Electric Shock Therapy

Aerolizing · Jul 29, 2004

Where I work, ECT is done quite often especially to those patients who have complicated medical histories who may not be good candidates for the usual antidepressants or who have had no sucess with antidepressants.

The patient is NPO after midnight and for the first few treatments, stays on the inpatient ward. Our ECT procedure is done under general anesthesia and only takes a few minutes to complete. Once they get down to PACU where the procedure is done, the IV is inserted, caffeine given through IV and the patient is fitted with the rubber strap with electrodes around the head and gel to conduct the shock. A BP cuff is inflated on one upper arm to 200 and clamped to prevent meds from getting through to the hand where the seizure is observed as a clenching fist. They are given meds (we usually use brevitol and succ) to paralyze and sedate. Once the shock is applied and the seizure is measured by sight and by EEG, ( trying not to forget to deflate the BP cuff) the patient quickly regains consciousness and returns to the unit for a few hours of recoop time then normal activity can resume. Generally, patients need 12-16 treatments (three a week) and some respond very quickly, others take the whole 16 treatments to respond. Once they have had a full course of ECT, we often see them once a month for maintenace ECT. I have seen it work very well. I know people think it is barbaric but for those who don't respond to any other treatment, it is a welcome last resort.

We always have quite a crowd during our ECT. There is the psych attending, psych resident, med students, anesthesia attending, anesthesia resident, psych nurse as well the whole PACU staff if we should ever need them (so far that has not happened). The worst incident that ever happened is that a patient received a small burn on her scalp from an arcing ECT machine. All in all, pretty boring. Lots of fuss for a clenching fist. First time observers always ask, "Is that it?"

As for where to get training, any teaching hospital around should have plenty of opportunity to do ECT. Any teaching hospital with a psych residency program and an inpatient psych ward. Where I work, there are a couple attendings who supervise it and a few resident who take a liking to it and always volunteer to take ECT cases.

CliveUK · Jul 29, 2004

Any RN that has worked w/ pts or has helped w/ this type treatment please respond. I know it is now done under anethesia. But is it general or conscience sedation?? How quickly do you start to see effects? How successful is it. Is there good training in US for Doctors? Were is it taught? Thanks in advance for this info.

Over here in the UK, we have an organisation called NICE (National Institute for Clinical Excellence) who have evaluated ECT and produced useful guidance to its use and efficacy. You can download a copy of their guidance here: -

http://www.nice.org.uk/page.aspx?o=68305

susanna · Jul 30, 2004

How exactly are the outcomes? I am assuming that the patient has absolutely no memory of the shocks,

Can I also ask what disorders are usually treated with EST?

I am only half kidding when I say to other people that I need and am begging for EST (for my depression and anxiety).

hypnotic_nurse · Jul 30, 2004

Some of the recent studies have shown that ECT works particularly well for suicidal ideation.

Although I haven't watched it, several of my former patients had it -- and the outcomes were very good.

I remember one of the psychiatrists telling me that some people are more forgetful or even muddled for a few weeks afterwards; but I think he said this was more likely to happen with the elderly.

CliveUK · Jul 30, 2004

How exactly are the outcomes? I am assuming that the patient has absolutely no memory of the shocks,
Can I also ask what disorders are usually treated with EST?
I am only half kidding when I say to other people that I need and am begging for EST (for my depression and anxiety).

The outcomes stack up pretty well, actually. Here in the UK, ECT is only given for recalcitrant depression that hasn't responded to antidepressant treatment.

MHN · Jul 31, 2004

How exactly are the outcomes? I am assuming that the patient has absolutely no memory of the shocks,
Can I also ask what disorders are usually treated with EST?
I am only half kidding when I say to other people that I need and am begging for EST (for my depression and anxiety).

I've seen ECT used with several disorders sucessfully,Mania, depression,and psychotic depression

finness · Aug 9, 2004

i am soo green! why would even extreme mania elicit use for est?

MHN · Aug 9, 2004

i am soo green! why would even extreme mania elicit use for est?

sarah ,the patient i saw was not reacting to any of the usual drugs here in fact diazepam caused the complete opposite effect.

ect was the only choice left to the psychiatrist to use.

btw the patient survived and even expressed that she would have ect again if she became that unwell again

finness · Aug 12, 2004

Thanks...I wasn't aware that worked for mania, too!

MHN · Aug 12, 2004

Thanks...I wasn't aware that worked for mania, too!

Finness ,The senior psychiatrists told us the staff at the acute unit that this would probably be the one true case of Mania we would see in our careers.