Electro Convulsive Therapy (ECT)

History of ECT

In the 1930s it was noticed that people who had both epilepsy and mental health problems often became brighter or indeed, happier after an epileptic seizure. Electro convulsive therapy (ECT) was introduced as a result of this.

When is it used?

ECT may be recommended for one of the following reasons:

• there has been severe depressive illness for some time and drug treatments have not, or only partly, worked
• illness is causing serious anguish, making it impossible for the patient to function
• anti-depressants have been tried but stopped because of side effects
• where a patient's life is at risk due to not eating or drinking, or because of suicidal intent

Will it work?

There are no 100% guarantees. Some people do benefit where other treatments have not worked. For some it can be life saving.

You will be anaesthetised. A small amount of electric current is used to stimulate the brain. This produces a modified seizure. This in turn changes the amount of certain chemicals in the brain.

Some of these changes are like those seen with some antidepressant medicines in the way they relieve
symptoms. The medications used for the anaesthesia prevent injury and you will feel no discomfort.

How will I feel after?

You will wake up in the recovery room. A staff nurse will be with you and will supervise your recovery. On
wakening you will be offered fluids. You may have no side effects at all, but common side effects include a sore head or some confusion.

Memory loss

The main side effect that can happen with ECT is some loss of memory. Not everyone suffers it. Patients who have report gaps in memory for certain past events. The memory usually returns within days or a few weeks. In rare cases, people complain of some lasting gaps in memory.

What is a course of ECT?

It is usually given twice a week until the patient has had between six and twelve treatments. This may vary, with some people needing more and some only needing two or three treatments.

Your consultant will review your progress weekly, and after every two treatments.

Treatment as an inpatient

The night before a treatment, do not have anything to eat or drink after midnight. You may have medicine in the morning with a sip of water for physical indications. A staff nurse will go with you for treatment. This is carried out at the day procedure unit (DPU) at the Borders General Hospital. When you arrive the you will be introduced to the ECT team, who have been trained to give ECT. The team is made up of a psychiatrist, an anaesthetist and nursing staff:

• the psychiatrist will give the ECT treatment
• the anaesthesia team will give medicines and monitor the patient's condition during the treatment
• after the treatment the nursing staff will continue to monitor the patient's condition until they go back to Huntlyburn

An appointment will be arranged for the you to come to the ward for physical tests before having the ECT.

You will attend the anaesthetic pre assessment clinic prior to treatment. You will be given information on ECT before the appointment.

You will be asked to come to the ward by 7.45am on the day of treatment.
Patients are not allowed to drive throughout the full course of ECT and will need a medical certificate from a Psychiatrist following episode to be able to drive again. You should bring someone who will stay with you and take you home following treatment.

After the treatment you and your relative or friend will be asked to read and sign an outpatient disclaimer form. This is to make sure you are aware of all the important information., ie you must have a responsible adult to stay with you for 24 hours post treatment.

You may have to stay in hospital overnight. If not, you will stay until at least 4pm. A doctor will check that you are physically and mentally fit to leave the ward.

What is the outcome?

People who progress with the help of ECT may not stay well for as long as those helped by medicines.

However, when other treatments have failed, ECT can give a foothold back to health. You will then be able to make more use of medicines and, or talking therapies.

You are free to ask questions and to be given as much information as possible about treatment with ECT.

• You can refuse the treatment. You will be asked to sign a consent form before a treatment course starts.
• You can withdraw consent at any time.
• You should not be put under any undue pressure to have ECT.

However in some cases a Consultant may decide that ECT is needed without the patient's consent:

1. Emergency situations, which are seen as life threatening.
2. Where the patient is seen as being unable to give informed consent.

Where possible relatives and, or carers should be involved in discussion about treatment options.

BIAS (independent advocacy) tel:01896 752200

Mental welfare commission Tel:0131 313 8777 or Tel:0800 389 6809

Huntlyburn House
Melrose
TD6 9BD
Tel:01896 827181