ECT Therapy

In this episode, Wendy looks into Electroconvulsive therapy (ECT) to see if it deserves its reputation.


** Be sure to find Wendy's surprisingly real novel, Involuntary Hold , on Amazon and Audible! **


International Helpline Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

       findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

Bipolar for Life

Ep 4/S2-ECT Therapy

Good evening and welcome to “Bipolar for Life.” I’m your host, Wendy Foard, and I’ve managed to live with bipolar disorder for 44 years now. It hasn’t always been pretty, but I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous trip to rehab. Yet, I’m still here!

 Let me say up front that I am NOT a medical doctor. I am simply a seasoned manic-depressive trying to help others survive this deadly mental illness through shared information and experiences.  

As we discuss issues, please remember that I am speaking from my own experience; your bipolar experiences may be entirely different. Yet, I suspect highly that we have more in common than not. 

 Tonight, I thought we’d talk about Electroconvulsive Therapy or ECT. I think we all have an exaggerated idea of this therapy from the portrayals in movies and TV. So, I thought I’d look into the reality of this procedure and see if it deserves its reputation. 

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

·     Depression-especially in people who are over the age of 60 

·     Schizophrenia-including other schizophrenia-spectrum conditions and psychotic disorders,

 ·     And Bipolar Disorder-and other conditions that involve mania.

ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, yet, 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.

 If you have ECT treatment, it will take place under general anesthesia. This means you will be asleep while it happens. As well as an anesthetic, you will be given a muscle relaxant, which reduces how much your body moves during a seizure. These measures make ECT safer today.

 Electroconvulsive therapy is most commonly used for severe depression that hasn’t responded to other treatments. It is also used to treat catatonia, an uncommon condition in which a patient stops eating, talking, or moving. Occasionally, it is used to treat people in the manic phase of bipolar disorder or when people have mixed symptoms of both mania and depression.

ECT is not advised for the treatment of anxiety disorders or most other psychiatric conditions. 

 However, ECT can provide rapid significant improvements in severe symptoms in conditions such as:

·     Severe depression, particularly when accompanied by a detachment from reality (psychosis), a desire to commit suicide, or a 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. 

·     Catatonia, characterized by lack of movement, lack of speech, and other symptoms. It’s associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia can be caused by medical illness. 

 ·     Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.

 Although it is effective and safe, ECT is not a common procedure, for several reasons. 

1)          ECT is rarely a first-line treatment for depression,

 2)          There are newer medications that can treat the condition, and 

3)          Fewer hospitals offer ECT, which affects the number of people receiving inpatient and outpatient care.

 ECT may be a good treatment option when medications aren’t tolerated, or other forms of therapy haven’t worked. In some cases, it’s used during pregnancy, when medications can’t be taken because they might harm the developing fetus. Or in older adults, who can’t tolerate drug side-effects.

 Before you start ECT, your healthcare provider will explain to you (or someone who is making healthcare decisions for you) what it is and how it works. They’ll also make sure that you don’t have any underlying health conditions or reasons that might keep you from receiving ECT. 

 Several tests are possible leading up to ECT, including but not limited to:

1)          Blood and urine tests: some examples include a complete blood count, a metabolic panel, thyroid function, kidney function and more.

 2)          Imaging tests: On your skull, brain, and spine, including X-rays or CT scans.

 3)           Electrocardiogram (ECG or EKG): This test looks at your heart function and can spot any unusual changes or problems with your heart’s electrical system. 

 There are some conditions and reasons why you shouldn’t receive ECT. Known as “Contraindications” these are considered on a case-by-case basis. Even if you have a contraindication, providers can often adjust the treatment procedure to take these into account so you can still receive ECT. 

Contraindications include:

·     A recent heart attack or other unstable heart condition,

·     Conditions that increase the pressure inside your skull such as Intercranial Hypertension, (or Pseudotumor Cerebri) and brain tumors,

·     A recent stroke, aneurysm, or other cause of bleeding in your brain, or

·     Severe lung disease like COPD or chronic obstructive pulmonary disease.

 Because ECT is done under general anesthesia, your healthcare provider will have you fast before this procedure. That means stopping food 8 hours before the procedure and stopping liquids 2 hours before. But most offices will ask you to stop eating or drinking after midnight with only a sip of water to take any medications in the morning.  

 A healthcare provider may tell you to remove jewelry, medical devices, accessories, or prosthetics before having ECT. Common examples include taking off or removing glasses, contact lenses, hearing aids, dentures, or dental plates, etc. This helps avoid any risks of injury or choking because of these items. 

 Certain medications can affect how ECT affects you, including how effective the treatment is. Your healthcare provider may ask you to stop certain medications or reduce your dosage. However, you should only stop or change medications as directed by your doctor.

The ECT procedure takes about 5 to 10 minutes, with added time for preparation and recovery. ECT can be done while you’re in a hospital or as an outpatient procedure. 

To get ready for the ECT procedure:

1)          You’ll have general anesthesia- So you can expect dietary restrictions before the procedure. Typically, this means no food or drink after midnight. Your healthcare team will give you specific instructions before your procedure.

 2)          You may have a brief physical exam- This is basically to check your heart and lungs.

 3)          You’ll have an intravenous (or I.V.) line inserted- Your nurse or other team member inserts an I.V. tube into your arm or hand, through which medications or fluids can be given.

 4)          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 the electric currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electric current.

 As part of the procedure, you’ll receive these medications through your I.V.:

·     An anesthetic to make you unconscious and unaware of the procedure, and 

·      A muscle relaxant to help minimize the seizure and prevent injury.

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

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 the seizure activity by watching the movement in that foot. 

·     There are monitors to 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.

  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 sign that you’re having a seizure may be the 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 (or an EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of the 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.  

 There are 3 different ways that providers can place the electrodes on your head:

1)          Right unilateral: This placement has both electrodes on the right side of your head. One electrode will be near your temple and the end of your eyebrow. The other electrode will be near the top of your head, directly above your right ear.

 2)          Bifrontal: Electrodes placed using this configuration are on opposite sides of your forehead, just above the end of your eyebrow.

3)          Bitemporal: This placement involves one electrode aligned with the temple area on each side of your head.

A healthcare provider will coat the electrodes in a conductive gel that should prevent irritation and burns to your skin. While the electrical current involved is very low, skin irritation and burns are still possible. 

 Seizures from ECT typically last between 30 and 90 seconds. In cases where they last longer, healthcare providers can stop the seizure using injectable medications. 

 Most people are fully conscious within 10 to 15 minutes after this procedure and can be on their feet and walk around within 30 minutes.  

In the United States, ECT treatments are generally given 2 to 3 times weekly for 3 to 4 weeks—for a total of 12 treatments. The number and types 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 ECT. However, some people may be advised not to return to work, make important decisions, or drive until one or 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. 

 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, and 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 ECT treatment, some people experience nausea, headache, jaw pain, or muscle ache. These can generally 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. 

  Many people begin to notice an improvement in their symptoms after about 6 treatments of ECT. Full improvement may take longer, though ECT may not work for everyone. Response to antidepressant medications, in comparison, can take several weeks or more before improvement is seen. 

 Each ECT procedure requires multiple providers with advanced training to be present. That means that this treatment is often not available in smaller healthcare facilities and communities.

 There are several other forms of brain stimulation therapy and they include:

·     Transcranial Magnetic Stimulation (TMS) is used to treat depression that has not responded to other therapies, but is often not as effective as ECT for very severe illness. It involves the use of rapidly alternating magnetic fields to stimulate specific areas of the brain. Unlike ECT, TMS does not cause a seizure, and the patient remains awake. TMS typically only has mild side-effects including headaches, muscle twitches, and pain at the stimulation site. TMS is usually administered 4 or 5 times a week, for 4 to 6 weeks.

 ·     Vagus Nerve Stimulation (VNS) was developed as a treatment for seizure disorders but can also be used to treat depression that has not responded to other therapies. VNS involves implanting an electrical pulse generator under the skin in the patient’s chest, that provides intermittent electrical stimulation to the vagus nerve in the neck. Response to VNS may take months to develop; for this reason it is not considered a treatment for acute severe depression.

 ·     Deep Brain Stimulation (DBS) is used to treat symptoms of movement disorders, such as tremors associated with Parkinson’s disease and conditions like dystonia (or involuntary muscle contractions) and treatment-resistant epilepsy. DBS is also used to treat severe obsessive-compulsive disorder (OCD) that hasn’t responded to traditional treatments. Although DBS is used less frequently for OCD, studies indicate that it can be effective for debilitating symptoms. 

 More recently, DBS is being studied as a potential treatment for Tourette’s syndrome, as well as for psychiatric conditions such as treatment-resistant depression associated with major depression and bipolar disorder. More information is needed on its effectiveness for these conditions, though studies involving severe and highly treatment-resistant depression have been encouraging. 

 The risks involved with ECT must be balanced with the consequences of ineffectively treated severe psychiatric disorders. For some patients, the risks of ECT may be less than those of ongoing treatment with medications. ECT can work more quickly than meds. It can be especially useful if a patient is suicidal, is not responding to medications, or cannot tolerate the medication side-effects.

 One of the most interesting things I found about ECT was the amount of electrical current used. ECT involves a very small electrical current, up to about .8 or .9 amps. For comparison, a 9-volt alkaline battery can deliver about .6 amps of current for one hour before the battery is empty.  So, it’s a little more than a 9-volt battery.

I also found that ECT has a very long history dating back to its inception in 1934. But we don’t have time to go into all that tonight. In fact, we’ve run out of time! 

 If you, or a loved one, find yourselves in a dark and dangerous place emotionally, please, don’t hesitate to reach for help. It’s as close as your phone. Just dial 9-8-8 and speak to someone at the Suicide and Crisis Lifeline. Or, if you have laryngitis and can’t speak to anyone, you can text H-O-M-E to 741741 to chat via text. If you live outside the United States, every country has a Suicide Prevention Line. Reach out for help! Your friends and family will thank you for being so brave—Call Now!

 As always, be safe in all your travels, and I’ll talk with you next time on “Bipolar for Life.” Good night.