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Electroconvulsive therapy memory loss


Electroconvulsive therapy (ECT) - Mayo Clinic

Overview

Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone.

Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.

ECT is much safer today. Although ECT may still cause some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks.

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Why it's done

Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of several mental health conditions. ECT is used to treat:

  • Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
  • Treatment-resistant depression, a severe depression that doesn't improve with medications or other treatments.
  • Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision-making, impulsive or risky behavior, substance abuse, and psychosis.
  • Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It's associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
  • Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.

ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. In some cases ECT is used:

  • During pregnancy, when medications can't be taken because they might harm the developing fetus
  • In older adults who can't tolerate drug side effects
  • In people who prefer ECT treatments over taking medications
  • When ECT has been successful in the past

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Risks

Although ECT is generally safe, risks and side effects may include:

  • Confusion. Immediately after treatment, you may experience confusion, which can last from a few minutes to several hours. You may not know where you are or why you're there. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
  • Memory loss. Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. This condition is called retrograde amnesia. You may also have trouble recalling events that occurred during the weeks of your treatment. For most people, these memory problems usually improve within a couple of months after treatment ends.
  • Physical side effects. On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle ache. These generally can be treated with medications.
  • Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.

How you prepare

Before having your first ECT treatment, you'll need a full evaluation, which usually includes:

  • Medical history
  • Complete physical exam
  • Psychiatric assessment
  • Basic blood tests
  • Electrocardiogram (ECG) to check your heart health
  • Discussion of the risks of anesthesia

These exams help make sure that ECT is safe for you.

What you can expect

The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you're hospitalized or as an outpatient procedure.

Before the procedure

To get ready for the ECT procedure:

  • You'll have general anesthesia. So you can expect dietary restrictions before the procedure. Typically, this means no food or water after midnight and only a sip of water to take any morning medications. Your health care team will give you specific instructions before your procedure.
  • You may have a brief physical exam.This is basically to check your heart and lungs.
  • You'll have an intravenous (IV) line inserted. Your nurse or other team member inserts an IV tube into your arm or hand through which medications or fluids can be given.
  • You'll have electrode pads placed on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electric currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electric currents.

Anesthesia and medications

At the start of the procedure, you'll receive these medications through your IV:

  • An anesthetic to make you unconscious and unaware of the procedure
  • A muscle relaxant to help minimize the seizure and prevent injury

You may receive other medications, depending on any health conditions you have or your previous reactions to ECT.

Equipment

During the procedure:

  • A blood pressure cuff placed around one ankle stops the muscle relaxant medication from entering your foot and affecting the muscles there. When the procedure begins, your doctor can monitor seizure activity by watching for movement in that foot.
  • Monitors check your brain, heart, blood pressure and oxygen use.
  • You may be given oxygen through an oxygen mask.
  • You may also be given a mouth guard to help protect your teeth and tongue from injury.

Inducing a brief seizure

When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electric current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.

  • Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you're having a seizure may be a rhythmic movement of your foot if there's a blood pressure cuff around your ankle.
  • Internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.

A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you're monitored for any potential problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.

Series of treatments

In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments. Some doctors use a newer technique called right unilateral ultrabrief pulse electroconvulsive therapy that's done daily on weekdays.

The number and type of treatments you'll need depend on the severity of your symptoms and how rapidly they improve.

You can generally return to normal activities a few hours after the procedure. However, some people may be advised not to return to work, make important decisions, or drive until one to two weeks after the last ECT in a series, or for at least 24 hours after a single treatment during maintenance therapy. Resuming activities depends on when memory loss and confusion are resolved.

Results

Many people begin to notice an improvement in their symptoms after about six treatments with electroconvulsive therapy. Full improvement may take longer, though ECT may not work for everyone. Response to antidepressant medications, in comparison, can take several weeks or more.

No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That's why ECT is most effective in people who receive a full course of multiple treatments.

Even after your symptoms improve, you'll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).

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Myth Busting: Spreading the Truth About ECT

Electroconvulsive therapy (ECT) has been around since the late 1930s, and it has been clear from the beginning that it is an effective treatment for patients with certain types of mental illness, including severe depression, severe mania, and catatonia.

Despite this potential to provide dramatic relief for patients, stigma surrounding the procedure—partially fostered by misleading portrayals of ECT in Hollywood productions as well as discouragement from other sources—has influenced many who might benefit greatly from ECT to shy away from getting the treatment.

Once known as “electroshock therapy,” ECT has frequently been represented as barbaric and violent, a process that produces memory loss or leads to mind control. Many people remember the dramatic depiction of the therapy in the 1975 movie “One Flew Over the Cuckoo’s Nest.”

However, with the help of advocacy from prominent figures who have had profoundly positive experiences with ECT, such as Kitty Dukakis and Carrie Fisher, more and more people are choosing ECT.

As a practitioner and advocate of ECT, McLean’s Stephen J. Seiner, MD, believes that it is important to spread the truth about ECT—including both its benefits and its risks. Below, Seiner addresses some of the most common questions he is asked about ECT.

Seiner is director of the Psychiatric Neurotherapeutics Program and the Electroconvulsive Therapy (ECT) Service at McLean Hospital.

Is ECT Painful?

ECT is done under general anesthesia—meaning that the patient is asleep—so the patient doesn’t feel any pain during the procedure and is also unaware while the procedure is taking place. Generally, the only potential discomforts for patients occur when they get a little pinprick before the procedure to insert the IV for the anesthesia, and after the first one or two treatments, when some patients experience mild headaches.

According to Seiner, many years ago, before ECT physicians started using general anesthesia and muscle relaxants, there was a risk of injuring bones, joints, or teeth because of the convulsions associated with the seizure induced by ECT. Now, however, by using anesthesia and a muscle relaxant, patients remain still throughout the procedure and significant complications are rare.

Does ECT Cause Seizures?

ECT does induce a seizure. This is intentional, as it is believed that this seizure helps to reset the brain and bring a patient back to their baseline—the person they used to be before they became sick. “However, it is important to note that this induced seizure doesn’t cause a seizure disorder (i.e., future seizures),” states Seiner.

In fact, there is evidence that this induced seizure can even be used to stop a prolonged seizure. It’s as though the induced seizure is acting as a vaccine, causing the brain to fix itself.

Does ECT Damage the Brain?

Numerous imaging studies over the years have consistently demonstrated that ECT doesn’t cause any structural damage to the brain. There is evidence that ECT causes growth in the hippocampus, and some people have postulated that this neurogenesis (new nerve growth) is an instrumental part of how ECT helps patients. It’s noteworthy that many antidepressant medications also cause some neurogenesis.

Does ECT Cause Memory Loss?

It can. There are two main types of memory loss that are seen in ECT patients. One is anterograde memory, which is the ability to remember new things. However, that is a very short-lived side effect of ECT. In fact, when people are tested two months or so after they have had ECT treatment, they typically test better on anterograde memory and cognitive function assessments than they did prior to having ECT treatment.

The clinicians and staff at McLean’s ECT Service are dedicated to delivering compassionate care to patients

This doesn’t mean that ECT is making people smarter. It means that ECT is helping make people less depressed. When people are depressed, it has a profound effect on cognition and memory, and ECT can dramatically reduce symptoms of depression, including negative impacts on memory and cognition.

The impact on retrograde memory—the ability to remember things that have already occurred—is a little less clear, with part of the issue being that retrograde memory is very difficult to test. The greatest risk appears to be for events that happened within a few months before ECT treatment.

For instance, you wouldn’t forget who your daughter is, but you might forget the details of a play you attended three months ago. Sometimes, however, these details come back with prompting or with time. Rarely, some patients describe much more significant retrograde memory loss, but with advances in ECT, this is much less common and usually only occurs in cases of severe illness and long or repeated courses of ECT.

The type and amount of ECT appear to be factors in memory loss, “so we try to be as conservative as possible when treating patients,” says Seiner.

“Newer ECT techniques have made it easier to protect memory. We discuss these factors and other risks and benefits with our patients before determining how to proceed, and we monitor memory throughout the course of treatment. ”

Does ECT Cure Depression?

There is no known cure for depression, psychosis, or any other illnesses that ECT treats. The goal of ECT is to bring patients back to their baseline. Once a patient is back to their baseline, the goal then is to keep them there, to keep them from relapsing.

This can often involve an ECT taper (gradually decreasing the frequency of ECT treatment and sometimes moving to a maintenance schedule), medications, and talk therapy support, although everyone is different.

Is ECT Ever Administered Involuntarily?

ECT is administered involuntarily rarely and only when there is a court order.

“It’s important to note that of all the patients who are treated with ECT involuntarily, my experience has been that the majority are very grateful afterward,” shared Seiner.

Is ECT a Last-Resort Treatment?

“I don’t think of ECT as a last resort anymore—the risk-benefit has shifted,” says Seiner. “It’s so much more comfortable, so much safer now. It does have some side effects, but it is a safe procedure.”

“ECT is a very powerful tool in the toolbox. Save it for when it’s needed, and for some patients, especially those who have become very ill very quickly and are suicidal, that tool should be used much sooner.”

Read more about how ECT is becoming a preferred depression treatment

Does ECT Work?

There is no question that ECT works. More than 70 years of data backs up this claim. No other treatment has ever been shown to be more effective in the acute treatment of depression than ECT.

“One of the beautiful things about ECT is that the more someone needs it to work, the more likely it is to work,” Seiner says.

“The further someone is from their baseline—the way they used to be—the more they can count on ECT working for them.”

With psychotic depression, a debilitating condition, response rates are around 85 to 90%. Catatonia, which is potentially life-threatening, has a similar success rate, 80 to 90%.

It’s quite remarkable. ECT helps bring people back to their true self.

Changing How We Talk About ECT

Unfortunately, because of the way it has been portrayed in books, films, and other media, many people have a mistaken impression of ECT.

What people rarely hear are the many stories of success and recovery for those who undergo ECT treatment. At McLean, we know that ECT is one of the most effective treatments we have for treatment-resistant mental illness like severe depression.

Paula Bolton, MS, CNP, ANP-BC, reports that after having ECT, many patients share responses like, “I feel like myself again” or “I’m getting my life back.”

Bolton is the program director of McLean’s Psychiatric Neurotherapeutics Program.

“Despite its effectiveness, there are still a lot of misconceptions about ECT,” says Bolton. “Perhaps that’s understandable because of the way electroshock therapy was performed in its early days, without the use of anesthesia or muscle relaxants. From a psychiatric point of view, patients got better, but the procedure often resulted in undesirable physical side effects.”

Today, ECT is administered in a far more controlled and safe manner than it was in years past. Surrounded by a skilled clinical team, the patient is given a short-acting anesthetic that puts them to sleep. They also receive a muscle relaxant that paralyzes their muscles for a short period to prevent movement during the treatment.

Heart rhythm, oxygen saturation, and blood pressure are closely monitored. Electrical stimulation is delivered to produce a seizure, but the seizure happens in the brain only, not the body.

“With ECT, we follow principles similar to when someone is put on a medication. We start low and go slow, using the minimum amount of electricity we can,” Bolton shared. “Everything possible is done to minimize the risk of memory loss or cognitive issues. The ECT team works with the patient and family to give enough treatment to be effective without causing unwanted side effects. ”

ECT success stories are being experienced every day at clinics like McLean’s ECT Service. While they might not be as dramatic as those old horror stories, these stories have happy endings. And this is how we should be talking about ECT.

McLean’s ECT Service performs over 7,000 treatments a year, making it one of the largest ECT centers in the country. Learn more about receiving ECT treatment at McLean Hospital

Topics

  • ECT
  • Depression
  • Stephen Seiner

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Rebooting the brain: how electroconvulsive therapy saves from suicide

Electroconvulsive therapy reduces the risk of suicide in patients with depression by 50%, Canadian psychiatrists found. How widespread ECT is in Russia, in what cases it is used, and whether such a “reboot” is dangerous for the brain, experts told Gazeta.Ru.

Electroconvulsive therapy reduces the risk of suicide among patients with depression by 50%, experts from the Center for Addictions and Mental Health in Canada found. They told more about this in an article in the magazine The Lancet Psychiatry .

Electroconvulsive therapy (ECT) is a method of treating psychiatric and neurological diseases that became widespread after the 1930s, in which a seizure is caused by passing an electric current through the patient's brain. Today, ECT is used, as a rule, in cases where other methods have not given a positive effect.

“Physicians and patients express great uncertainty about whether to undergo ECT treatment,” the authors explain. “Part of this is due to misconceptions about what ECT is and when it should be used. Some of them are related to the ongoing uncertainty about the potential benefits and risks. ” nine0003

Researchers collected data on 67,000 patients treated for depression in a hospital. Of these, 9% underwent electroconvulsive therapy. The rest were not offered this option, or they themselves refused out of fear of the procedure.

Within a year of hospitalization, the rate of suicide among patients treated with ECT was 50% lower than among those treated with other methods. They also had a 25% lower all-cause mortality within a year after discharge.

“Depression is a major psychiatric disorder that contributes to suicide, and ECT is an effective treatment for depression. nine0003

Since it helps to reduce depressive symptoms, then the risk of suicide is reduced, this is logical, ”

- Viktor Guldan, doctor of medical psychology, head of the laboratory at the Center for Forensic Psychiatric Examinations at the Central Moscow Regional Psychiatric Hospital, told Gazeta.Ru.

ECT is usually given when antidepressants, psychotherapy, or other treatments have failed, notes Guldan. The point, however, is not so much in the possible side effects of the procedure, but in its negative reputation, formed by films and books, as well as the complexity of the technical implementation. nine0003

“ECT sounds frightening, looks frightening, but in itself it is not crippling, not painful,” Pavel Beschastnov, a psychiatrist and psychotherapist, explained to Gazeta.Ru. — The procedure is performed under sedation, under anesthesia. But it requires special equipment, requires a highly qualified specialist. It was not used right or left before, but now there are few devices left for it. ECT has been, and remains, the last choice in the treatment of depression. In particular, it happens that when no drug therapy helps, only ECT remains.” nine0003

The most common side effect of ECT is the risk of memory loss. However, Beschastnov notes, long-term memory loss is extremely rare. At the same time, the patient can really forget about the events that took place shortly before or after the procedure. However, ECT is usually prescribed in cases where there are no alternatives left, and the benefits of the procedure outweigh the possible negative effects.

“We are talking about extremely serious conditions, when there is no other choice, and when possible side effects are a risk that you can take,” says Beschastnov. nine0003

Guldan concedes that, if indicated, it would be possible to give the patient ECT even before drug therapy - but in practice this approach is rare, and doctors prefer to start treatment of depression with antidepressants.

“As long as the patient is not yet healed with various drugs, the old methods of antiquity are very good. Because any treatment with psychotropic drugs leads to a change in emotionality, this can affect motivation, and ECT in this regard is just the least of the side symptoms, ”he believes. nine0003

Although ECT has been around for almost a century, its mechanism of action on the brain is still not fully understood.

“ECT somehow reboots the brain, its chemical activity – and there is hope that it will work in a healthier format. There are many theories of what exactly is happening, but science has not come to a consensus,” explains Beschastnov.

ECT significantly reduces the risk of death by suicide and is medically safe, the study authors conclude. They stress the need to ensure access to ECT for all patients hospitalized with major depression. nine0003

How much evidence does ECT cause harm? An hour and twenty-two minutes.

WATCH DOCUMENTARY

Therapy or harm?
The truth about electric shock

The $5.4 billion ECT industry, its history, its practitioners, and its shocking results are exposed and revealed in this breathtaking film. nine0003

DISCOVER THE TRUTH

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YOUR OPINION

Every person's voice matters and creates change

There are many ways to join the fight to end ECT abuse. Here's what you can do: use social media, organize marches, collect petition signatures, and write letters to your local legislature. nine0003

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REPORT ABUSE

Protect yourself from psychiatric abuse

If you become aware of any adverse effects of ECT, report it to the appropriate regulatory authority. You may also submit a confidential report to CCHR.

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“Here’s a fact about ECT: It damages the brain. And period... ECT should have been banned 50 years ago.” nine0003

Dr. Norman Shealy, neurosurgeon

WHAT IS ECT?

Electroconvulsive therapy, or ECT, is a procedure used in psychiatry. A stream of electricity with a voltage of up to 460 volts is passed through the brain. What for? To induce a grand mal seizure, which some mental health professionals claim will "restart" or "reboot" the brain.

This theory has not yet been confirmed. In fact, there is strong evidence that ECT causes significant and irreversible brain damage. nine0003

The human brain is an extremely complex organ. It controls the body by sending out over five trillion signals per second. He manages to do this due to the current almost eight times less power than in a watch battery. Whereas in one session of ECT, 2,300 times more electricity is passed through the brain than is required for the brain to work. And this leads to serious injury.

THE TRUTH ABOUT ELECTRIC SHOCK

CONTENT: nine0084

  • What is ECT?
  • It was a lesson on the theory of est. Now the history lesson.
  • Birth of est. Death of animals.
  • And much more...

FREE DOWNLOAD

HOW MANY ELEVATORS CAN BE POWERED BY THE ELECTRICITY REQUIRED FOR ONE ECT SESSION? WATCH THE DOCUMENTARY. nine0003

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SOME FACTS ABOUT ECT *

  • The death rate from electroconvulsive therapy is 50 times higher than the homicide rate in the US (as a percentage).
  • After ECT for pregnant women, the infant mortality rate was 7.1%.
  • ECT sends 460 volts of electricity through the brain to induce a grand mal seizure.
  • With an estimated 100,000 Americans receiving ECT a year and a total cost of electricity of $260, psychiatry has created a $5.4 billion electroshock empire. nine0088
  • The human brain runs on 0.2 volts, which is almost 8 times less than a watch battery (1.5 volts), compare this to 460 volts of electricity passed through the brain during a shock therapy session. This is 2300 times more than what the brain uses to function.