Electroconvulsive therapy

Overview of Treatment

Electroconvulsive Therapy (ECT) is a medical procedure that induces seizures in the brain using electrical currents, primarily used to treat severe and treatment-resistant mental illnesses. This therapy involves brief electrical stimulation of the brain to regulate neurotransmitter balance, making it especially suitable for patients who do not respond to medication or require rapid symptom improvement. In Taiwan and Hong Kong, ECT is often regarded as a key treatment option for severe depression, bipolar disorder, and other psychiatric conditions.

Types and Mechanisms of Treatment

ECT mainly divides into two modes: “bilateral electrode” and “unilateral electrode,” differing in the placement of the electrical current. Bilateral ECT tends to be more effective but may increase cognitive side effects, while unilateral ECT is milder. Its mechanism involves inducing seizures that promote the secretion of neurotransmitters such as serotonin and dopamine, and may repair abnormal metabolic activity in the prefrontal cortex and limbic system of the brain.

Indications

ECT is primarily used in the following situations:

Patients with severe depression unresponsive to medications or psychotherapy
Patients with severe suicidal tendencies or inability to eat independently
Manic or depressive episodes in bipolar disorder

Additionally, certain organic brain lesions or catatonia syndromes are also suitable candidates. This therapy is especially appropriate for acute cases requiring rapid symptom relief.

Administration and Dosage

The treatment process includes:

Patients undergo general anesthesia and muscle relaxant injection
Electrodes are placed at specific locations on the head, delivering brief electrical currents (usually 0.5-1 second)
The entire procedure is monitored by anesthesiologists and psychiatrists for vital signs

The course typically occurs 2-3 times per week, totaling 6-12 sessions. The intensity of the current and electrode placement are adjusted based on patient response.

Benefits and Advantages

Advantages of ECT include:

High remission rates for severe depression, up to 60-80%
Rapid onset of effect (improvement after a few treatments)
Suitable for patients intolerant to medication side effects

Additionally, it has unique efficacy for certain organic psychiatric conditions (such as cognitive impairment due to brain tumors) and can be combined with medication therapy.

Risks and Side Effects

Common short-term side effects include:

Transient dizziness or nausea after treatment (usually resolves within 24 hours)
Transient memory loss (mostly short-term, with less impact on long-term memory)

Serious risks: Rare cases may experience fractures (due to seizures), arrhythmias, or anesthesia-related complications, which require monitoring by a professional medical team.

Precautions and Contraindications

Contraindications include:

Recent intracranial hemorrhage or severe brain injury
Uncontrolled severe cardiac disease
Spinal instability or musculoskeletal issues

Prior to treatment, a thorough assessment of cardiopulmonary function is necessary, and patients should be informed of potential memory effects. Elderly patients require special attention to cognitive function evaluation.

Interactions with Other Treatments

ECT can be combined with antidepressants or psychotherapy, but caution is needed:

Antiepileptic drugs may reduce ECT efficacy and require dosage adjustments
Anesthetic drugs should be evaluated for interactions with existing cardiac medications

Regarding treatment sequence, ECT is usually performed first for rapid control of acute symptoms, followed by maintenance medication therapy.

Effectiveness and Evidence

International studies show that ECT achieves remission rates of 70-85% in patients with severe depression, far higher than single medication therapy. Long-term follow-up indicates that combining ECT with medication maintenance can prolong remission. For patients resistant to medication, ECT remains the only option for rapid improvement of suicidal behavior.

Alternatives

Alternative options include:

Combination antidepressant therapy
Transcranial Magnetic Stimulation (TMS)
Inpatient psychological and nutritional support

However, these methods are less effective in speed and suitability for severe cases compared to ECT. Selection should be based on the patient’s physiological condition and severity of symptoms.

Frequently Asked Questions

What preparations and examinations are needed before undergoing ECT?

Patients should undergo a comprehensive physical examination, electrocardiogram, and blood tests before the first treatment to assess cardiopulmonary function and metabolic status. Doctors will determine if anesthesia consultation is necessary based on age and health, and patients should fast for at least 6-8 hours before treatment to reduce anesthesia risks.

How long do the memory problems after treatment usually last?

Short-term memory confusion typically improves within hours to days after treatment, but some patients may experience short-term memory gaps around the time of treatment. This phenomenon usually recovers gradually over several weeks after the course ends. Long-term memory is generally unaffected; if persistent cognitive impairment occurs, medical team should be informed immediately.

How is the frequency and total number of ECT sessions arranged?

The typical course involves 2-3 treatments per week, with a total of 6-12 sessions, depending on symptom severity and response. Doctors will dynamically adjust the frequency based on patient improvement, with intensive treatment during the acute phase and maintenance therapy afterward.

Can patients work or perform daily activities normally during treatment?

Patients should be observed for 1-2 hours after each session, and driving or operating machinery should be avoided on the day of treatment. Some patients may feel fatigued; initial rest is recommended, but mild activities are usually unaffected. The doctor will advise on work adjustments based on individual recovery.

How to prevent symptom relapse after completing the treatment?

Doctors often recommend combining ECT with antidepressants or mood stabilizers and regular follow-up assessments. If signs of relapse appear, additional treatment or medication adjustments may be necessary. Patients should maintain a regular lifestyle and stay in close contact with their healthcare team to monitor changes in their condition.