BIOLOGICAL THERAPIES FOR DEPRESSION – ELECTROCONVULSIVE THERAPY (ECT) ALICIA

WHEN IS ECT USED? - Generally used in severely depressed patients who have already tried psychotherapy and mediation but it has failed. - Also used for schizophrenic patients or those experiencing severe manic episodes. - Used when there is risk of suicide as it has quicker results than drugs do. -The National Institute for Clinical Excellence (2003) suggest that ECT should only be used when other treatments have failed or when the patients condition is considered life threatening.

THE USE OF ECT… An electrode is placed above the temple on the none dominant side of the patients brain and the second in the middle of the forehead (unilateral ECT). Alternatively, one electrode can be placed above each temple (bilateral ECT). The patient is injected with a short acting general anaesthetic so they are unconscious before the electric shock is given. They are also given a nerve blocking agent which paralyses the muscles so that they are unable to contract during the treatment. Oxygen is then given to the patient to help them breathe. A small amount of electric current (0.6 amps) lasting about half a second is then passed through the brain. This produces a seizure which can last up to a minute, affecting the entire brain. Usually given 3 times a week with the patient requiring between 3 and 15 treatments.

THE MECHANISM OF ECT… There is no explanation as to why ECT is effective but there is evidence that it is the seizure rather than the electrical stimulus that generates the improvements in depressive symptoms. The seizure is able to restore the brain’s ability to regulate mood. It may do this by enhancing the neurochemicals or by improving the blood flow in the brain.

THE EFFECTIVENESS OF ECT ECT vs ‘sham’ ECT Gregory et al (1985) compared ECT with ‘sham’ ECT and found significant difference in the outcome of favour of real ECT. It has been found to be effective in cases of treatment resistant depression (Folkerts et al 1997). However, Hussain (2002) showed no difference in response to ECT in treatment resistant depression. ECT vs antidepressants Scott (2004) carried out a review on 1144 patients comparing ECT with drug therapy in short term treatment of depression.

THE APPROPRIATENESS OF ECT Datto (2000) Side effects include impaired memory, cardiovascular changes and headaches. This can be supported by research by Rose et al (2003) who found that at least one third of patients complained of persistent memory loss after ECT. Weiner (1980) found general slowing of cognition following ECT that takes weeks to disappear. The Department of Health report (2007) found that among those receiving ECT within the last two years, 30% reported that it had resulted in permanent fear and anxiety.

Unilateral vs bilateral ECT Cognitive problems can be minimised by using unilateral ECT (this is where electrodes are placed on one side of the skull) rather than bilateral where electrodes are placed on each side). Sackeim et al (2000) have found that unilateral ECT is less likely to cause cognitive problems than bilateral ECT however, it may be just as effective.