Electroconvulsive therapy (ECT)

(ECT) was the first brain stimulation method established in psychiatric treatment, and thus, it exists long-standing experience with the procedure. It is a very effective treatment with rapid onset of action, especially in severe affective disorders. ECT is one of the most effective standard procedures in the treatment of treatment-resistant depression and other severe psychiatric disorders (catatonia, bipolar disorder, clozapine-resistant schizophrenia, schizoaffective disorder, etc.).

Effects of ECT

ECT has a broad spectrum of action and characterized by rapid and reliable onset of action. ECT has antidepressant and antimanic effects, as well as effects on catatonia. In treatment-resistant depression, ECT is still the most effective antidepressant treatment method with efficacy rates of 50-70%. In the presence of additional delusions, hallucinations or depressive stupor, ECT has a success rate of 82%. In accordance with the criteria of evidence-based medicine, a large number of national and international scientific studies have shown that ECT is a valid, effective and well applicable method.

Mechanism of action

In ECT, a seizure, which is triggered in a targeted and controlled manner (i.e. healing seizure) is considered to be decisive for the treatment effect. It causes numerous functional changes in the brain similar to those caused by permanent antidepressant medication. For example, the concentrations of hormones and neurotransmitters in the brain are favorably influenced and regenerative processes in the central nervous system are stimulated. ECT does not result in nerve cell death, but, on the contrary, it leads to growth of gray matter and new connections between neurons.

Procedure

Before ECT, each patient is given detailed information about the procedure, and comprehensive internal, neurological and anesthesiologic examinations are performed. An anesthesiologist separately provides patients with information about the short anesthesia, which is necessary several times during the treatment series. A specially trained team is present during each treatment (doctor of psychiatry and psychotherapy and doctor of anesthesiology). The treatment takes place in a specially equipped treatment room in the Department of Psychiatry and Psychotherapy. After induction of anesthesia, the patient sleeps for about 10 minutes and a short acting drug for muscle relaxation is applied. Breathing is monitored by the anesthesiologist and supported by mask ventilation. Subsequently, the doctor of psychiatry and psychotherapy induces a therapeutic seizure by electrical stimulation in the area of the head for a few seconds. Seizure duration is usually about 20-30 seconds and is continuously monitored by an EEG (electroencephalogram). Shortly thereafter, the patient wakes up again and is subsequently monitored in the treatment room and further in a room on the hospital ward. Since treatments take place in the morning, patients usually are able to get up at noon and participate in meals and their regular therapy program.

Risks and side effects

ECT is a safe procedure. Risks and side effects have been minimized over the decades through improved preparation and implementation and follow-up of patients. The risk of a serious complication is reported to be 1 in 50,000 treatments, no higher than the general risk of anesthesia for minor surgical procedures, such as tooth extractions. Comprehensive examination prior to anesthesia further minimizes the risks.
Undesired adverse effects of ECT may include transient headache and nausea, which are treated symptomatically when needed. Cognitive side effects such as impaired orientation, concentration and memory problems may occur, which completely remit after the end of treatment. Whereas anterograde memory deterioration (impaired ability to remember new memory content) usually resolve rapidly, i.e. after hours to a few days, impaired retrograde memory (memory content before ECT cannot be remembered) may persist for longer. Neuropsychological disorders occurring immediately after ECT (e.g., aphasia, apraxia, agnosia) are very rare, always remit and do not require treatment. Structural changes of the brain are not induced even by repeated applications of ECT.

Contact person:

Michael Junginger
Email:  michael.junginger@unimedizin-mainz.de

Registration:

Appointments for outpatient preliminary consultation can be booked via the university outpatient clinic for affective disorders.
Tel. 06131 17-734 or via
Email:   ambulanz.psychiatrie@unimedizin-mainz.de
Monday-Thursday, 9.00-13.00 and 13.30-16.00
Friday, 9.00–13.00 Uhr