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Electroconvulsive Therapy (ECT)

Electroconvulsive therapy or ECT has been used to treat depression for decades. Unfortunately, in some cases the treatment was misused and ECT acquired a reputation for harming patients as much as it helped them. Today, however, the American Psychiatric Association has developed strict guidelines for using this procedure and most states require that patients grant their written consent before ECT can be used. An explanation of the procedure including all the risks involved must be given to the patient and their family before they sign the consent form. Generally, ECT is used only after psychotherapy and medication have proven to be ineffective. Since it works far quicker than medication or therapy, it is also used when there's an immediate risk of suicide if the depressed state is not relieved.

ECT is usually performed as an inpatient procedure although repeat treatments may be given on an outpatient basis.The patient must fast for 8 to 12 hours before treatment and is anesthetized with an injection of barbiturate or other anesthetic. In addition, the muscles are temporarily paralyzed with succinylcholine to prevent any violent movement which could cause the patient's bones to break and vital signs are carefully monitored throughout the procedure.

The actual treatment is accomplished very quickly. Electrodes are attached to the patient's temples and a current is passed through the brain for 30 seconds to a minute. This causes a form of grand mal seizure which results in a change in the brain waves. These changes are evident on an electroencephalogram (EEG) and they level off when the seizure is over.

Afterwards, the patient may experience headache, nausea, muscle stiffness, and sometimes a loss of memory for days or weeks after the treatment. These memories may or may not return but the sense of depression is generally significantly improved.

Merln Hurd PhD; BCN, QEEGT

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