Your doctor has recommended electroconvulsive therapy (ECT) for your illness because it is thought that ECT would be the best treatment for you at this time. Your doctor will talk to you about other available treatments and the reasons why they are not being recommended at this time. This information is given to you to help you in deciding whether or not to agree (consent) to receive the ECT treatments. Please take the time to read this; then ask your doctor to explain anything you do not understand. If you then agree to have ECT, you will be asked to sign a consent form. If you need more information, you may watch a videotape of the ECT procedure.

ECT is a safe and effective treatment for some forms of mental illness. For example, it is usually used to treat severe depression. It is also used to treat patients with bipolar affective disorder who have manic illnesses; and, ECT is also used to treat schizophrenia. It is most often used after medications have been found not to work.

As is the case with medical treatments, the actual way that ECT helps symptoms of mental illness is unknown. It is now believed that ECT affects some of the chemicals, which transfer impulses or messages between nerve cells in the brain. This action may correct some of the biochemical changes that are seen in some mental illnesses.

The Treatment Procedure

A course of ECT consists of individual treatments that are usually most often given 3 times per week, usually Monday, Wednesday and Friday. Your doctor determines the total number of treatments and how often they are given. The number varies, usually between 8 and 15, but it may be more or less depending how you improve. The total number of treatments required cannot be predicted ahead of time. Each treatment is given while you are asleep under anaesthesia. The anaesthetic drug is injected by an anaesthetist through a needle inserted in the vein. Oxygen is given by a face mask. The level of oxygen in the blood and the heart rate and rhythm are monitored during the treatment.

Each treatment procedure involves passing a small, controlled electric current between two metal discs (electrodes) which are applied on the surface of the scalp. The electrodes may be placed on the top of the head and one side of the forehead for unilateral ECT or on both sides of the forehead for bilateral ECT. Your doctor will decide whether you get unilateral or bilateral ECT. The small electric current passes between the two electrodes and through part of the brain in order to stimulate the brain. That electrical stimulation causes a convulsion or seizure that usually lasts from 20 to 90 seconds. More than one stimulation may be required to cause a convulsion. In addition to an anaesthetic to cause sleep before every treatment, a drug is injected by the anaesthetist to partially paralyze the muscles so that the convulsion is well controlled. The amount of electrical current used to cause a convulsion at each treatment is based on a standardized procedure used at this hospital. You are asleep during the entire treatment. The treatment lasts about 10 minutes from the time the anaesthetic is given until its major effect wears off and you awaken. Further recovery from the anaesthetic occurs over the next 1 or 2 hours, in the recovery room. The treatment is not painful and you will not feel the electric current and the seizure.

Potential Risks and Benefits

The most troublesome side effect of ECT is memory loss. Recovery from that memory loss begins a few weeks after treatment and is usually complete within 6 to 9 months. There may be a permanent loss of memory for details of some events, particularly those that occurred some time before and during the weeks the treatment is given. Also, there may be some difficulty learning and remembering new information for a short period after ECT. However, the ability to acquire new memories recovers completely, usually a few months after treatment. Thus, the treatment does not cause a permanent loss in the ability to learn and remember events following the treatment. A very small number of patients report severe problems with memory that remain for months or years. Some patients experience a brief period of confusion after waking from anaesthetic. Some also experience muscle aches and headaches, but these are usually not severe and go away after a few hours.

ECT is given under anaesthesia. Therefore, as with any treatment given this way, there is a risk of death but this is now rare, between 2 and 4 deaths being reported for every 100,000 treatments. The risk may be higher for patients who have other physical illnesses. The effect of any patient’s physical illnesses on the treatment risk will be discussed with you. Also very rare are bone fractures and broken teeth or other dental injury. Spontaneous seizures may occur some time after the treatment but are rare.

Because of the time required to recover fully from the anaesthesia, you must not operate a motor vehicle or any potentially dangerous equipment/machinery/tools until the day after each treatment.

The potential benefit of the treatment is recovery from the symptoms of your illness for which ECT is prescribed. As with many forms of medical treatment, not all patients respond the same. Some patients recover quickly; some patients seem to recover but then the symptoms recur so that more treatments are required; and some patients have symptoms that do not respond at all to ECT.

If you wish, other information about the treatment is available. Please ask you doctor any questions you may have about the treatment and how it is given at this hospital.

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