ECT

elkpark · Jan 23, 2013

It is safe and effective (as much so as anything else we do for people with serious mental illness, more so than a lot of the medications we give), and it helps a lot of people (in my opiinion/experience). The main risks are those associated with the anesthesia used for the procedure. Most psychiatric facilities don't offer ECT (psychiatrists have to have additional specialized training to be able to administer it), so you could go your entire career in psychiatric nursing without actually working anywhere you would encounter it.

I have personally seen it help lots of people, and I have talked to lots of other people who credited it with saving their lives when nothing else was helping their profound depression.

I'm a big fan; if I were ever in the situation where I had to decide for myself, I would happily take ECT before I'd take a lot of the meds we give people.

edie1 · Jan 23, 2013

Thanks so much elkpark :)

Orca, ADN, ASN, RN · Jan 23, 2013

I saw it work wonders on a couple of patients who had failed every conceivable intervention for their depression. The first was a female, mid 50s, attempted suicide on our unit and nearly succeeded. When she left her affect was much brighter, and she was smiling. She said that she would call and let us know how she was doing - then with a laugh - "if I remember", alluding to the period of short-term memory loss that commonly follows a course of ECT.

The second patient was a female, late 60s, minimally reponsive verbally. When we opened the curtains in her room in the morning, she would get up and close them, return to bed and pull the covers over her head. She had failed therapy with pretty much every antidepressant on the market. Although her psychiatrist was reluctant to recommend ECT, he was out of alternatives. When she left us she was actively engaging in conversation and didn't resemble the almost mute recluse who came to the unit.

ECT isn't for everyone, but it can be a viable option for those who are not responding to more traditional therapy.

edie1 · Jan 23, 2013

Hi Orca - Thank you too! What a lovely site to be able to "cut to the chase" and really find out stuff! :)

allnurses Guide · Jan 23, 2013

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.

Cheers.

Meriwhen, ASN, BSN, MSN, RN · Jan 24, 2013

ECT unfortunately still has a stigma, thanks to the barbaric practices of the past as well as folklore/legend/what-have-you that still keeps perpetuating the unsavory reputation. It is actually rather safe and effective when done properly.

Like other posters, I've see ECT accomplish a lot where the psychotropics and other interventions have failed. It's not for everyone, but for some patients, it's the best--or only--option for treatment.

edie1 · Jan 24, 2013

Hi Hygiene Queen

I love the "essay" - great information and I thank you!

edie

Whispera, MSN, RN · Jan 24, 2013

Here's a video on the history of ECTs. It also presents some of the good and bad aspects of them.

Video Project - Electroconvulsive Therapy - YouTube

edie1 · Jan 25, 2013

Yall are so wonderful to assist me! I am not sure where I am supposed to post my gratitude so it is going RIGHT HERE! Thanks everybody!

edie

poppycat, ADN, BSN · Jan 26, 2013

I can speak from a patient perspective. I have had 3 courses of ECT in the past 25 years. It saved my life because at those times, I was seriously suicidal. I had no discomfort other than a mild headache with the treamtments. (The worst part for me was the IV because I have terrible veins!)

edie1 · Jan 26, 2013

OH KarenfRN

Thank you! The opinion of someone who actually has gone through it is sooo helpful! You are a brave soul my dear and hope things are better for you now! Thank you Thank you

edie