ECT is amazing and it is not "evil" or "cruel" as some believe.
It is true that one of the biggest concerns is the anesthesia, especially in the geriatric population.
Another concern would be cardiac issues, in which case ECT may not be an option for such a pt.
It is a last line of treatment and if a psychiatrist feels all other options have been exhausted, that psychiatrist may ask for an ECT consult with a psychiatrist who is specially trained to do the procedure.
If the ECT psychiatrist agrees the pt could benefit from ECT, then they will order a work up which includes recent labs, EKG, any cardiology reports, diagnostic tests and a consult with the medical doctor.
The pt is educated re the procedure by the psychiatrist and the nurse.
Verbal, written and even a video are provided as part of the education.
If the pt consents, forms are signed and completed.
Prep for the procedure is that the pt with be NPO 6 hrs prior and that all benzos/anti-seizure meds are held from 12 hrs prior to the procedure.
The significance of the benzos/anti-seizure meds is that they may interfere with the ability to induce the seizure (which is the whole point).
The procedure may be unilateral or bilateral. I am not totally sure how the psychiatrist decides.
They usually do a total of 10 procedures, with the pt usually going 2-3x's a week.
After that, over the course of time, the pt will get what we call "tune ups" because the effects of the treatment do not last indefinitely.
How it actually truly works, even the docs aren't totally sure, but we can see that it usually does.
Afterward, the pt is monitored and it is not uncommon that they will be very tired, have headaches and some nausea and some STM loss.
Usually, if it doesn't work, it just doesn't work. In that case, there may come a point where deep brain stimulation may be considered.
While ECT is usually used for profound and untreatable depression, it is starting to be used for hard to treat bipolar. The jury is out on the effectiveness of this.
Sorry for the essay.
Hope some of this is useful.
I think it's fascinating.