Electroconvulsive therapy (ECT): what it is, when to do it and how it works

Electroconvulsive therapy, popularly known as electroshock therapy or just ECT, is a type of treatment that causes changes in the electrical activity of the brain, regulating the levels of the neurotransmitters serotonin, dopamine, norepinephrine and glutamate. By regulating these neurotransmitters, it is a therapy that can be used in some more serious cases of depression, schizophrenia and other psychological disorders.

ECT is a very efficient and safe method, as brain stimulation is performed with the patient under general anesthesia, and the convulsions generated during the procedure are only perceived on the equipment, meaning there is no risk to the person.

Despite having good results, electroconvulsive therapy does not cure the disease, but it considerably reduces symptoms and should be performed periodically according to the psychiatrist’s recommendation.

When is indicated

ECT may be indicated in the following situations;

• Major depression;
• Bipolar disorder;
• Schizophrenia;
• Parkinson’s disease;
• Tourette syndrome;
• Obsessive-compulsive disorder (OCD);
• Epilepsy;
• Serious mental illness during pregnancy in which the use of medication is contraindicated.

Furthermore, electroshock therapy can also be performed when treatment with medication is not recommended, which happens mainly in the case of pregnant women, breastfeeding women or the elderly.

How it works

ECT is performed in a hospital environment and can last up to 30 minutes and does not cause pain or discomfort for the patient. To carry out the procedure, the person must fast for at least 7 hours, because general anesthesia is required, in addition to muscle relaxants and the application of heart, brain and blood pressure monitors.

Electroconvulsive therapy is carried out under the supervision of an anesthetist and psychiatrist and consists of applying an electrical stimulus, from two electrodes placed on the front of the head, capable of inducing a seizure, which is only seen on the encephalogram device. From the electrical stimulus, the levels of neurotransmitters in the body are regulated, making it possible to reduce the symptoms associated with psychotic and depressive disorders. Find out what the encephalogram is.

After the procedure, the nursing team ensures that the patient is well, and can then have breakfast and go home. ECT is a fast, safe and effective therapeutic method, and periodic sessions must be carried out according to the degree of the psychological disorder and the psychiatrist’s recommendation, with 6 to 12 sessions being normally recommended. After each session, the psychiatrist evaluates the patient to check the results of the treatment.

How it was done in the past

In the past, electroconvulsive therapy was not only used to treat psychiatric patients, but also as a form of torture. This is because the procedure was not performed under general anesthesia nor was there the administration of muscle relaxants, which resulted in contortions during the procedure and multiple fractures, due to muscle contraction, in addition to the loss of memory that often occurred.

Over time, the method was improved, so that it is currently considered a safe procedure, with a low risk of fracture and memory loss and the seizure is only perceived on the equipment.

Possible complications

ECT is a safe technique, however after the procedure the patient may feel confused, have temporary memory loss that lasts less than 60 minutes, or feel unwell, usually due to the anesthesia.

In addition, mild symptoms may appear, such as headache, nausea, muscle pain or aspiration pneumonia, which can be quickly treated with some medications.

When not indicated

Electroconvulsive therapy can be performed on anyone, and there are no absolute contraindications for this type of treatment. However, there are some relative contraindications that the doctor must take into account, such as high intracranial pressure, intracerebral tumor, pheochromocytoma, cerebral aneurysm, malformations in the arteries and veins, cerebrovascular accident or heart attack in the last 3 months.