Electroconvulsive Therapy (ECT)
Electroconvulsive therapy, or ECT, has been an effective procedure for many treatment-resistant mood disorder patients. It is typically used to treat depressed patients who fail to respond to antidepressants or TMS. At MUSC, clinicians have access to the latest equipment and are using the most effective evidence-based treatments. These newer forms of ECT aim to reduce the undesirable side effects associated with classic ECT, such as short-term memory loss or headaches.
Modern ECT is considerably different than the primitive "shock treatments." There are no paddles or violent convulsions. Patients are under anesthesia. A muscle relaxant called succinylcholine is administered to completely relax muscles. Soft electrode patches are placed on the face and temple. The new ultra-brief pulse unilateral ECT sends a series of low-voltage currents, and only to one side of the brain. The procedure lasts for a few minutes. Patients are awakened and are generally able to go home within an hour.
Patients typically receive about seven treatments spaced out over a period of two to three weeks. Some patients return for maintenance treatments. These might be one per week, or one per month or as infrequent as once per year. All patients respond differently. On average, 50 percent of even severely depressed patients show improvement.
The placement of the electrodes on the head has a significant effect on the outcome. The two most commonly used positions are bilateral and unilateral as shown below. Bilateral is more widely used presumably due to increased efficacy. However, bilateral ECT is also associated with greater cognitive side effects. Unilateral ECT requires greater electrical stimulation to have similar efficacy, but can still have fewer side effects (Sackeim et al., 2000).
At the Brain Stimulation Lab, ECT is administered clinically on a daily basis. You can get a prescription for ECT, and the costs are mostly covered by insurance. Often times, the Brain Stimulation Lab has ECT studies going on to test the efficacy of newer types of ECT. To find out more about clinical ECT at MUSC, please call 843-792-5716. To learn more about current ECT clinical trials, call William DeVries at 843-876-5141.