ECT

Tanja M. Meece

ECT, electroconvulsive therapy or what was once know as electroshock therapy, conjures visions of fright wigs and tables the equivalent of electric chairs. The therapy of today doesn't bear a resemblance to those visions - backs don't break and hair doesn't stand on end. The controversy regarding the use of this therapy has not died down over the years. The results have improved to the point that managed care providers and authorities such as Kay Redfield Jamison, Ph. D., a bipolar sufferer and author, consider it to be a viable front-line therapy for bipolar disorder, schizophrenia, and psychotic episodes. For some ECT is a less-than reliable form of treatment, but for a growing number of patients it is becoming a more powerful and longer lasting cure than medication alone. It should be remembered that there are no drugs or treatments available at this time that work for every patient across the board.

Like all medical procedures ECT involves a certain amount of risk, but unlike the ECT of the past, today's procedure is performed with every step and action focussed on the safety of the patient. The first step involves giving the patient medication to help prevent abnormal heart rhythms, followed by an IV given barbiturate, which is used as an anesthetic, and then blocking agents. Electrodes are placed on one or both sides of the scalp and then the current is switched on for a few seconds. Today's usage of currents varies from 170 to 500 volts, which are delivered in pulses, with only a small part of the electricity actually reaching the brain. The only visible sign that anything is happening is the twitching of one of the patient's toes during the duration of the voltage administration. In the past the current used was 120 volts, but it was continuous, not pulsed, and was often repeated immediately after the first procedure was completed, without knowing whether or not the patient had received any benefit or damage.

The patient will wake up a short time later, slightly groggy and disoriented. There is some initial short-term memory loss, which usually disappears within the course of a few weeks. Occasionally the effects will last for a longer period of time. There is seldom, but occasional, long-term memory loss. This treatment is considered so effective by managed care providers that they no longer consider it an experimental treatment, believing it to provide better long-term results than medication alone, and are willing to foot the bill for the therapy, which says a lot for ECT and its effectiveness in the long term. The current costs for ECT are $300.00 to $1,000.00 per treatment, with treatments usually running 3 days a week for about a month. There are studies that have shown that ECT recipients stay symptom free for considerably longer periods than patients being treated solely by medication do.

But, with all of the controversy surrounding ECT, it may become a moot therapy, as repetitive transcranial magnetic stimulation (rTMS). rTMS is performed by holding a metal coil against the scalp and stimulating the left-prefrontal lobe area of the brain, which tends to shut down during depressive episodes. It appears that rTMS is the next step in the war against depression, it is safer than ECT and the patient is able to stay awake during the procedure, so there is no short-term memory loss. Until rTMS becomes widely available and affordable the option most like it, in similarity and success, is still ECT. For the risks, short-term and occasional long-term memory loss, it is still a viable treatment option and one that has been refined over the years to provide treatment to patients with a modicum of risk, but maximal results.


 


 

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