Psychiatrist may used ECT to treat depression in select groups such as clients who do not respond to antidepressants or those who experience intolerable side effects at therapeutic doses ( particularly true for older adults ). ECT involves application of electrodes to the head of the client to deliver an electric impulse to the brain; this causes a seizure. It is believed that the shock stimulates brain chemistry to correct the chemical imbalance of depression.
Historically clients did not receive any anesthetic or other medication prior to ECT, and they had full-blown grand mal seizures that often resulted in injuries from biting the tongue to broken bones ( Challiner & Griffiths, 2000 ). ECT fell into disfavor for a period and was seen as “ barbaric. ” Today although ECT is administered in a safe and humane way with almost no injuries, there is still critics of the treatment. Clients usually are given a series of 6 to 15 treatment scheduled 3 times a week. Generally a minimum of 6 treatments is needed to see sustained improvement in depressive symptoms.
Maximum benefit is achieved in 12 to 15 treatments. Preparation of client for ECT is similar to preparation for any outpatient minor surgical procedure. The client is NPO after midnight, remove any fingernail polish, and voids just prior to the procedure. An IV is started for the administration of medication. Initially, the client receives a short-acting anesthesia so he or she receives a muscles relaxant, usually succinylcholine, that relaxes all muscles to reduce greatly the outward signs of the seizure ( e. g. , clonic, tonic muscle contractions ).
Electrodes are placed on the client’s head: one on the other side ( bilateral ), or both on one side of the head ( unilateral ). The electrical stimulation is delivered, which causes seizure activity in the brain that is monitored by an electroencephalogram ( EEG ). The client receives oxygen and is assisted to breathe with an ambu bag. He or she is generally begins to waken after a few minutes. Vital signs are monitored, and the client is assessed for the return of a gag reflex.
Following ECT treatment, the client may be mildly confused or disoriented briefly. He or she is very tired and often has headache. The symptoms are just like those of anyone who has a grand mal seizure. In addition, the client will have some short-term memory impairment. Following a treatment, the client may eat as soon as he or she is hungry and usually will sleep for a period. Headaches are treated symptomatically. Unilateral ECT results in loss memory for the client, but more treatments may be needed to see sustained improvement.
Bilateral ECT result in more rapid improvement but with increased short term memory loss. Studies regarding the efficacy of ECT are as divided as the opinions about its use. Some studies report that ECT is as effective as medication for depression, while other studies report only short-term improvement. Likewise, some studies report that side effects of ECT are short-lived, while others report they are serious and long-term ( Challiner & Griffiths, 2000 ).
PSYCHOTHERAPY. A combination of psychotherapy and medication is considered the most effective treatment of depressive disorders. There is no one specific type of therapy that is better for treatment of depression ( Rush, 2000). The goals of combined therapy are symptoms remission; psychosocial restoration; prevention of relapse or recurrence; reduced secondary consequences such as marital discord or occupational difficulties; and increasing treatment compliance.