Electroshock

The most common treatment of depression is with antidepressants and psychotherapy but there are other forms of treatment. One of them is ECT, (an abbreviation which stands for electroconvulsive therapy), which is also called electroshock.

Despite all the rumours, ECT is an effective, quick and gentle treatment of depression. Electroshock can sound like an old-fashioned and dangerous treatment but the truth is that ECT is a save treatment. ECT is the fastest working and most effective treatment of depression. The treatment can be used on both the elderly and on people who are suffering from heart disease or are otherwise frail.

Anaesthesia

You are fully anaesthetized, and you are then given a muscle relaxing injection. We then provoke a convulsive fit by giving a weak electric shock over both temporal regions or over the right temporal region and the crown.

A very small part of the current from the electric shock reaches the brain. The current activates the nerve cells, and if they are activated sufficiently, it triggers a convulsive fit. The convulsive fit is a rhythmic, electric activity in the nerve cells which lasts for 25-60 seconds. As you are anaesthetized and completely relaxed, only small contractions in the muscles are noticeable.

It is phenomena in connection with this convulsive fit which have the antidepressant effect. No collective explanation to the question about how ECT works has yet been found but there are many hypotheses and many research results, which present a certain understanding of the effect mechanisms.

After the treatment, you rest for a short time while we make sure that you are feeling well, and after a few hours you are on your feet again.

It takes place in hospital

In most places you receive ECT treatment three times a week. The number of treatments required often ranges between six and twelve but sometimes it is necessary to give more ECT treatments. It very much depends on the individual.

The ECT treatment always takes place in a hospital, often in a psychiatric ward. In most cases, you would be admitted for one day. But it can happen that you receive your treatment as an out-patient and go home on the same day.

One of the doctors employed in the psychiatric ward will give you the treatment. A doctor or nurse from the Anaesthesia Department will give you the anaesthetic.

Severe depression

If you are suffering from severe depression with psychotic symptoms, we often recommend ECT. It is so painful and sometimes dangerous to be suffering from severe depression that we recommend this treatment even though you are nervous about ECT. Most of those who have received ECT would like to receive ECT again if they develop another depression.

We offer you ECT if you drink or eat so little that your situation is life threatening or if you have serious suicide thoughts. In certain cases ECT can be life saving. We also offer you ECT treatment if your antidepressant medicine hasn't had any effect.

Compulsion

In rare cases, we are forced to use compulsory ECT treatment. This is only considered an option in severe, life threatening depressions, which cannot be treated in any other way.

Some people with depression can feel such low self-esteem that they believe that the depression is a rightly deserved punishment. They therefore do not believe that the depression should be treated. Some patients can get so bewildered and capricious that they cannot make a decision on the question about receiving ECT treatment.

If ECT has to be given compulsorily, you need to have a patient adviser, and all the requirements of the law must be obeyed.

Effective

ECT is the fastest working and most effective treatment of depression. From testing the effect of ECT, it appears that between 70 and 90% of patients become well (with regard to the actual depressive episode). The corresponding figures for patients who are treated with medicine range between 50 and 70%.

The effect of ECT sets in after one to two weeks while the effect of a medicinal treatment sets in after two to four weeks.

Approximately 50% of those who have improved after the ECT treatment unfortunately have a relapse within 6 months. If we use both ECT and preventive antidepressants, the frequency of relapses is reduced.

ECT is therefore not a curative treatment. We always need to follow up the treatment with preventive treatment and monitoring.

Adverse effects

ECT is safe, but a number of patients do experience reduced short term memory after the treatment. Some don't have any adverse effects at all but some can have difficulties remembering events from the time during and around the ECT treatment. For most, the memory function returns to normal again after a few weeks.

A few can have problems for a few months but there is no scientific basis for permanent memory problems. Very few have experienced permanent memory problems. But whether that was caused by the ECT treatment is very uncertain.

Some patients can be confused immediately after the treatment. This confusion is short term and completely temporary. It disappears typically within a few hours.

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