Process whereby a patient is
- is given a light general anaesthetic and muscle relaxant,
- has a seizure induced by apparatus generating an electrical stimulus and
- is recovered safely, for the purposes of treating specific mental health conditions.
Current ECT practice is well regulated within guidelines published by the Royal College of Psychiatrists, and is subject to rigorous audit. It is considered to be safe, well tolerated and effective as a treatment by both professional bodies and lay organisations such as MIND.
NICE guidelines therefore restricted the use of ECT. However there will be patients who:
- do not respond to pharmacological treatments.
- are unwilling or unable to tolerate the side effects of effective drug treatments.
- who in the past responded well to ECT but not to antidepressants.
ECT has been subject to rigorous prospective randomised double blind trials and has been shown to be an effective treatment for severe depressive illness.
Bilateral ECT is thought to be more efficacious than unilateral ECT.
Number of doses should be titrated according to response. Courses rarely exceed 12 sessions but more research is needed.
There are no absolute contraindications to ECT
Relative contraindications: Raised intracranial pressure, cerebral aneurysm, history of cerebral haemorrhage, recent myocardial infarction, cardiac arrhythmias, brain tumours, demyelinating diseases and acute respiratory infection.
Physical morbidity relates mainly to the anaesthetic and pre-existing pathology.
Psychological morbidity is principally a mild degree of cognitive impairment with anterograde and retrograde amnesia. Effects on remote memory are less well understood. However, small number of service users continue to complain of a prolonged cognitive impairment. Research so far failed to demonstrate evidence of brain damage from ECT.
Click here to view a short documentary film about the current use of ECT in psychiatry. Made with the support of St George's, University of London & South West London & St George's Mental Health NHS Trust.