Electroconvulsive Therapy (ECT) at Mount Sinai
Electroconvulsive Therapy (ECT) is a treatment for severe depression, typically prescribed after antidepressant medications have not been effective. The procedure, which involves applying an electrical stimulus to the brain, is a standard clinical treatment that has been extensively studied, significantly refined, and used for millions of people worldwide.
ECT has long carried a negative public image, fueled by outdated and sensationalized depictions in the media. In reality, improvements to ECT technique have made the procedure safer and comfortable for patients.
While it’s particularly useful as a geriatric treatment, ECT can help patients of all ages. The therapy is mainly indicated for people who are incapacitated by a type of depression so severe, it’s considered a life-threatening medical illness. Patients suffering from such serious depression are often unable to function and at high risk for suicide. For patients fitting this profile, ECT is the most effective acute antidepressant treatment available.
What to Expect During ECT Treatment
Under the leadership of Charles Kellner, MD, Professor of Psychiatry and Director of the Division of Geriatric Psychiatry, Mount Sinai provides ECT for both inpatients and outpatients. In fact, Mount Sinai is one of only a few hospitals in New York City where a full range of outpatient ECT is offered.
An acute course of ECT is intended to treat a serious episode of depression, and is continued until symptoms remit. In a typical acute course, the procedure is performed three times a week (normally Monday, Wednesday, and Friday) for two to four weeks, usually totaling 6-12 treatments.
On the day of the treatment, the patient comes to the hospital early in the morning, having fasted since midnight. The procedure itself takes 10-15 minutes, during which the patient receives general anesthesia and a muscle relaxant. Disposable electrodes are placed on one or both sides of the patient’s head, and an electrical stimulus is applied to the scalp, producing a brief, controlled seizure lasting approximately 45 seconds.
The treatment is administered by an integrated health care team consisting of a psychiatrist (who is the ECT attending doctor), an attending anesthesiologist, an ECT nurse, and recovery nurses. The patient is guided through the overall logistics of the treatment process by the ECT nurse coordinator.
Following a successful acute course of treatment, a patient may go on to receive maintenance ECT, a type of “booster” therapy that is typically given approximately once a month on an outpatient basis.
The Benefits of ECT
The typical remission rate (meaning the complete resolution of symptoms) with ECT is approximately 70 percent, which is more than twice the remission rate of first-line antidepressant medication. ECT is also a particularly fast-acting antidepressant therapy: Most patients experience improvement in symptoms within a week, and are feeling well within two to three weeks. Such quick response is important given the high risk of suicide among patients suffering from serious depression.
It is not uncommon for patients previously incapacitated by depression to undergo a course of ECT and reclaim their family roles, return to work and school, and re-engage in their favorite activities.
The Side Effects of ECT
As with any medical procedure, ECT carries its own set of risks, which need to be balanced against its benefits.
ECT has cognitive side effects, typically a small amount of recent memory loss. While the procedure doesn’t interfere with memory functioning, it may erase some newly-formed memories. For example, a patient undergoing a typical course of ECT lasting three weeks may not remember much of that three-week period (though some of those memories may eventually return).
ECT is one of the safest procedures performed under general anesthesia, and serious medical complications are extremely rare. Frequent, non-serious side effects include nausea (as a result of the anesthesia) and headaches.
Mount Sinai is currently co-leading the largest multicenter ECT trial funded by the National Institute of Mental Health. Called PRIDE (Prolonging Remission in Depressed Elderly), the trial seeks to study the optimal way of using ECT to treat geriatric depression.
Mount Sinai is also beginning collaborative studies to further refine ECT technique, optimize clinical application of the treatment, and elucidate its mechanism of action. Such studies are also hoped to provide information about the underlying brain abnormalities that lead to depression.