Anyone have any words of wisdom re: ECT?

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Specializes in adult ICU.

Someone close to me is diagnosed with bipolar disorder (longstanding - x20 years) and it is to the point where it is debilitating. He is considering ECT.

Now, I'm licensed and practicing, but I don't work in psych. I know the nuts and bolts of how ECT works and I know it can cause memory loss. I also don't really know anything about the procedure itself -- I know it's not long, and in my facility it is attended by anesthesia. Is it ever done in an outpatient setting (meaning, in a clinic) or is it typically always done in a hospital? Do they strap the patient down? Are they incontinent? Is it like it is on TV (I doubt it...)

Can any of you that work with patients that have had ECT, have had ECT yourself, or assist with the procedure comment? I'm looking for personal opinions and experiences. Thank you in advance.

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Specializes in NICU, Pediatrics.

I watched an ECT during my clinical rotation in psych. It was really fast and slick. The patient was out, bagged for a bit, the only evidence you could see of the seizure was his toes twitching. He woke up shortly afterwards.

On another note, my mom had ECT done for depression for several years. First as an inpatient. Then she had maintenance treatments done every few weeks in an outpatient setting. Her short term memory was definitely affected, but that's a small price to pay for feeling better. It really helped her for a while, but the effects wore off. I have heard great success stories about it though.

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Specializes in NICU, Pediatrics.

Oh and to answer your other questions, no the patient I saw wasn't incontinent from the procedure. I don't recall him being strapped down. I don't think that would be necessary since they are paralyzed.

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Specializes in Medsurg/ICU, Mental Health, Home Health.

I used to work in a hospital that did ECTs three times per week.

The patients had IVs started, bite blocks placed and were put under with gas.

The induced seizure itself wasn't anything exciting - blink and you miss it. Then the patient was brought out of anesthesia. Hung out in PACU (where the procedure was performed) until fully conscious, then monitored in Same Day Surgery for about half an hour.

I never saw anything crazy happen. There was associated short term memory loss but usually only with the first few treatments.

I worked in this area from 2005-2007, so this was fairly recent.

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From a research standpoint, I remember reading good things about ECT some years ago. Yes there are side effects (I believe mostly on short-term memory) but it did seem to be an effective therapy for patients who had not responded to medication. I don't have personal experience with the procedure so unfortunately can't offer any perspective on that. Speaking as a (recovering) neuroscientist, I would say that repeated doses of general anesthesia would worry me more than the ECT itself.

Another option is TMS, which I have seen performed - it is very noninvasive. I'm not sure how often TMS is used outside of the experimental setting yet, but it is a good method and worth looking into. Wouldn't be surprised if it had similar efficacy to ECT without the risks of anesthesia.

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Specializes in NICU/Subacute/MDS.
Transcranial magnetic stimulation = TMS
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Thanks for clarifying!

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Specializes in ER.

Nothing is more effective or quicker than ECT at bringing about remission from a major depressive episode. ECT maintenance treatment is sometimes required to maintain remission. TMS does not have a a good track record for bringing about remission of a major depressive episode (http://www.bcbs.com/blueresources/tec/vols/24/transcranial-magnetic.html). Perhaps your friend needs a new psychiatrist if he is not getting better with his current treatment.

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Specializes in adult ICU.

He has a psychiatrist who has trialed many different medications, but he doesn't do ECT. He is referring him to a colleague at an academic medical center that does.

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TMS does not have a a good track record for bringing about remission of a major depressive episode (http://www.bcbs.com/blueresources/tec/vols/24/transcranial-magnetic.html).

Good to know. It was just the first thing that came to mind when brainstorming alternatives.

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