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 particularly suitable for patients who do not respond to medication or require rapid symptom improvement. In Taiwan and Hong Kong, ECT is often considered a key treatment option for major depression, severe mania, 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 electrodes. Bilateral ECT tends to have a stronger therapeutic effect 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 activities 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 syndrome may also be suitable candidates. This therapy is especially appropriate for emergency cases requiring rapid symptom relief.

Administration and Dosage

The treatment process includes:

Patient receives general anesthesia and muscle relaxants
Electrodes are placed at specific head locations, delivering brief electrical currents (usually 0.5-1 second)
Monitoring of vital signs by anesthesiologists and psychiatrists throughout the procedure

The frequency of sessions is typically 2-3 times per week, totaling 6-12 treatments. The current intensity 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 effects (improvement after a few treatments)
Suitable for patients intolerant to medication side effects

Additionally, it has unique efficacy in 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)
Temporary memory loss (mostly short-term, with less impact on long-term memory)

Serious risks: Rare cases may involve 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 detailed 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 should be combined with antidepressants or psychotherapy, but attention is needed for:

Antiepileptic drugs may reduce ECT efficacy and require dosage adjustments
Interactions between anesthetic agents and existing cardiac medications should be evaluated

Regarding treatment sequence, ECT is usually performed first for rapid control of acute symptoms, followed by medication maintenance 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 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 generally 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 preparatory examinations are needed before undergoing ECT?

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

How long do the memory issues after treatment typically last?

Short-term memory confusion usually improves within hours to days after treatment, but some patients may experience short-term memory gaps before and after treatment. This phenomenon often recovers gradually within weeks after the course ends. Long-term memory is generally unaffected; if cognitive impairment persists, medical team should be notified immediately.

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

The typical course involves 2 to 3 treatments per week, with a total of 6 to 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 to 2 hours after each session, and driving or operating machinery should be avoided on the treatment day. Some patients may feel fatigued; rest is recommended initially, but mild activities are usually unaffected. The doctor will advise on work adjustments based on individual recovery.

How can symptoms be prevented from relapsing after completing the course?

Doctors often recommend combining ECT with antidepressants or mood stabilizers and conducting regular follow-up assessments. If signs of relapse appear, additional treatment or dosage 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.