ELECTROCONVULSIVE THERAPY

ELECTROCONVULSIVE THERAPY
Reality often fails to jibe with movies and books. While psychotherapy and antidepressants have garnered some positive fictional portrayals, electroconvolsive therapy (ECT) typically evokes frightening pictures. More than 30 years after One Flew Over the Cuckoo-s Nest won its Academy Awards, the images from the film linger in many people's minds. Yet ECT remains one of the most effective treatments for severe depression, with responsive rates from 80%-90% for people with major depression. ECT may also be used to treat mania when a person fails to respond to other treatments.
Despite its effectiveness, doctors usually reserve ECT for situations in which several drugs have failed. That's partly because of its technical complexity, and partly because of its negative image.
How ECT works
The discomfort of ECT is roughly equivalent to that of a major surgical procedure. The purpose of ECT is to induce a seizure, which acts as the therapeutic agent. Before receiving treatment, a person is given general anesthesia. Then the doctor places elecatrodes on the patient's scalp and administers an electric current in a brief pulse that causes a seizure. Medicine is given to prevent the muscular effects of the seizure, so there are no obvious convulusions. The seizure is evident only because it registers on an electroencephalographic monitor. The procedure takes a few minutes, after which the person is roused from the anesthesia.
On average, 6-12 treatments are given over several weeks. Contrary to what some people might expect, when there is a good response, the improvement occurs gradually over the course of treatment, rather than all at once. Generally, the response occurs faster than with medications, making ECT a good treatment a good treatment for severely depressed people who may be at very high risk for suicide.
In the best-case scenariio, a prospective patient is well-educated about ECT. Usually, doctors and nurses explain the treatment in detail, and often patients watch videotapes of the procedure. Sometimes other people who have had ECT explain what the experience is like to further demystify it. Patients decide if they want to try ECT only after they have been fully informed about how the procedure works and what its risk and benefits are. Most states have clear safeguards against involuntary ECT treatment.
ECT and memory
The most commonly described side effect of ECT is memory loss. Routinely, patients lose memories of events that occurred just before and soon after treatment. After the treatment concludes, some people will have difficulty remembering things that occurred during the course of treatment. Once all the treatments have ended, relatively few people have persistent memory problems. However, ECT may exaggerate problems in people already having memory trouble.
Other side effects are fleeting. Some people feel a bit sedated or tired on the day of the procedure, or they might have a mild headache or nausea. However, these symptoms might come from the anesthesia rather than ECT itself. To date, no study has shown that ECT causes brain damage.
One drawback to ECT is a relapse rate of about 50% in people treated for severe depression. It may be even higher with so-called double depression (the combination of depression and dysthymia). To help avoid a relapse, a person who responds to ECT might also take an antidepressant medication or mood stabilizer. If dual treatment doesn't work, some people receive maintenance ECT on an outpatient baiis about once a month. Some people with severe depression may have done very well with this approach.
Http://www.everydayhealth.com/emotional-health/depression/electroconvulsive-therapy.aspx