Treating depression with Electroconvulsive Therapy (ECT)

What is ECT

A patient receives electric shock
therapy in the UK in 2013
(BBC/Newsnight)

Electroconvulsive therapy (ECT) is an invasive type of brain stimulation that’s sometimes recommended for severe depression if all other treatment options have failed, or when the situation is thought to be life threatening, (NHS).

ECT, given to depressed patients under anaesthesia, sends electrical pulses to the brain through electrodes applied to the head. The electrical stimulation triggers a seizure, which seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. Repeated a few times a week for a short period, ECT eliminates depressive symptoms for an extended time in many patients, Brainwise, 2018.

“ECT is the most effective treatment available for severe and treatment-resistant depression, but it requires anaesthesia and can cause side effects like memory loss,” says Irving Michael Reti, M.B.B.S., M.D., director of the Brain Stimulation Program.

Who invented ECT

ECT causes change in the brain —
Medical Brain Health

There’s much written about the invention of ECT but I love and have used excerpts from this article written by Robyn Wilson for the Independent, 2017 — Once upon a time in April 1938, a team of Italian medical researchers got ready to do one of the most controversial things that medicine had ever seen. They’d attempt to heal a mentally ill patient by applying a jolt of electricity through his brain. They didn’t know if he’d live or die but it was a risk they were willing to take.

Leading the team was 61-year-old Ugo Cerletti, and his assistant, Lucio Bini who, together had been working on the intriguing new medical machine they were soon to put to use.

In a large, secluded room they shaved the patient’s head and stretched him out on a bed. They attached two electrodes to his temples, placed a rubber tube in his mouth as a bite-bloc and flicked the switch of Cerletti and Bini’s device.

The team braced themselves as the electrical current coursed through the man’s head. He let out a small spasm and then bizarrely burst into animated song. Interesting, amusing certainly, but it wasn’t a seizure.

They tried again, increasing the voltage, until finally the patient went into what was a rather dramatic convulsion; face purple, mouth clenched, fists balled, heart racing. The medical staff all nervously watched on, fearing his death. Until suddenly the man slumped back, still. His breathing was steady, regular.

Right then, they knew they had completed what they had set out to do. After two years of research, they had proven that an electrical current could be used to induce a seizure without it resulting in the patient’s death; a seizure that, as they had hoped, would go on to relieve the patient’s symptoms.

They had just given birth to electroshock therapy and psychiatric medicine would never be the same again.

Modern day ECT

Going from Mental Health Ward to a general hospital — Pixabay.com

Today’s ECT involves going to a general hospital, where the patient is given short-acting anaesthesia (including a muscle relaxant) before ECT is administered. The targeted (and very low-level) electric jolts, it’s said, stimulate the brain to address everything from depression to dementia-related outbursts of anger (something I haven’t seen it used for).

In my first post as a mental health nurse I’d developed a good therapeutic relationship with a lady who had bipolar disorder and during the depression phase she felt hopeless and suicidal — it was pitiful to see. Over the years she had been treated with several courses of ECT and this time, she requested more. When it was agreed she could have ECT she asked if I, as her nurse, would accompany her.

Jack Nicholson’s character Randle McMurphy received electroconvulsive therapy in the 1975 film ‘One Flew Over The Cuckoo’s Nest’ (Fantasy Films)
Independent 2017

I’d only ever seen Jack Nicholson in One Flew Over The Cuckoo’s Nest — and I cried watching that — so I wasn’t looking forward to observing Lyn having ECT. Oh my word, I thought I was going to have a panic attack as they pressed the button and she went into a seizure which lasted around 80 seconds. The ECT nurse must have noticed as she gave me a comforting shoulder rub and a smile that said she understood.

I waited for Lyn to come round in the recovery room with another nurse who took regular observations (obs) i.e. blood pressure, temperature and pulse to ensure Lyn wasn’t experiencing any unusual side effects. When she woke from the mild anaesthesia Lyn was drowsy but able to get into a waiting wheelchair with support from me and the other nurse.

Once back on the mental health ward I was to observe Lyn throughout my shift, taking hourly obs and asking her how she felt; documenting everything in her notes and on charts. She remained drowsy and confused for a few hours and her memory lapsed, she was unable to concentrate and complained of a headache, for which she was given paracetamol.

Shock and horror

ECT for treatment resistant depression — Image from
Youwillbearwitness.com

I was about 15 and terrified when my mum went into hospital — well, an asylum actually. I later learned she’d been suffering with clinical depression which was treatment resistant. When I became a mental health nurse, I was telling mum about ECT when she confessed that she’d been in an asylum once before, when I was about 4-5, and on both occasions, she’d had ECT.

I’m glad I had more awareness and insight into ECT when mum told me because I would have thought, like most people, it barbaric, inhumane. She said she didn’t remember too much about it all — long-term memory loss? Or perhaps she just shut it out for all those years? Still, it had relieved the depression and her mood had improved.

My conclusion on ECT

I’d accompanied Lyn on six more occasions and my anxiety lessened each time as I saw how much her mood improved — and I realised that ECT is actually more civilized than I’d been led to believe.

I’m not sure it would be my choice of treatment but then again, I’ve been lucky that medication and talking therapies were, and still are, beneficial to me — they’ve helped me out of a massive black hole — on more than one occasion.

Would you be able to explain what ECT is to other people now? What do you think of ECT? Is there anything I missed? I am happy to answer your questions. In the meantime, you might like to read more about depression here.

This article was first posted on the Blogger Community here – thanks to Saumya and Niki; authors on this blog. Why not drop in and say hi to some fellow-bloggers.

Author: mentalhealth360.uk

Mum to two amazing sons. Following recovery from a lengthy psychotic episode, depression, anxiety and anorexia, I decided to train as a Mental Health Nurse and worked successfully in various settings before becoming a Ward Manager. I am a Mental Health First Aid Instructor and a Mental Health Awareness Trainer, Mental Health First Aid Youth and Mental Health Armed Forces Instructor. Just started my mental health from the other side blog.

21 thoughts on “Treating depression with Electroconvulsive Therapy (ECT)”

  1. Congrats on your first community mental health safe space post. )

    Great read, very important information and personal observations and insight. That is why I asked for you to guest post on this one. You know your mental health care 😉

    Thanks for contributing and I hope you will keep an open mind on doing it again in the future. <3

  2. how much ECT is voluntary, do you know?
    I would agree with you that it seems a very unpleasant idea but I don’t feel it is something I know enough about to really have a view. A lot of health treatment is compartmentalised away these days, such that unless something actually happens to us, we can be blissfully unaware of what it entails. I’m not sure that’s entirely a good thing.

    1. I’d say the majority of ECT is conducted voluntarily. As it’s used mainly for severe depression, the patient generally isn’t seen as a risk to the public so ECT wouldn’t be enforced. I’ve never seen anyone ‘forced’ to have it (without their consent under the MHA).
      I think, as Ashley said previously, people should be more aware of ECT and its effectiveness.

  3. ECT is something my mum has promised me from a very young age that she doesn’t want this again. Now the again part when she first spoke about this and we chatted aout this when I was 11,or 13. Then we had another chat about this when I was an adult and I have been made to promise that I am never to allow this to happen to her as I have blogged about.
    This conversation came up last year, again I have blogged about this: I received the same papers as mum will have gkt when she was sectioned and I felt sick to the stomach because there was a leaflet that was about ECT. So panic set in, because of the promise my mum made me do at such a young age.
    They resassured me that ECT was not on the cards, but we had quite a conversation about it via email, so they had details to hand, should it crop up.
    Nothing at present since last year has been brought up about ECT, so it’s still meds, which is either still injection because she wasn’t complying, unless it’s now tablets, I don’t know.
    But I would hate the idea if the topic of ECT came up, because of such a promise I made all those years ago. It’s not something I think I would want myself either and hopefully I never will be in that position.

    1. I’m sorry to hear your mum had a bad time with ECT and I can appreciate her not wanting to have it again after that.

      And of course, if it was so bad that you had to promise she’d never go through it again, then you have to honour that promise.

      It’s not something I’d want to have either. But sometimes, like toothache, you just have to do something, despite being terrified of the dentist. Not quite the same, I know and hopefully I’ll never be in the position of having to consider ECT.

  4. awesome post as I looked into ECT as well. I figured the screwdriver in the socket has been enough…j/k. I’ve done a report (eons ago) as well on this…hmmm…maybe that’s why the cable guy was here saying I had a leak?!?!?!? …again…j/k but one really did come here saying that to me….about 2 months ago??? Anyway, frequencies are amazing…ty for this share ….

  5. Great blog post!! I do wish that ECT was more readily available. For some people, I think it could remove the need for antidepressants and their side effects. It was interesting to read about your experiences with the patient you cared about! How nice of you to accompany her!!

  6. ECT saved my life & I’d do it again in a heartbeat. I know I was incredible lucky to have such a positive experience & few side effects, both short & long-term.. You can read my book “Birth of a New Brain” and also this Huff post article for details. Thanks!

    https://www.huffpost.com/entry/how-electroconvulsive-therapy-ect-helped-me-survive-to-battle-bipolar-depression_b_9455412?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAEz8FsLPFRb0ujLmzc-jbPNV9elRVeYanX_LYKlmoWYMZs6q1laMVseRF5jIU1zC4zZBaFXrf7sW5wDVpx9ERf2IAqaD6I2d5S52bL4JeMX-RAOFqNNmuIkhawghhSTByunb7HoX_9JbcnzMtYcSQsCr4ID-1hxKn0st8alsvnTN

    1. That’s really good to read Dyane, that you had a positive experience. And I hope others read this comment too.

      For anyone reading, you might like to drop in to see what Dyane has to offer. I’ve only just started the book and it’s an experience that needs reading.

      1. Thanks so much; once again you’ve made my day with your kindness (Sorry for the super-late reply!)

  7. The psychiatrist I used to see recommended this for me. It sounds scary, though, and I don’t know if I could work it into my schedule (although given the way everything is turned upside down right now, maybe something might work out… hmmmm…..)

    1. Aaww, Greg, of course it sounds scary and I know I’d definitely be anxious about it. But when I was so unwell a few years back, I so wanted to get better (I couldn’t bear the hell I was living in), if the 3 years of counselling and the meds not worked — I think I might have been begging for ECT.
      Your health is more important than your schedule lol. Some people have it done one afternoon and go back to work the next morning. Have look at Dyane’s comment on here — see what she said 🙂

      Stay safe and well Greg. Caz x

  8. It’s nice to get information on this from someone with direct clinical experience. It certainly gets a bad media rap, but if patients request it and find it helps them, I’m grateful there are professionals who can administer it for them.

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