18 April 2016

The truth about Electroconvulsive Therapy

WiltsECTteamIt's often considered a treatment from yesteryear and can be viewed as controversial, but what's the truth about Electroconvulsive Therapy (ECT) and its role in modern mental health care? Who better to tell us than one of the busiest ECT teams in the country?

What is ECT and why is it used?

ECT is a psychiatric treatment, always given under general anaesthetic, traditionally by doctors. It involves administering an electric stimulus through the brain to trigger a seizure. ECT was developed in Italy in the late 1930's by two psychiatrists researching schizophrenia, although the treatment has no impact on this illness.  

ECT is now used to treat people suffering from severe, disabling and often life threatening depression.

The treatment process

John Leyden, a national ECT senior nurse and manager of Wiltshire's ECT service, tells us a bit more about the treatment.

"All referrals come through community teams and Trust consultants" says John. "The decision to undertake ECT needs to be carefully considered. Treatment should only be prescribed for specific criteria, including those suffering from mania, catatonia or moderate to severe treatment resistive depression, often when a person's illness has become severely debilitating or is life threatening. Some patients are so ill they have stopped eating and drinking and in these cases ECT can be lifesaving."

It is important to complete the treatment course (routinely 6-9 treatments) with improvement generally noted after the 3rd or 4th treatment. ECT carries the same risk as other procedures carried out under general anaesthetic. The risks of treatment are weighed up against the benefits and the risk of not treating.

Patients and relatives are often anxious about the procedure, so a big part of the ECT team's job is to minimise their distress and anxiety. Once people equate feeling better with the treatment, they become less anxious.

After treatment

ECT has a 73% effectiveness rating and scores well considering the nature of treatment resistive depression. Relapse can happen and it is important that ECT ties in with other treatments to maintain improvement.

Side effects from treatment include post treatment headache and nausea, short term memory loss and disruption of autobiographical memory. Considerable work has gone into research over the last few years to improve equipment and minimise the side effects.

Innovators in the field

The Wiltshire ECT team (pictured) had an academic paper published in the Journal of ECT in December 2015, reporting on a successful pilot study of nurse administered ECT treatment. The subject remains under discussion but following this, our Trust may have the first ECT team worldwide to have nurse administered ECT.

The Wiltshire ECT team has been recorded as the most travelled in the country and has achieved an excellent accreditation rating for 3 years running. John has even been asked to sit on an expert panel at the Old Vic in London to answer questions and discuss ECT following a showing of Harold Pinter's play The Caretaker which features a scene about the treatment.







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