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Electroconvulsive therapy (ECT) – barbaric or lifesaving?

About 18 months into my mental health career I started working full time in a psychiatric intensive care unit, where I was asked to assist with an ECT treatment. I just froze wondering if this was a new girl wind up because as far as I was aware, this sort of treatment was no longer carried out. Having stood, frozen, for long enough to realise that they were actually awaiting a response I readily agreed; if this was for real I wanted all the experience I could get. As I was preparing to go to the ECT suite I don’t mind admitting how worried I was, worried about what I was going to witness, worried about what my role in all this would be (would I have to tip the switch?) and worried if I would be able to make it through the procedure without passing out.

Now for those that are a little confused, ECT is electroconvulsive therapy, often referred to as electric shock treatment. If, like I was, you are unfamiliar with this treatment it may conjure up images from films such as One Flew Over the Cuckoos Nest, where you see a patient literally being electrocuted with body spasms, tongue waging, eyes rolling and body parts flying all over the place. Now despite my mental health experience, the only knowledge I had of ECT was what I had seen in these films and although embarrassed to admit it now, this is what I was expecting would happen to my patient.

In all honesty I didn’t think this still took place, let alone in an NHS hospital on my doorstep. In some ways I was right, this 1930’s treatment is rarely used today and only for a very small number of patients who have severe depression. By severe I mean the patient is so consumed by their depression that they become unable to look after themselves, unable to eat or drink, unable to move in some cases and are not responding to other treatments.

Nervously I escorted our female patient, Emily, to the ECT suite. We were greeted by a doctor who explained the procedure to Emily and it became clear my role was just to stand next to the bed and be a familiar face for morale support – phew, I could breathe again. Once Emily was ready and comfortable on the bed the procedure started.

First, the patient is given an anaesthetic and a muscle relaxant to put them to sleep, then an electrical current is passed through the brain using a specialist ECT machine – no big switch on the wall. This current causes an epileptic fit, but as I stood and stared with nervous anticipation at Emily, waiting for convulsions and violent banging, nothing happened. At first I was worried it wasn’t working and then I noticed that her toes were curling under and a slight twitch in her leg was taking place, but that was it. It was over so fast and I was amazed at how uneventful the whole procedure was. It was nothing like the movies.

Once Emily had come round there was no difference in her depressive state, to be honest I would say she was quieter and more drowsy than usual for the following couple of days. However after 8 treatments, Emily was like a different person, her depression had lifted, her child like “naughty behaviours”, including pinching people, had stopped, she spoke with more authority, class and knowledge about her work (all I can say is she is very high up in a very demanding, highly academic role) and all in all, was a totally different person. I couldn’t believe the recovery she had made, had I not witnessed the transformation with my own eyes I am not sure I would believe it.

ECT is usually given in a course of 6-8 treatments, with no noticeable difference occurring until 2-3 procedures have been undertaken, though in some rare cases as many as 12 will be carried out. It is still not exactly known how or why ECT works but it is believed that the ECT releases certain chemicals in the brain, altering the chemical imbalance that often causes severe depression. Due to the lack of clear understanding around this treatment and the way it is portrayed in horror films, there are a lot of misconceptions around its success. As I said earlier, I was expecting something totally different to what I witnessed – not a smoking ear in sight! Yet despite the success rate of ECT some people still believe that it is a barbaric treatment that belongs in the past, seeing it more as a punishment or torture device than a treatment, with possible side effects including damage to the brain and the mind.

Many patients who have had ECT often complain about memory loss following the treatment, they also have limited memory about the severity of their depression and the behaviours they displayed whilst in the depressive state, so the way they view the success of the treatment often differs from that of the doctors, nurses and loved ones. Having said that, some patients will request ECT if they have had it previously and feel themselves slipping into a depressive state again. When you think that 15% of people with severe depression will take their own lives it’s safe to say that ECT is a lifesaving treatment. I for one would agree to it, if the time came, would you?

****Names have been changed to maintain patient confidentiality and anonymity****

Comments

  • I’ve known two people who went through this procedure. As there aren’t many ‘perfect’ cure-alls, ECT has been frightening and not something either of them went into without much thought and professional input. In both cases, after all was said and done, ECT was beneficial. A life saver in one case.
    Terri, thank you for shedding light on a rather ‘taboo’ subject AND for dispelling abundant myths!

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