At Providence Alaska Medical Center, our focus is to get you back to wellness and back to your life. We believe in a compassionate, collaborative approach and will work closely with you and your outpatient treatment team during each step of your recovery.
The Electroconvulsive Therapy Service is a consultation service that specializes in evaluations for and treatment with Electroconvulsive Therapy (ECT). ECT is provided by a team of board-certified physicians with specialized training in electroconvulsive therapy, with the assistance of anesthesiologists, nurse anesthetists and registered nurses.
What is Electroconvulsive Therapy (ECT)?
ECT is a very safe medical procedure used to treat severe psychiatric and neurological illnesses. A small electric current is applied to the brain using electrodes (stickers) on the scalp to generate a brief seizure while a person is anesthetized and muscles are relaxed.
When is ECT used?
ECT is the most effective treatment for depression, including severe depression that may have not responded to conventional medication and therapy treatments. Response rates for uncomplicated depression can be as high as 90 percent. For medication refractory depression, the response rate is 70-80 percent.
ECT can also be used to treat bipolar depression, bipolar mania, catatonia, schizoaffective disorder, and mood symptoms associated with Parkinson’s disease.
How does ECT work?
The exact mechanism by which ECT works isn’t clear. There are neurochemical, neurohormonal and physiological changes in the brain after ECT, in a manner similar to antidepressant medications. ECT may also stimulate the development of new brain cells.
What happens during a procedure?
Before ECT, patients are asked not to eat or drink from midnight the night before treatment. During the procedure, the patient receives a short-acting anesthetic agent that puts the patient to sleep for approximately 5-10 minutes. A muscle relaxant is also used during the procedure to stop the patient’s muscles from moving during the seizure.
Cardiac monitoring pads are placed on the patient’s chest to check on the cardiac status during and after the procedure. Four electrodes are placed on specific areas of the patient’s head. Two of these electrodes are for monitoring the brain waves. The other two are for delivering a short, controlled set of electrical pulses for a few seconds.
The electrical pulses must produce a generalized seizure to be effective. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current.
Patients awaken about 5-10 minutes after the end of the treatment. Patients are then moved to the recovery room and remain there until their blood pressure, pulse and breathing return to their pre-treatment levels. Usually this takes about 20-25 minutes.
Patients who are given ECT on an outpatient basis must have someone drive them home after the procedure and stay with them until they go to sleep at night. People should not drive in the 24 hours following ECT.
How long is a procedure?
A single ECT session usually lasts one hour. This includes the time the patient will be in the treatment room (approximately 15-20 minutes) and the time spent in the recovery room (approximately 20-30 minutes). Typically, ECT (whether inpatient or outpatient) is administered two to three times a week for a total of six to 12 sessions. Some patients may need more or fewer treatments. These sessions improve depression in 70-90 percent of patients, a response rate much higher than that of antidepressant medications. Some patients continue taking antidepressant medications or continue receiving ECT periodically to prevent relapse.
What are the side effects?
The immediate side effects of the procedure include:
- Muscle aches and soreness
- Disorientation and confusion
Patients may also develop memory problems. Memories formed closer to the time of ECT are at greater risk of being lost, while those formed long before ECT are at less risk. The ability to form new memories is also impaired after a course of ECT treatments, but this ability usually makes a full recovery in the weeks and months following the last treatment.
Are there any restrictions while a patient is receiving ECT?
- Patients must refrain from driving while getting ECT more than once weekly.
- Patients must be accompanied by a responsible adult when leaving the hospital after each ECT treatment.
- As the ECT Service does not manage outpatient medications, patients must continue to regularly meet with their outpatient psychiatrist, psychiatric nurse practitioner or psychiatric physician assistant for ongoing psychiatric care.
Does ECT cause permanent brain damage?
No. This is a frequently asked question and a major concern for most patients. Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction. In fact, ECT often improves the cerebral functioning of patients with severe depression. By treating the depression, patients often report that they are able to concentrate better and think more clearly.
During the course of ECT, we recommend that important decisions be delayed or postponed until after recovery. If any important decisions must be made while receiving ECT, we suggest that family, friends and the treatment team be consulted.
What types of insurance are accepted?
We accept most commercial insurance plans as well as traditional Medicare, replacement and supplement Medicare insurance plans. Coverage for ECT is based on medical necessity, and preauthorization may be required by your insurance company.
We use an insurance specialist to come to an agreement with your insurance company regarding coverage prior to treatment. Please contact our ECT coordinator for more information about your specific insurer.