having a person of your choice with you during discussions with your psychiatrist or doctor
• The right to complain
• The right to refuse.