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Frequently Asked Questions
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Category
Health Professionals
Patients and their Family

Health Professionals
What is ECT seizure quality and how is it measured?
The quality of the ECT-induced seizure is a reflection of the degree to which the seizure is generalized throughout the brain. Traditionally, seizure quality is evaluated by examining the paper EEG record for signs of high amplitude, rhythmical discharge patterns, symmetry, and a sharp voltage drop (postictal suppression) at seizure termination (Fink and Abrams, 1998). In recent years, computer programs have been developed that perform these analyses automatically while the seizure is in progress and print the results when the treatment ends.

The Thymatron® System IV provides several computer-automated, end-of-treatment reports of seizure amplitude (Maximum Sustained Power, Seizure Energy Index), symmetry (Maximum Sustained Coherence), and termination (Postictal Suppression Index), providing immediate feedback on several key aspects of seizure quality.
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What is the importance of being able to deliver the maximum ECT dosage using stimulus parameters in the physiological range?
Younger patients with their low seizure thresholds are relatively easy to treat, even with inefficient stimuli. It is the increasing number of older, high seizure threshold patients that present the greatest challenge, and many of these will require maximum device dosage. Because seizure thresholds are lower with short-pulsewidth, long-duration stimuli (Swartz and Larson, 1989; Isenberg et al, 1996; Chanpattana, 2001), such stimuli will also be most effective in obtaining seizures in patients who require the maximum dose.

The Thymatron® System IV can deliver its maximum dose across its entire dosage range with the shortest pulsewidths (0.25 or 0.5 msec) and longest stimulus train duration (8 sec) of any available ECT device.
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What is transcranial magnetic stimulation, and is it likely to replace ECT?
Transcranial magnetic stimulation (TMS) uses high-energy magnetic fields to induce electric currents in the brain. Thus, like ECT, TMS is a brain electrical stimulation treatment method. Such stimulation can be administered at doses too low to induce a seizure (nonconvulsive TMS) or at seizure-inducing levels (convulsive TMS).

Neither form of TMS is yet FDA-approved, but controlled research studies have shown that nonconvulsive TMS, which does not require anesthesia, can be an effective treatment for some forms of depression, with a therapeutic yield similar to that obtained with antidepressant drugs (Abrams, 2002). Nonconvulsive TMS may possibly receive FDA approval within a few years, at which time it is likely to be a useful addition to available treatment choices for depression; however it seems unlikely that it will ever replace ECT in the more severe (e.g., melancholic) forms of depression.

Convulsive TMS has only been used in one human experiment in which several costly high-energy magnetic boosters were required to induce a seizure similar to that obtained with ECT. It is likely to be many years before convulsive TMS could receive FDA approval, and little chance that it could exhibit greater therapeutic potency than ECT.
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Patients and their Family
Can ECT Cause Brain Damage?
The available evidence speaks strongly against this possibility. Patients receiving ECT show no elevation of brain enzymes and proteins that are released into the bloodstream when brain damage occurs, such as after a stroke. Carefully-controlled animal studies have shown no evidence of brain damage from brief seizures as given with ECT, and sensitive brain-imaging studies performed months after ECT have shown no structural changes. The amount of electricity used in ECT raises brain temperature far less than 1/10 of a degree and cannot cause electrical injury.
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Does ECT Cause Permanent Memory Loss?
On awakening from ECT, it is customary for patients to experience some confusion, which generally clears within an hour. Although most patients consider their memory function significantly improved after ECT, memory for some recent events, dates, names of friends, public events, addresses and telephone numbers may not be as good. In most patients the memory disturbance goes away within a few days or weeks, but it occasionally continues in a mild form for a period of months, or even longer. Rarely, a patient has claimed severe, permanent memory loss, but such claims have not been substantiated by objective memory testing. Many patients will find that their memories are somewhat hazy for the time that they were ill; the same problem is frequently experienced by depressed patients who do not receive ECT. Memory disturbances are not needed for ECT to work, and doctors use special techniques (such as brief pulse and right unilateral ECT) to minimize or avoid any effects on memory.

Many patients experience temporary loss of recent or remote memories with ECT, particularly with traditional bilateral ECT. A few patients have reported experiencing persisting loss of memories or memory functions after ECT. These are subjective symptoms that have not been related to observable structural brain changes. Mental and physical illnesses, anesthesia, medications, and postponement of treatment each have their own adverse effects, which can be substantial.

Please note that nothing in this website constitutes, or should be construed as, a claim by Somatics LLC that confusion, cognitive impairment, or memory loss (short-term, long-term, recent, remote, transient, or persistent) can not occur as the result of ECT.
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Hasn't ECT Been Replaced by Medication Therapy?
Medication helps many patients who might otherwise require ECT, but for over 30,000 U.S. patients each year ECT is the most effective treatment. Some patients do not respond to medications, others cannot tolerate the side-effects, and still others--those whose illness has made them seriously suicidal, for example--urgently require the reliable symptom relief that only ECT can provide.
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How Does ECT Work?
Although it is necessary for the brain cells to interact with each other chemically and electrically for ECT to work, exactly how this interaction is therapeutic needs further investigation. We believe that patients with melancholia have a severe biochemical disorder of the nervous system that ECT corrects. A number of rigorously-designed research projects are under way to study this question.
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How is ECT Given?
With the patient reclining, a sleeping medication is injected in a vein and the patient rapidly falls asleep. A muscle-relaxing medication is then injected, while the patient breathes pure oxygen. When the patient's muscles are relaxed, a brief electrical charge is applied to the scalp, stimulating the brain into rhythmical activity that lasts about a minute and is accompanied by release of chemicals from nerves in the brain. Mild contractions of the muscles occur during this "convulsion." When it is over, the patient is taken to a recovery area and observed by trained staff until he awakens, usually within 20 minutes.
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How Many Treatments Are Given and How Often?
ECT is usually given two or three times a week for a total of 6 to 12 treatments. A few patients may require more than 12 treatments for maximum benefit.
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How Safe is ECT?
A 1999 study from California found about one death per 50,000 treatments, which is far below the risk of childbirth. Other studies have shown that death from heart attack and other causes is less frequent among depressed patients who received ECT than among those who did not. With modern anesthesia, fractures and oxygen deprivation virtually never occur, and most patients with high blood pressure or heart conditions can now safely receive ECT.
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Is ECT a Frightening Procedure?
The dramatization of ECT in movies like "One Flew Over the Cuckoo's Nest" bears no resemblance to modern ECT, which is neither painful nor a punishment. Most patients surveyed after ECT say that it is no worse than going to the dentist, and many find ECT less stressful.
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Is ECT Considered a Standard Psychiatric Treatment?
Yes, one that has been used for over 60 years. A blue-ribbon panel convened in 1985 by the U.S. Government's National Institutes of Mental Health found that ECT was "demonstrably effective for a narrow range of severe psychiatric disorders", including depression, mania and schizophrenia. In 1990 and in 2001, the American Psychiatric Association reaffirmed ECT as effective for all types of major depression and manic-depressive illness, and for some instances of schizophrenia.
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Is ECT Curative?
ECT is an exceptionally effective medical treatment, helping 90% of patients who take it. Most patients remain well for many months afterwards. The tendency to relapse after a favorable treatment outcome can often be countered by medication taken for up to a year after ECT. Permanent cures for psychiatric illnesses are rare, however, regardless of the treatment given.
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Must a Patient Give Permission for ECT?
Virtually always, just as with any medical procedure. Most states require that informed consent for ECT be obtained in writing after an explanation of the procedure, its potential benefits, risks and side-effects, and a description of available alternative treatments. Of course, the patient can withdraw consent at any time. Treatment of patients who have been declared incompetent by a court of law may require professional legal guidance.
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What About Talk Therapy or Psychotherapy?
Psychotherapy employs techniques of education, suggestion and persuasion to help many people adjust to stress and emotional situations. Although it is usually not very helpful in treating the more serious illnesses that lead to hospitalization, psychotherapy may be useful once ECT has relieved the illness.
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What are the Indications for ECT?
Severe depression (melancholia) is the most frequent indication for ECT. Patients with this illness experience sadness and despair, have difficulty concentrating, lose appetite and weight, sleep poorly, blame themselves, are unable to enjoy life, and often think of suicide. Mania and schizophrenia are other illnesses that can be helped by ECT.
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What Are the Main Side-Effects of ECT?
On awakening from ECT, it is customary for patients to experience some confusion, which generally clears within an hour. Although most patients consider their memory function significantly improved after ECT, memory for some recent events, dates, names of friends, public events, addresses and telephone numbers may not be as good. In most patients the memory disturbance goes away within a few days or weeks, but it occasionally continues in a mild form for a period of months, or longer. Many patients will find that their memories are somewhat hazy for the time that they were ill; the same problem is frequently experienced by depressed patients who do not receive ECT. Memory disturbances are not needed for ECT to work, and doctors use special techniques (such as brief pulse and right unilateral ECT) to minimize or avoid any effects on memory.
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What is Electroconvulsive Therapy?
Electroconvulsive therapy (ECT) is a modern medical treatment for certain illnesses that have mental or emotional symptoms. In this treatment, the patient goes to sleep under general anesthesia, receives muscle relaxants and oxygen, and then receives a brief electrical stimulation to the scalp. The resultant nerve-cell activity releases chemicals in the brain and helps restore normal functioning. ECT resembles cardioversion, a common medical procedure in which the heart is stimulated electrically in order to restore normal functioning, but ECT uses a much smaller amount of electricity.
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Who Gives ECT, and Where?
ECT is given by a treatment team of doctors, nurses, and nursing assistants, including an anesthesia specialist. Virtually all ECT is given in hospitals or ambulatory care centers, in a specially-equipped area, either on an inpatient or outpatient basis.
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Why Does ECT's Public Image Suffer?
Just as with other medical treatments, from appendectomy to penicillin, ECT was used excessively in the past, mostly in large, understaffed mental hospitals in the 1940s. The drama of mental illness has also been exploited by fictional movies such as "The Snake Pit" that included stark and exaggerated portrayals of ECT to emphasize a story. More recently, quasi-religious groups have received media attention for unsubstantiated claims that all medical approaches to psychiatric illness are undesirable. This pamphlet is intended to provide the facts about ECT in order to further understanding of its value.
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