MENTAL HEALTH

Electroconvulsive therapy - ECT

ECT - elbehandling - engelska

When is ECT used?

Severe depression

Electroconvulsive therapy, generally known as ECT, can be a form of treatment for a number of mental illnesses including severe depression, and for people having suicidal thoughts as part of an episode of clinical depression. ECT can also help in cases ofmania and in some types of psychosis and in schizophrenia.

This treatment might be an option where medication has not helped, if you have experienced a lot of adverse reactions to medications, or if you are older, since advanced age can make you more prone to adverse reactions to medications. It can also be used in cases of severe post-natal depression or breastfeeding psychosis because the therapeutic effects of ECT are often more rapid than for medications.

Get information before treatment

Before treatment, it's important that you get information about the treatment options available to you and how the treatment is carried out, what therapeutic benefits you can expect, and what the potential side effects are. You also need to know what to do if you do experience side effects and where you can go for assistance.

You have the right to information adapted to your circumstances. For example, you might not have the energy to absorb the information you get yourself. So it's a good idea to have a close relative or friend with you when getting information. You will have the opportunity to ask questions on a number of occasions, and you will get the information in written form.

It's also a good idea to talk to your doctor if you have any questions during the treatment period.

How ECT is carried out

ECT is given at a hospital

ECT is always given in a hospital setting. This is because you will be anaesthetised for a short time during the treatment. You might be a patient admitted to the hospital, but you might also just go there for the treatment and then go home again a few hours later.

Between five and twelve treatments

You may feel that your symptoms have improved after only a few treatments, but it's normal to need between five and twelve treatments before you feel better. Sometimes you might need more than this, but this is rare. ECT is usually given two to three times per week.

Some people might need ECT treatment on a regular basis. For example, you can have one or two ECT treatments per month to reduce the risk of becoming ill again, or if medication does not usually help.

Preparations

Since you will be anaesthetised for a short period, you will see an anaesthetist before your treatment. The anaesthetist will carry out a physical examination and you will be asked to provide a blood sample for testing. Among other things, the anaesthetist will want to know the concentrations of salts in your blood and in some cases he or she will also check your heart with an ECG.

Some medications can reduce the effect of ECT or may be inappropriate to take while receiving ECT. Your doctor will explain to you how to take any medications during the treatment period.

Since you will be anaesthetised during the treatment, you must not eat or drink beforehand. You will get information about how many hours before the treatment you will need to fast. If you use spectacles or have dentures, they will be removed temporarily during your treatment.

You will be anaesthetised

When you come to the treatment room, wires will be connected to your chest and forehead for ECG and EEG so that your heart and brain activity can be monitored during the treatment.

The anaesthetist will remain with you the whole time, checking on how your heart and your breathing. Another doctor or nurse administers the ECT.

Usually, the treatment starts with you breathing oxygen because your body needs a bit more oxygen during ECT. Then you are anaesthetised with a rapid-acting anaesthetic, and once you have fallen asleep, you will receive a muscle relaxant. These medications make you sleep and ensure that your muscles are relaxed. All medications are administered directly into your blood via venous catheter, a narrow plastic tube which is inserted into a blood vessel on your hand or in the crook of your arm. So that you don't damage your teeth during the convulsion, you get a bite block to bite onto. It is inserted in your mouth after you have fallen asleep.

ECT causes a brief convulsion

During the treatment, short bursts of electrical current pass through your brain for a few seconds. The electrical current is applied to your brain via a type of electrode placed on your head. This induces a controlled convulsion. The convulsion usually lasts between fifteen and sixty seconds. You wake up about five to ten minutes after the treatment once the aesthetic has worn off.

There is only a partial explanation as to why ECT often has a good effect. In depression, the balance between certain neurotransmitters and the receptors that transmit them is altered. There is research showing that ECT restores the normal balance.

After ECT

How will I feel after the treatment?

During the actual treatment, you are asleep so you don't feel anything. Because you have been anaesthetised for such a short time, most people don't feel ill after waking up. You may feel a bit confused for a while after you have woken up.

Immediately after the treatment, some people feel a bit tired and get a headache. Ordinary, non-prescription pain medication usually helps and you can also take this kind of medication preventively before the treatment. You might also experience some muscle soreness after the convulsion.

You usually need to stay in the treatment room for a short while after treatment so that your heart rate and blood pressure can be checked. If you have been admitted to the hospital, you then go back to your ward. If you have not been admitted, you usually stay at the hospital for a while before going home.

You should not drive a car because you have just been under anaesthetic and received ECT. It's a good idea to have a close relative or friend come with you to the treatment.

Side effects of the treatment

All treatments can have side effects and it's always a good idea to consult with your doctor and your close family or friends and weigh up the advantages and disadvantages of this form of treatment for you.

ECT can result in memory disturbances. Often these are temporary, and mainly concern the period of illness. Some people experience that their memory is impaired for a longer period. Since memory disturbances can also occur when a person is depressed, it can be difficult to know if these are due to the illness or the treatment.

The risk of memory disturbances can be reduced if the electrical current is only applied to one side of the brain, called unilateral stimulation. This is also the most common form of ECT. But sometimes bilateral stimulation, which means applying electrical current to both sides of the brain, might be required, for example, if you are feeling very bad or if unilateral stimulation has had no effect.

The ECT experience

The experience of having ECT varies between individuals. Many who have received ECT find that it is the treatment that has had the best and fastest effect on their severe depression, for example. If you become ill again, it might be the treatment that you want to repeat.

Others would rather not experience this form of treatment again. This might be because they don't feel that the treatment helped or that they feel that their memory deteriorated for a long time afterwards.

If you have not had ECT previously, you might think that it sounds rather unpleasant. This might be due in part to the treatment previously being called shock therapy, which is an inaccurate term because it is not about receiving any kind of shock.

Before the treatment, it is important that you get all the information you need to feel safe and confident about having it.

Quality register

To be able to monitor and improve the quality of care, a national quality register for ECT is kept. As a patient, you will be informed about the register. Your input is entirely voluntary, and you can change your mind at any time and ask to have your data removed from the register. The information in the register is confidential, and may only be used for evaluating ECT and research into ECT.

You can get more information from your attending doctor.

Reading tips

The National Board of Health and Welfare has produced a book entitled in English My guide to safe care  to promote patient participation in their own health care. You can download this book as a PDF, or some other formats on request. It is also available in an easy-to-read version in Swedish, and in ten different languages.

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