Electroconvulsive Therapy (ECT)

Effective Treatment for Challenging Disorders

Thanks to advancements in technology, people suffering with certain severe behavioral health problems now have access to safe, effective and compassionate treatment with the use of electroconvulsive therapy (ECT).

Endorsed by the American Psychiatric Association as a safe treatment for certain mental illnesses, ECT uses electrical stimulation in the brain to alter chemistry and reduce harmful symptoms caused by various conditions. While ECT is often used to treat severe depression when patients no longer respond well to psychotherapy and medications, it is also a valuable treatment for a variety of other psychiatric and neurological conditions.

At Providence Milwaukie Hospital, ECT treatment is provided by a team of board-certified physicians credentialed in electroconvulsive treatment, with the assistance of anesthetists and registered nurses for pre- and post-recovery care.

Behavioral health issues that may benefit from ECT include major depression, bipolar disorder, schizoaffective disorder, catatonic disorder, schizophrenia and other functional psychoses.

How does ECT work?
Essentially, electroconvulsive therapy involves restructuring the brain’s neurochemistry by inducing a seizure. Once referred to for ECT, patients and their loved ones receive thorough education about what to expect. The procedure is handled the way many other hospital procedures are, with specific instructions, a review of medications, intravenous (IV) therapy and anesthesia. Patients are not restrained, there is no pain and the procedure is over in a matter of minutes.

Patients undergoing the treatment receive a medication to relax their muscles so the seizure does not affect their bodies, but is limited to brain activity only. The physician delivers the tiniest amount of electricity to the appropriate area of the brain; after just two to three seconds, the seizure is induced and the electricity is stopped. Then the brain carries out the seizure for about 20-40 seconds. All the while, a computer is mapping the length and intensity of the seizure. In three to four minutes, the anesthesia wears off and the patient begins to wake up and receives one-on-one care from a nurse. Patients usually return home with a loved one within an hour and a half of their arrival.

For more information, to make a referral or to schedule a consultation, please call our admission coordinator at 503-513-1410.

Frequently Asked Questions about Electroconvulsive Therapy (ECT)

What is Electroconvulsive Therapy?
Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. ECT is a safe and very effective treatment for certain psychiatric disorders. ECT is most commonly used to treat patients with depression. In addition, ECT may also be used to treat patients with major depression, bipolar disorder, schizoaffective disorder, catatonic disorder, schizophrenia and other functional psychoses.

Why ECT at Providence Milwaukie Hospital?
Providence is committed to expanding mental health service needs for our patients. Many people struggle every day with common symptoms of depression which may include feelings of sadness, lack of pleasure in activities, changes in appetite or sleep, concentration difficulties, hopelessness, and thoughts of suicide. Patients are typically referred when medications and psychotherapy are not providing sufficient relief or if side-effects are intolerable. We strive to provide for these patients, especially the poor and vulnerable in support of our Mission.

What types of insurance are accepted?
We accept most commercial insurance plans as well as traditional Medicare, replacement and supplement Medicare insurance plans.

Why does it work?
No one is sure how ECT helps certain psychiatric disorders. It may promote changes in how brain cells communicate with each other at synapses and it may stimulate the development of new brain cells. ECT may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in conditions like depression and schizophrenia.

When is it used?
People with major depression typically first receive antidepressant medication and psychotherapy. These treatments, though often effective, take time to work. This delay can be dangerous for patients whose depression is accompanied by delusions (false beliefs) or intense suicidal thoughts. ECT can work much more quickly than antidepressants and is useful when patients are at immediate risk for self-injury or suicide.

ECT may also be prescribed when antidepressant medications have not worked. It can be useful for older patients who are unable to tolerate antidepressants and for pregnant women in whom medication might damage the fetus. People suffering from bipolar disorder, schizoaffective disorder, catatonic disorder, schizophrenia and other functional psychoses may also benefit from ECT.

What happens during a procedure?
Before ECT, patients are asked not to eat or drink from midnight the night before treatment.     During the procedure, the patient receives a short acting anesthetic agent which puts the patient to sleep for approximately 5-10 minutes. A muscle relaxant is also used during the procedure to stop the patient’s muscles from moving during the seizure. Cardiac monitoring pads are placed on the patient’s chest to check on the cardiac status during and after the procedure. Four electrodes are placed on specific areas of the patient’s head. Two electrodes of these electrodes are for monitoring the brain waves. The other two are for delivering a short, controlled set of electrical pulses for a few seconds. The electrical pulses must produce a generalized seizure to be effective. Because patients are under anesthesia and have taken muscle relaxants, they neither convulse nor feel the current.

Patients awaken about 5 to 10 minutes after the end of the treatment. Patients are then moved to the recovery room and remain there until their blood pressure, pulse and breathing return to their pre-treatment levels. Usually this takes about 20 to 25 minutes.

Patients who are given ECT on an outpatient basis must have someone drive them home after the procedure and stay with them until they go to sleep at night. People should not drive in the 24 hours following ECT.

How long is a procedure?
A single ECT session usually lasts one hour. This includes the time the patient will be in the treatment room (approximately 15-20 minutes) and the time spent in the recovery room (approximately 20-30 minutes). Typically, ECT (whether inpatient or outpatient) is given two to three times a week for a total of six to twelve sessions. Some patients may need more or fewer treatments. These sessions improve depression in 70 to 90 percent of patients, a response rate much higher than that of antidepressant drugs. Although ECT is effective, its benefits are short-lived. For this reason, patients take antidepressant medication after ECT or may continue receiving ECT periodically to prevent relapse.

What are the side effects?
The immediate side effects of the procedure which may last for about an hour include:

  • Headaches
  • Nausea
  • Muscle aches and soreness
  • Disorientation and confusion

Patients may also develop memory problems. Memories formed closer to the time of ECT are at greater risk of being lost while those formed long before ECT are at less risk of being lost. The ability to form new memories is also impaired after a course of ECT treatments but this ability usually makes a full recovery in the weeks and months following the last treatment.

Does it cause permanent brain damage?
No. This is a frequently asked question and a major concern to most patients. Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction. In fact, ECT often improves the cerebral functioning of patients with severe depression. By treating the depression, patients often report that they are able to concentrate better and think more clearly. During the course of ECT, we recommend that important decisions be delayed or postponed until after recovery. If any important decisions must be made while receiving ECT, we suggest that family, friends and the treatment team be consulted.

How do I make a referral?
For more information, to make a referral or to schedule a consultation, please call our admission coordinator at 503-513-1410.