WHAT IS ECT?
You'll have heard about shocking people with electricity when they have gone into cardiac arrest to restart their heart. Well, the same basic principle can apply to mental illness. We call that Electro-Convulsive Therapy, or ECT, and there are two types; bilateral and unilateral ECT.
It was originally developed in the 1930s and was widely used in the 1950s and 60s for a variety of conditions. Nowadays it is less wide-spread and only used for specific illnesses.
Without putting too fine a point on it, ECT involves sending a small electric current through your head (both sides if it's bilateral, and only one if unilateral) in order to trigger an epileptic fit or seizure.
The idea is that it can relieve symptoms of severe depression and treatment-resistant depression.
It sounds serious, but you will be under a general anaesthetic and have been administered muscle relaxants, so the muscles will 'twitch' rather than sending you into full-on convulsions.
HOW DOES ECT WORK?
After having a physical examination and general anaesthesia, you will have an intravenous (IV) line inserted. You will then have small electrode pads placed on your head. Their location will depend on whether you're having bi- or unilateral ECT. You'll be glad to hear that, after the anaesthetic and muscle relaxants, you will out cold during the procedure.
The medical team will then pass an small electric current, via the pads, into your brain. This will trigger a seizure which will last less than a minute. You will be totally unaware of this, but your brain will go into overdrive.
This will be monitored by an electroencephalogram. Let's just call this an EEG. A few minutes later, the anaesthetic will begin to wear off and you'll start to wake up. You may be a little confused when you come around, but this will soon ease.
To be honest, Doctors aren't entirely sure 'how'' ECT works exactly, but the belief is that it improves the way the chemicals behave in your brain and help create new cells and neural-pathways to grow. These chemicals act as neurotransmitters, carrying messages around your head. Think Inside Out or the Numskulls.
WHO IS ECT FOR?
Electroconvulsive therapy, as mentioned above, is designed for those with severe depression, we're talking life-threatening-style depression. It should only be used when medication or other talking therapies haven't worked.
It can also be used to treat mania or catatonia (the condition, not the welsh pop group!). It can also be used to treat schizophrenia, although ECT for this condition rare and isn't recommended for most people.
ECT is a treatment that you have to agree to, even if you've been admitted to hospital under the Mental Health Act. If you're in a position where you lack the mental capacity to agree, then your Doctor needs another Doctor to agree.
They will need to sign a form known as a Part 4A Certificate. This second Doctor is known as a SOAD (Second Opinion Appointed Doctor). Before agreeing he or she must interview you, talk to your Doctor about the treatment you are undertaking and also speak to two further health care professionals who are involved in your treatment.
The SOAD will not be able to agree to ECT if you have made an advance decision to refuse it, or someone who has the authority to make medical decisions for you refuses treatment on your behalf.
An advance decision is a legally-binding decision that you can make beforehand should you lose the mental capacity to make decisions in your life. Within this document you will need to explain the treatments you do NOT want and when this decision would apply.
You can be administered ECT without consent, but only in very strict circumstances including emergency treatment, when there is a very real risk to your life or to stop you becoming even more ill. These would overrule an advance decision you may have made.
As with any treatment, the effectiveness of ECT is open to debate. The ECT Accreditation Service (ECTAS) did a survey in the mid 2000s and found that, of the people who had tried it, 72% said it was helpful, 20% said it had no effect, 14% said it changed or saved their life and only 5% said they would not want it again.