Electroconvulsive Therapy (ECT)

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.

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 reputation is related to a lack of knowledge of current practices and is based on unfounded beliefs and old tales.

The technique most often allows patients to regain an unprecedented quality of life with few side effects.

The treatment involves applying an electrical stimulus to the surface of the skull under a short general anesthesia. This stimulation induces a seizure, always under anaesthesia, during which a powerful muscle relaxant is administered. It is the combination of the direct electrical stimulation of specific brain regions and the induction of a seizure that produces the therapeutic effect. This treatment is the focus of numerous scientific publications and its functioning is much better understood today.

ECT is completely painless — the patient is asleep throughout the entire procedure.

Who is ECT indicated for?

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.

Primary indications

• 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
• Schizophrenia that does not respond adequately to standard treatments. In this case, ECT is not used alone, but as a complement to drugs.
• Cases where antidepressants or antipsychotics are poorly tolerated or contraindicated

There is no age limit — ECT is suitable for young adults as well as elderly patients.

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.

ECT may be a long-term treatment, well-tolerated, with occasional booster sessions spaced at maximum intervals, but frequent enough to avoid relapses.

Treatment procedure

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.

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.

All ECT treatments are performed on an outpatient basis, without hospitalization, 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.

After each session, the patient must be accompanied and should under no circumstances drive or travel alone on public transportation on the same day.

ECT sessions are supervised by Dr Mall, specialised in interventional psychiatry.

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 well-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.

Risks and contraindications

Contrary to what is often reported, ECT is an extremely safe, highly studied and well documented 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.

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