ECT, electroconvulsive therapy, is a first-line treatment for major depression with psychotic features. It is appropriate for severely depressed elderly patients who are not eating or drinking and require rapid intervention. It is also used to treat unipolar and bipolar depression, catatonia, bipolar mania, schizophrenia, and acute suicidality. If antipsychotics are insufficient in postpartum psychosis, ECT is an effective second-line therapy. ECT is usually prescribed when other treatments, such as medication and therapy, have not successfully improved symptoms.
ECT is a medical therapy in which electrodes are placed on the scalp, and an electrical current is released. This induces a briefly controlled tonic-clonic seizure. It is classically administered in a hospital setting and is usually given to the patient under general anesthesia. Muscle relaxants are also provided to prevent muscle contractions. This process helps to minimize discomfort and the risk of injury. A workup is done to monitor for side effects. ECT is a safe, effective, and painless treatment for the aforementioned mental health conditions.
A team of medical professionals administers ECT. The group includes a psychiatrist, anesthesiologist, nurses, and other medical personnel. The psychiatrist evaluates the patient’s mental health condition and determines the appropriate treatment plan, including the number and regularity of ECT sessions. The anesthesiologist administers the anesthesia and monitors the patient’s vital signs throughout the procedure. The nurse assists with preparing the patient for the procedure and provides support during and after the procedure. Other healthcare workers may also be involved in the ECT process, depending on the specific treatment plan.
As with any medical treatment, there are risks and side effects of ECT. These may include confusion, anterograde/retrograde amnesia, muscle soreness, a temporary headache, and cardiac events, such as heart attack or stroke. ECT is contraindicated in patients who have a history of cardiac problems, have certain medical conditions such as bleeding disorders or aneurysms, or have brain damage or brain abnormalities. Electroconvulsive therapy is an evidence-based treatment that carries a low risk of complications. The number of treatments and the regularity of treatments may vary depending on the patient’s condition and response to treatment. Acute treatment comprises 6-15 treatments, followed by less frequent maintenance treatments. Each session of ECT may take about 1 hour (from the time you walk in to the time you walk out).
Patients who have experienced ECT say they have experienced significant improvement in their symptoms after a course of treatment. ECT is a rapid-acting treatment, with some patients experiencing improvements in their symptoms within a few days of beginning treatment. ECT may be safer than other treatments, such as medication, which can have significant side effects. However, it is essential to continue with medication and therapy, even after ECT, to help maintain the benefits of treatment. In a patient with depression, relapse can occur quickly if antidepressant therapy is not taken during and after ECT.
ECT is safe in pregnancy and in the elderly and can be used in patients who have specific medical ailments that make other treatments less safe. For example, a patient who is bipolar and has chronic kidney disease has a contraindication to taking lithium, a medication that is the first line for bipolar. In Texas, individuals under 16 cannot be administered ECT. According to the Texas Health and Human Services, there were no deaths, fractures, apnea, or cardiac arrests within 14 days of ECT in 2019 and 2020. This further highlights the safety of ECT.
The average cost of ECT in the United States is approximately $2,500.
If a patient does around ten sessions, that’s 25,000 dollars. There will be additional costs if the procedure is done in a hospital. ECT is expensive if an individual does not have insurance. Depending on the insurance, there might be out-of-pocket costs such as a co-pay and deductibles.
During my six weeks at Tropical, I have been a part of a team of outstanding healthcare providers who genuinely care for their patients. I have had the opportunity to meet with patients in their homes and hear their life stories. I have met individuals on the highest dose of their antidepressants who are still experiencing severe episodes of depression. I have met patients with severe psychosis despite being on the most antipsychotic medication. As an inpatient treatment, patients in the Valley should have access to ECT without traveling hundreds of miles to another city.
If the government can spend 24 billion dollars on NASA in 2022, it may contribute more to combating mental health concerns among our underprivileged citizens. When individuals are cured of their depression or psychosis, they can become more productive members of society and cause incredible economic growth. Thus, ECT can be an essential investment in the Valley’s future. I hope this will become a reality one day.
