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Brain; Mental Health

Debunked! 4 myths about electroconvulsive therapy for depression

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Electroconvulsive therapy can help patients with treatment-resistant depression have more good days.

Electroconvulsive therapy (ECT) is one of the most effective treatments for severe mental health conditions, most commonly treatment-resistant depression. ECT also can be used to treat other psychiatric issues, such as psychosis and catatonia (a condition that affects speech and movement).

ECT is approved by the U.S. Food and Drug Administration (FDA) and has been shown to be highly effective, giving some patients full reversal of severe depression symptoms. Overall, ECT is approximately 80 percent effective when a patient is a good candidate. By comparison, about 50 percent of patients respond to antidepressant medication. 

ECT is primarily reserved for patients who do not respond to other types of therapy, but in some patients with severe symptoms, failure of other therapies is not a requirement.

Electroconvulsive therapy (ECT) is one of the most effective treatments for severe mental health conditions, most commonly treatment-resistant depression, and can also be used to treat other psychiatric issues, such as psychosis and catatonia (a condition that affects speech and movement).

While ECT can be incredibly effective, the internet is rampant with misinformation about the therapy. People liken ECT to the outdated “treatment” in the movie One Flew Over the Cuckoo’s Nest. But that’s simply not the case. Let’s discuss ECT and debunk four myths about this advanced therapy.

What is electroconvulsive therapy?

ECT is a therapeutic procedure in which a doctor induces a medically-controlled seizure using electrical currents in a patient who is put under general anesthesia. The seizure lasts 30 to 45 seconds, and the entire procedure lasts only about five minutes. ECT is generally well-tolerated. Most patients report feeling back to baseline within a few hours.

While we don’t know 100 percent how ECT works, we know it is highly effective. Researchers believe the seizure affects specific circuits or neurotransmitters in the brain that are associated with symptoms of mental health disorders.

4 ECT myths – busted

1. ECT is like One Flew Over a Cuckoo’s Nest.

ECT today is a sophisticated procedure – nothing like how it’s portrayed in that old movie. Today, ECT is performed under general anesthesia. Patients are monitored continuously to reduce the risk of complications. Patients are asleep and unaware of the stimulation.

2. ECT is a miracle cure.

It is an incredible therapy, but it is not a miracle cure. Depression is a chronic condition, and relapses can occur after ECT. If relapse occurs, we can offer maintenance treatments to patients who have previously completed ECT therapy to regain control of depression symptoms.

3. I’ll get injured during the seizure.

Patients lie down while the medically-controlled seizure is induced, and we will ensure they are stabilized. People who experience spontaneous seizures often fall down and risk head injury. That won’t happen during an ECT treatment. In fact, most patients don’t move or jerk their limbs at all; those who do move only minimally. 

There is a risk of shoulder dislocation or biting the tongue during the procedure, similar to during a non-medical seizure. However, because this procedure is medically-controlled, we take precautions to reduce the risk such as giving patients medication to relax the muscles and placing bite blocks in their mouths during the procedure. 

4. I’ll have permanent brain damage.

For many patients, this is the most worrisome ECT myth. However, there is no evidence of structural brain damage in patients who have ECT. Some patients have slight memory loss of recent events, and in most patients, this resolves within a few months after treatment ends.

What to expect from ECT therapy

In our program, patients average 10 to 15 treatments total. Patients come in three times a week to start. Once we determine that the symptoms are fully managed based on specific factors, tests, and patient improvement, we can initiate a tapering phase.

The future of severe depression treatment

As effective as ECT can be for treatment-resistant depression, there is room for improvement – and UT Southwestern is leading the charge. We are the only medical center in the U.S. participating in a National Institute of Mental Health-funded clinical study for magnetic seizure therapy (MST). Along with the University of Toronto Centre for Addiction and Mental Health (CAMH), we are enrolling patients to compare the effectiveness of right-unilateral ECT and MST.

Magnetic seizure therapy: A new treatment for depression

UT Southwestern is the only clinical trial site in the country using a new form of brain stimulation to treat major depression.  Preliminary findings indicate that magnetic seizure therapy can ease depression without the cognitive side effects associated with electroconvulsive therapy.

MST is similar to ECT but uses magnets in place of electrical currents to stimulate the brain. We know that bilateral ECT (both sides of the brain are treated) is superior to MST and unilateral ECT (only one side is treated). Preliminary data suggests that right-unilateral ECT and MST are comparable, but MST carries fewer memory-loss symptoms. We are excited about this trial because we hope to, in the future, offer magnetic therapy as an alternative for patients who are concerned about cognitive side effects of ECT.  

Another therapy for treatment-resistive depression is repetitive transcranial magnetic stimulation (rTMS), which does not carry some of the side effects of ECT. While rTMS is not as effective as ECT, there is exciting research in progress that could lead to rTMS becoming a more effective option for patients in the future. 

Additionally, the drug ketamine was approved by the FDA in March 2019 as a therapy for treatment-resistant depression. Ketamine is still being studied for other major depressive disorders; clinical studies are currently being conducted at UT Southwestern. 

Today, no treatment is generally more effective for treatment-resistant depression than ECT. With this and other ever-improving therapies, we can achieve our continual goal in mental health care: Helping more patients and families have more good days together.

To visit with a UT Southwestern ECT expert, call 214-645-8300 or request an appointment online.

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