Electroconvulsive therapy (ECT)
Research at Lausanne Centre for Interventional Psychiatry
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What is ECT?
Electroconvulsive therapy (ECT), also known as sismotherapy, is the most effective treatment for all forms of depression, especially the most resistant and severe ones, as well as for bipolar disorder.
Its efficacy is superior to all drugs and other techniques currently available in psychiatry for these indications.
ECT is also indicated in cases of schizophrenia if the usual treatments are not sufficiently effective.
90% of patients with depression will have a significant improvement in their condition and 6 out of 10 will have a total resolution of their symptoms, even if no antidepressant had been effective before.
Although the treatment has been around for many years and was called “electroshock therapy”, the modalities of administration, safety, type of electric field used and side effects are totally different today. The main problem with this treatment has been its poor reputation, much more than its side effects. This poor image is linked to a lack of knowledge of current practices and is based on unfounded beliefs, misunderstandings, outdated stories and publications. While this treatment may have been misappropriated, as other medical techniques have been, its current use in psychiatry most often allows patients to regain an unprecedented quality of life with few side effects.
Treatment consists of applying an electrical stimulus to the surface of the skull under a short general anesthesia. This stimulation will induce a seizure, always under anaesthesia during which a powerful muscle relaxant is administered.
It is the combination of direct electrical stimulation of certain brain areas and the induction of a seizure that is responsible for the effectiveness of the treatment.
This treatment is the focus of numerous scientific publications and its mechanism, as well as the explanations for its effectiveness, are much better understood today.
ECT is totally painless, the patient is asleep during the entire procedure.
Who can benefit from ECT?
While ECT can be extremely effective in many situations, it is not a miracle treatment, and a thorough preliminary assessment will be essential in each case. As with any other treatments, a poorly set indication would only expose the patient to side effects.
ECT has shown significant effectiveness in:
– All forms of depressive episodes, particularly those resistant to treatment or particularly severe, with or without psychotic symptoms. It may be a complement or alternative to antidepressants.
– Depressive or manic episodes in the context of bipolar disorders. ECT can act as an antidepressant as well as a mood stabilizer and can sometimes help to limit or discontinue other treatments if they are poorly tolerated or not effective enough.
– Schizophrenia that does not respond adequately to standard treatments. In this case, ECT is not used alone, but as a complement to drugs.
– Cases in which antidepressants or antipsychotics are poorly tolerated or contraindicated.
ECT can be chosen by patients with depressive episodes, bipolar disorder or schizophrenia who wish to limit the use of medication.
There is no age limit, ECT is available for young adults as well as for elderly patients.
ECT is generally not effective in the following cases:
– Isolated anxiety, obsessive-compulsive disorder
– Addictions to substances (alcohol, cocaine, etc.)
– In case of some personality disorders, in particular borderline personality disorder
Is ECT effective?
ECT is the most effective treatment for all mood disorders (depressive episode, manic episode…) and is a very valuable supplement for resistant schizophrenia. ECT is a fast acting treatment, with far fewer side effects than usually imagined, that effectively stabilizes mood, that can suppress suicidal thoughts, psychotic symptoms and reduce the need for medication and inpatient stays.
In the case of resistant depression, 9 out of 10 patients will respond to the treatment and in 6 out of 10 cases the depression will be completely relieved within a few weeks.
ECT may be a long-term treatment, well-tolerated, with occasional booster sessions spaced at maximum intervals, but frequent enough to avoid relapses.
How is the treatment performed?
A first appointment with a psychiatrist specialized in interventional psychiatry will assess the indication for ECT during a preliminary check-up.
A pre-anaesthetic appointment will then be provided at the centre (LCIP), and additional tests may be required if needed to ensure that the ECT sessions are carried out in the best and safest conditions.
Regular clinical interviews will be systematically scheduled to monitor the clinical evolution with the patient and his relatives if he wishes and in collaboration with the usual treating medical doctors and therapists (general practitioner, psychiatrist, psychologist…).
All treatments are carried out exclusively on an outpatient basis in Lausanne, in a discreet and comfortable setting, specially designed and optimized for ECT. The patient will spend approximately 1 hour on site for each session. Accommodation and transport can be arranged if the patient wishes, with many comfortable hotels located nearby.
After each session, the patient, who may have some transient attention or concentration disorders, must be accompanied and should under no circumstances drive or travel alone on public transportation on the same day.
ECT procedures meet the highest standards currently available, for the technical aspect of interventional psychiatry as well as for anaesthesia and comprehensive integrated management of the patient. Each patient benefits from a highly personalized treatment for maximum effectiveness with minimal side effects.
How many sessions are required?
Initially 2 or 3 ECT sessions will be offered weekly, the objective being the total resolution of symptoms. It generally takes an average of 8 to 12 sessions (3 to 6 weeks) for this first phase (may vary depending on the patient).
Then, during the continuation phase, which generally runs for a period of 6 months, the sessions will be gradually spaced to avoid relapses. At the end of the continuation phase, discontinuation of treatment can be considered.
A maintenance phase can then be proposed for patients who request this. Over long term, it helps to avoid relpases and limit medication. One session every two months may be sufficient.
What are the side effects?
Despite statements that can often still be heard due to lack of knowledge, ECT does not cause brain damage. On the contrary, neuronal growth is promoted in some areas of the brain involved in depression. It is a very well documented technique that continues to be the focus of many scientific publications.
While the side effects are very different from those of drugs, ECT is often much better tolerated than drugs, especially in case of combinations or high dosages that can cause significant weight gain, heart problems, diabetes, dizziness and falls…..
After each ECT treatment, the patient will experience a period of confusion on awakening that will last approximately for 15 minutes, during which he will be under observation in the recovery room. Then, some fatigue may persist for a few hours.
Memory impairment is often the most feared adverse effect. While this is still the main side effect, its intensity and duration are far from what can sometimes be heard. This side-effect is systematically and regularly evaluated for each patient and is mainly experienced when sessions are close together in time. It varies from patient to patient and is welle-tolerated in the vast majority of cases. A modification of the treatment parameters will be provided if memory impairment is too uncomfortable.
Memory disorders are transient and patients will return to their normal level of performance most of the time when the sessions are spaced during the continuation phase.
In the case of long-term treatment, a large number of sessions do not increase the risk of cognitive disorders, dementia, brain damage or anaesthesia-related complications.
What are the risks and contraindications?
Contrary to what is often reported, ECT is an extremely safe, highly studied and well documented treatment.
The risk of mortality is the same as that for anaesthesia, and is about 1 in 15,000 patients or 1 in 100,000 sessions. This is why an extensive evaluation will be carried out before the start of treatment.
While there is no absolute contraindication for ECT, the benefit/risk will be discussed for each patient, particularly in relation to their overall health condition and the associated anaesthetic risk. Patients with pre-existing cardiovascular or respiratory disorders will often require more extensive investigations.
Is ECT reimbursed by insurance?
Electroconvulsive therapy (ECT) is fully covered by basic insurance in Switzerland.
For foreign patients, more information about costs and payment terms is available upon request.
Research at Lausanne Centre for Interventional Psychiatry
The Lausanne Centre for Interventional Psychiatry offers the most up-to-date treatments and protocols for all types of brain stimulation.
In order to better explain the mechanisms and effectiveness of ECT, to optimize its effectiveness and to better target patients likely to respond, we give a fundamental role to research and training for physicians and health professionals.
Involvement in research protocols, most often in partnership with academic hospitals, will be offered to most patients, without any obligation and on a voluntary basis.
This may include certain types of brain imaging, such as functional MRI, or cognitive tests (memory, attention, etc.)
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