Electro-convulsive therapy, also known as ECT may be prescribed for a variety of psychiatric illnesses.

It is used to achieve rapid and short-term improvement for the severe symptoms of your illness after a trial of other treatment options have proven ineffective and when the condition is considered to be potentially life threatening.

Your doctor may recommend you be given ECT treatment if you have responded well in the past to this treatment.

 

Alternative treatment options

Other treatment options include medication, talking therapies and psychological treatments.

 

How does ECT work?

ECT is a carefully controlled electric current passed briefly through the brain, via electrodes applied to the head. This current produces a seizure, which affects the whole brain (bilateral ECT) or just one side (unilateral ECT), including the centres which control thinking, mood, appetite and sleep.

Repeated treatments can alter chemical messages in the brain and bring them back to normal. This may help you recover from your illness.

 

Consent

Your doctor (or another doctor nominated to act on their behalf) will explain the procedure and the following to you:

  • the intended benefits
  • serious /frequently occurring risks
  • transient side effects
  • what the procedure is likely to involve
  • the risks and benefits of any alternative treatments (including no treatment).

 

Intended benefits

Improvement of depression and various psychiatric illnesses.

 

Serious or frequently occurring risks

ECT is one of the safest procedures performed under general anaesthesia: the risk of death or serious injury with ECT is slight about 1in 50,000 (reference; Susan M Benbow and Jonathan Waite, R C Psych ECT Handbook 3rd Edn [2013] , Ch 7, p 71-72 )

Your doctor may ask another doctor for advice if there are concerns about your physical health prior to starting a course of treatment.

Memory loss following ECT is common. Memory impairment can be associated with severe depression/psychiatric illness and can be marked even when patients have not had ECT. Short-term memory loss around the course of ECT and the few weeks afterwards is very common (60-70% of patients (reference; Semkovska M and McLoughlin D M [2010]. Biological Psychiatry 68, 568 - 577. In ECT handbook 3rd Edn [2013].  Past memories can also be affected. 

Once you have received the above information and have had time to ask any questions, obtain further information and discuss the proposed treatment with your family, carers or advocate you will be asked to sign a consent form.

You can withdraw your consent at any time and will be asked before each treatment if you want to continue.

 

How many treatments will I have?

This normally ranges between six and 12 sessions during a course of ECT.

ECT treatment will be stopped:

  • once a response is achieved
  • if there is evidence of significant adverse effects
  • if the individual withdraws consent.

ECT is usually given, twice a week. Your doctor will review you between treatments.  No more than two treatments will be prescribed at a time.

It is difficult to know how much of this is caused by ECT and how much by severe depression.

Memory impairment due to ECT recovers gradually over the six months following treatment, some patients, only very slowly recover their past memories and some have permanent gaps in their memory for some past events.

Your doctor will discuss the laterality (bi-lateral or unilateral) of treatment with you.It is still not clear which type of ECT is best: 

  • Bilateral ECT seems to work more quickly and effectively but it does seem to cause most side effects
  • Unilateral ECT has fewer side effects, but may not be as effective.

Transient side effects:

  • headache
  • muscle aches
  • nausea
  • muzzy – headedness
  • fatigue

 

The risks and benefits of any alternative treatments

(including no treatment)

ECTis never the only alternative, although the doctor prescribing it may feel it represents the best chance of recovery. If someone with severe depression declines ECT there are a number of possibilities:

  • medication may be changed or new drugs added
  • a referral for counselling or psychotherapy may be appropriate
  • staff involved in your care may look at ways of helping the person change aspects of their life that are causing the depression.

 

Usually a combination of all three of these will be tried:

  • catatonia can be treated with benzodiazepines
  • acute mania can be treated with lithium, anti-psychotics or anti-convulsants.

 

Consent

Your doctor (or another doctor nominated to act on his behalf) will explain the procedure and the following to you:

  • the intended benefits
  • serious /frequently occurring risks
  • transient side effects
  • what the procedure is likely to involve
  • risks and benefits of any alternative treatments (including no treatment).

 

Where will I have the treatment?

ECT is given at the Ryedale Suite at Roseberry Park, Middlesbrough. Treatment sessions are on a Tuesday and Friday morning.  If you are receiving maintenance treatment this will take place on a Wednesday morning.

In exceptional circumstances, if capacity exceeds demand for treatment, you may have to travel to the alternative site within the Trust to receive your treatment. This will be arranged by nursing staff and will be for the shortest possible time.

Very occasionally ECT may be administered in the theatre area of a general hospital.

If you wish to visit the ECT suites prior to starting your course of treatment, this can be arranged by nursing staff.  Staff in the ECT suites will be happy to answer any further questions and show you round.

 

What the procedure is likely to involve?

A senior anaesthetist will give you a general anaesthetic and this puts you to sleep. The anaesthetist will administer a muscle relaxant to relax the muscles in your body. Once the anaesthetist is satisfied that you are deeply unconscious, your treatment will begin.

 

How do I know ECT is carried out in my local clinic?

ECT clinics can apply for accreditation with the Royal College of Psychiatrists ECTAS.

ECTAS applies very high standards for how ECT is given, and visits all sites that are signed up for it. The Ryedale suite is accredited by the Royal College of Psychiatrists. The suite complies with relevant guidelines from the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland.

Outpatients - where an individual attends for treatment from their home and will be directly discharged back home to the ongoing care of a responsible adult.

Maintenance ECT - defined as ECT delivered at intervals usually between one week and three months, this is designed to prevent relapse of illness.

In both cases further information can be requested from your consultant/care co-ordinator.

 

What if I really don’t want ECT?

Before you can be given ECT, the doctor in charge of your treatment must have your consent.   If you do not want to have ECT, you must tell the doctor who must make sure that you are able to fully understand all of the information about the ECT treatment and the consequences of not having it.  If the doctor confirms that you are able to understand the information and that your refusal to accept the treatment is valid, you cannot be given it. 

If you have made a valid advanced decision that you do not want ECT, you cannot be given it.  If you have an attorney acting on your behalf and they refuse ECT, you cannot be given it nor can you be given ECT if the Court of Protection has decided you should not have it. These rules apply even if you are detained under the Mental Health Act (MHA) 1983 www.gov.uk/government/publications/code-of-practice-mental-health-act-1983 )

If you are detained under the Mental Health Act, and your doctor confirms that you do not have the capacity to consent, ECT can only be given to you with the agreement of a second opinion by another doctor in all but extreme emergencies.

If you are not detained under the Mental Health Act 1983 and your doctor confirms that you do not have the capacity to consent, they may, in consultation with others, decided to proceed with the treatment in your best interests, under the Mental Capacity Act 2005.  When you regain your capacity you will have the option and choice to refuse or continue with further treatments. 

 

Further information

There are wide differences in how much information people want and some of the explanations may be complicated, so if you want further information please ask.  The ECT suites carry a number of ECT information leaflets including:

 

Royal College of Psychiatrists information leaflet

www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/ect.aspx

 

ECT in Scotland: Mental Health (Care and Treatment) (Scotland) Act 2003

www.legislation.gov.uk/asp/2003/13/contents

 

Guidance on the use of electroconvulsive therapy

www.nice.org.uk/guidance/ta59

 

 

Anaesthesia for electro-convulsive therapy (ECT)

Electro-convulsive therapy, also known as ECT is always administered under a general anaesthetic.

There are differences in how much information people want and some of the explanations may be complicated, so if you don’t understand or want further information please speak to your consultant/carer co-ordinator who will always make time to listen and answer your questions. 

 

Consent for ECT

Before you have your treatment you will be asked to sign a consent form that shows that you fully understand the treatment and anaesthetic and agree to them. It is important you have the answers to all your questions before you sign this form.

 

General anaesthesia

Is a state of controlled unconsciousness during which you feel nothing and may be described as ‘anaesthetised’.  Anaesthetic drugs injected into a vein are carried to the brain by the blood. They stop the brain recognising messages coming from the nerves in the body. 

 

The anaesthetist

Anaesthetists are doctors with specialist training in anaesthetics that are responsible for your well-being and safety throughout your treatment.

 

You will normally meet the anaesthetist immediately before the treatment. They will have been fully informed about your general health before they meet you. If they do have any concerns about your general health, they may ask you to visit the ECT suite before you to start your treatment or they may arrange to visit you on the ward. They may also request that further tests are performed prior to you commencing treatment.

The anaesthetist works closely with other staff, including:

  • operating department staff (ODPs) with training in anaesthesia who prepare the equipment, help the anaesthetist and take part in your care
  • recovery staff who will care for you after your treatment
  • medical students and other healthcare staff in training will only be present if you have given your permission for them to be there. They are carefully supervised at all times.

 

Health check before your anaesthetic

Prior to attending the unit for your treatment you will have had a full physical examination and other investigations. When you first meet the anaesthetist they may wish to ask further questions or clarify points.

What sort of questions will the anaesthetist ask me? The anaesthetist may ask about the following:

  • your general health and fitness
  • any serious illness you have had
  • any problems with previous anaesthetics
  • whether you know of any family members who have had problems with anaesthetics
  • any pains in your chest
  • any shortness of breath
  • any heartburn
  • any pains you have which make lying in one position uncomfortable
  • any medicines you are taking, including herbal remedies and supplements you may have been prescribed or may have bought
  • any allergies you have
  • any loose teeth, caps, crowns or bridges
  • if you smoke and/or drink alcohol.

 

On the day of treatment

Fasting - You must not eat food (or chew chewing gum) for 6 hours before your treatment. You must not drink opaque drinks (drinks you cannot see through) for six hours before your treatment.  Clear fluids (drinks you can see through) can be drunk in small quantities for up to two hours before the start of your treatment.

It is important that you follow these rules - failure to do so will result in your treatment being cancelled or delayed.

Normal medication - You should continue to take your normal medication up to and including the day of your treatment.  A small sip of water may be drunk in order for you to swallow tablets.

If you feel unwell - When you are due to have your treatment it is important to make the nursing and medical staff aware.  Depending on the illness and how urgent your treatment is your treatment may need to be postponed until you feel better.

Needles and local anaesthetic cream - A needle will be inserted to start your anaesthetic. If this worries you, you can ask to have a local anaesthetic cream put on your arm to numb the skin before you attend for treatment. Unfortunately, this is not always effective.

 

What will I feel like afterwards?

You may have no side effects at all, but you may have a headache or feel confused for a while.

 

Getting ready for your treatment

Washing and changing

A bath or shower before your treatment will clean your skin. Make-up, body lotions or creams prevent heart monitor pads and dressing sticking to your skin. Washing your hair prior to treatment is helpful. Hair spray should not be used.

Personal items and jewellery

You can wear your glasses, hearing aids and dentures to go for treatment. You will be asked to remove them before being anaesthetised.

If removing dentures would cause you distress please let staff know and the staff can do this for you once you are asleep.

Jewellery and decorative piercing should ideally be removed. If you cannot remove your jewellery it may need to be covered with tape.

The ECT suite has facilities to store small amounts of personal property safely.

 

When you are called for your treatment

A member of staff who is known to you will accompany you to the ECT suite. A family member can wait with you in addition to nursing staff

 

The ECT suite

The ECT suite includes a waiting area, treatment room, recovery and a post recovery area.

The waiting areas are pleasantly decorated and comfortable with TV and magazines available. 

In the post recovery area there are facilities for light refreshments.

 

The staff

A psychiatrist administers ECT and will work with the anaesthetist, operating department practitioner and nurses trained in ECT and recovery.

 

The treatment room

You will be asked to sit on a bed and the psychiatrist will check your consent form and the ECT nurse will check your identity band.

You will then be asked to lie down and remove your shoes/slippers.

The anaesthetist will monitor you during your treatment by:

  • your heart; sticky patches will be placed on your chest (electrocardiogram or ECG)
  • your blood pressure; a blood pressure cuff will be placed on your arm
  • the oxygen level in your blood; a clip will be placed on your finger  (pulse oximeter).

 

Setting up your cannula

A needle will be used to put a thin plastic tube (a cannula) into a vein in the back of your hand or arm.  An adhesive dressing protects this. Sometimes it takes more than one attempt to insert the cannula.

 

Starting a general anaesthetic (induction)

Anaesthetic drugs are given through the cannula.

Induction happens very quickly, and you will be unconscious within a minute or so. People usually describe a swimmy, light-headed feeling.

If it hurts when anaesthetic drugs are given through your cannula, it is important that you tell your anaesthetist.

The anaesthetist will administer a muscle relaxant to relax the muscles in your body.

Once the anaesthetist is satisfied that you are deeply unconscious, your treatment will start.

The anaesthetist will monitor you during your treatment.

 

After a general anaesthetic

Most people will regain consciousness in the recovery room. Recovery staff will be with you at all times and will continue to monitor your blood pressure, oxygen levels and pulse rate.

Oxygen will be given through a lightweight clear-plastic mask, which covers your mouth and nose. Breathing oxygen is important after an anaesthetic and helps the anaesthetic wear off.  Staff will remove your mask as soon as you no longer need oxygen. If you feel sick, you may be given drugs to stop you feeling sick.

When you are fully alert, dentures, hearing aids and glasses can be returned to you.

You will be aware that the bed/trolley will be at a height to allow recovery staff to easily attend to your needs. Protective sides will be raised to prevent you falling off the trolley when you are drowsy (sleepy / light headed feeling).

 

Back to the ward or home

The recovery staff must be satisfied that you have safely recovered from your anaesthetic, and all your observations (such as your blood pressure and pulse) are stable before you leave the ECT suite.

This involves spending some time in the post recovery area of the ECT suite following your treatment and this can vary between 30 minutes or up to 2-3 hours, especially if you have travelled any distance or are receiving treatment as an out-patient. 

You may also need to see a psychiatry doctor before leaving the ECT suite.

 

How did it all go?

If there have been any problems during your anaesthetic that have affected you or your treatment, you will be told about them.  This is not only because you have a right to know, but also so that you can let other anaesthetists know who may care for you in the future.

 

What are benefits and risks of anaesthesia?

The likely benefit of the ECT treatment needs to be weighed against the risks of the anaesthetic procedure and the drugs used. The balance will vary from person to person.

The risk to you will depend on whether you have any other illness and personal factors, such as whether you smoke or are overweight.

Anaesthetists and patients may also have different views about the importance of risk.

To understand a risk, you must know:

  • how likely it is to happen
  • how serious it could be
  • how it can be treated.

 

Alternatives

There is no alternative to general anaesthesia for ECT.

 

Safety of anaesthetic drugs

Many of the drugs used by anaesthetists have been successfully used for a long time. In the UK, all drugs must be tested and licensed by the Committee on Safety of Medicines www.mhra.gov.uk  (regulating medicines and medical devices) before they can be generally prescribed.

This involves examining the risks, safety, effectiveness and side effects of each drug before it is given a licence.

 

Risks and complications of anaesthesia

Anaesthetic risks are thought of in terms of side effects and complications.

Side effects are secondary effects of a drug or treatment. They can often be anticipated but are sometimes unavoidable.  Unpleasant side effects do not usually last long. Some are best left to wear off and others can be treated. Examples would be a sore throat or sickness after a general anaesthetic.

Complicationsare unexpected and unwanted events due to a treatment. An example would be an unexpected allergy to a drug.

 

Common side effects and complications:

  • feeling sick, sore throat, dizziness, blurred vision
  • your anaesthetic may lower your blood pressure and may make you feel faint
  • headache, aches, pains and backache
  • pain during injection of drugs
  • bruising and soreness around the injection site.

 

Uncommon side effects and complications:

  • chest infection; this is much more likely to happen to people who smoke
  • muscle pains
  • damage to teeth by clenching your teeth as you recover from the anaesthetic.  If your anaesthetist finds it difficult to get the breathing tube in place, your teeth may also be damaged.  This is rare and you would be told about this if it happens to you
  • an existing medical condition may get worse.   Conditions such as diabetes or high blood pressure need to be closely monitored and treated
  • serious allergy to drugs; allergic reactions will be noticed and treated very quickly. 

 

It is important to remember that death caused by anaesthesia is extremely rare, and is usually due to a number of serious complications arising together.

 

 

 

Reference:

L374 and L375

Version:

V3

Date last updated:

17/10/2016

Archive date:

17/10/2019