Other Treatments
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is commonly called shock treatment. It has received bad press, in part for its potential memory-depleting effect. Since its introduction in the 1930s, ECT has been significantly refined, and is now considered to be the best treatment for severe depression. It is especially effective for patients with severe depression who experience delusions and hallucinations. Maintenance ECT may also help prevent relapse. In a 2000 study, continued use of ECT in responsive patients, along with long-term antidepressant use, prevented relapse in 73% of patients after 5 years compared to 18% in patients on antidepressants alone.
Candidates for ECT. About 40,000 Americans receive ECT each year. Many are elderly women who are psychiatric inpatients. Many experts urge that ECT be used earlier in the course of major depression, although most insurers or HMOs will not pay for early treatment. ECT may be beneficial for the following patients with severe depression:
- Patients who cannot, for any reason, take antidepressant drugs
- Suicidal patients
- Elderly patients who are psychotic and depressed
- Pregnant women with severe depression
- Patients with certain heart problems
- Young patients who fit the adult criteria for ECT
The Procedure. In general, hospitalization is not necessary. ECT involves the following steps:
- The patient receives a muscle relaxant and short-acting anesthetic.
- A small amount of electric current is sent to the brain, causing a generalized seizure that lasts for about 40 seconds.
- Most patients receive 6 treatments, spaced every 2 - 5 days. Others receive up to 15 treatments, followed by 6 - 12 additional treatments spaced every other week or longer for another 2 - 4 months.
This procedure is associated with a great deal of anxiety and the patient should be reassured. One form of ECT called right unilateral ECT (RUL ECT) may provide equal therapeutic benefits to more traditional bilaterally applied forms of the therapy, and more importantly, may have a less potentially deleterious effect on memory.
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