Electroconvulsive Therapy (ECT)

ECT stands for Electro-Convulsive Therapy and is commonly used for patients who are resistant to medications and need electrostimulation to reset the brain’s activity. It is a highly effective, safe and evidence based procedure that uses brief, controlled electrical stimulus to produce therapeutic seizure like activity in the brain. This is thought to bring about changes in brain chemistry and promote other positive changes such as possible increase in Brain Derived Neurotrophic Factor (BDNF), that contribute toward quick relief of symptoms in patients. The procedure is performed while the patient is under general anesthesia.

ECT is a low-risk procedure offered in a highly monitored setting. At Baptist Health, our expertly trained psychiatrists use innovative technology and finely tuned equipment to administer electrical stimulation to the brain with continuous monitoring of cardiac and respiratory status in the safest setting possible.

ECT is recommended for people with:

• Severe depression, especially if there are life threatening conditions such as suicidal thoughts with a serious intent and failure to thrive where there is refusal to eat or catatonia
• Treatment resistant depression, when multiple medication trials failed
• Bipolar disorder, either in the manic or depressed phase, when medications only partially relieved symptoms
• Schizophrenia with severe psychosis or catatonia
• Psychosis and depression who are also pregnant

It is also a safe alternative for pregnant patients, who cannot tolerate a lot of medications

The number of treatments depends on your psychiatric condition, how quickly you respond to treatment and the clinical judgment of your psychiatrist. Most people need anywhere between 6-12 treatments to successfully treat their condition.

Treatments are usually given 2 to 3 times a week. Once you respond to the Acute Phase of the treatment, you move to the Maintenance Phase, which is a tapering dose of treatments over the course of 3 months. Some patients may need more or less treatments, depending on tolerance and efficacy.

The treatment occurs in the surgical space at downtown Baptist Medical Center Jacksonville, in the Post Anesthesia Care Unit (PACU) area. You will have at least 2 nurses monitoring you at all times, along with the ECT administering psychiatrist and the ECT anesthesiologist.

1. When you arrive to the PACU, you will be made comfortable in a medical bed and small sticking pads will be placed on your chest, leg, forehead, and behind your ear. These pads monitor brain activity, heart activity, oxygen saturation and blood pressure throughout the treatment. The nursing staff will also start an IV line for medications and fluids that you may need.
2. The team will review the anesthesia and ECT consents with you, and the anesthesiologist will provide you with two medications intravenously. One medication will put you to sleep and the other will relax your body muscles as we are looking for the seizure like activity only in the brain. The anesthesiologist will help you breathe by providing oxygen through a face mask. You will not experience any pain or discomfort during the procedure.
3. The physician will choose the lowest and most effective electric stimulus based on your age, body build and medical comorbidities, and you will receive the stimulus either bilaterally (both sides of the head) or unilaterally (one side of the head). This determination is made after a careful discussion with you.
4. Once we obtain an adequate seizure response, typically between 30 and 90 seconds, the treatment is complete.
5. The anesthesia medications wear off shortly after the treatment and you will slowly regain consciousness. You will be monitored by a recovery room nurse until you are fully oriented and your vital signs look stable.
6. You may receive additional medications if there is a concern for high blood pressure or if you have headaches or body aches.

ECT is generally safe but, like any medical treatment, there are known risks and side effects. These might include memory loss, cognitive impairment medical complications, and other physical problems as detailed below:

• Confusion - Some patients may experience confusion soon after the treatment. Typically, it only lasts a few minutes. Occasionally, it can last several hours. Rarely, it may last several days or longer. Confusion is more common in older adults.
• Memory loss - Some patients have trouble remembering events that occurred right before treatment and in the weeks or months before treatment. Rarely, patients have trouble remembering events from previous years. This condition is called retrograde amnesia. Patients may also have trouble recalling events that occurred during the weeks of your treatment. For most patients, this is small in magnitude and short-lasting. Many patients report their memory actually improves with ECT, as ECT treats the underlying psychiatric conditions that can contribute to poor short term memory and concentration.
• Physical side effects - Some patients experience nausea, headache, jaw pain or muscle ache. These can generally be addressed adequately with medications.
• Medical complications - As with any medical procedure that involves anesthesia, there are risks involved. For every patient requesting ECT, we obtain medical clearance to proceed with the treatment. Patients are advised not to eat anything after 8pm the night before the treatment.

For every patient requesting ECT, it is essential to obtain a medical clearance to proceed with the treatment.