If you are currently considering ECT for yourself or a loved one, you have likely exhausted all other forms of treatment. This is because electroconvulsive shock therapy is considered a treatment of last resort for those with medication and therapy-resistant depression. ECT has come a long way since it was first introduced in the 1930s. Patients are now anesthetized, given muscle relaxers and the length of electric shock is less than 60 seconds. Despite these advancements and continued success in treating depression, its use is still clouded by stigma and misperceptions, causing potential patients to have high levels of anxiety and fear. Getting accurate information will help you make the best decision and dispel any fears or misgivings. Here we will explore a list of questions for you to ask your psychiatrist when considering ECT.
1) Who makes the best candidate for ECT? Patients who are older, female, have melancholic depression or who are bi-polar often make the best candidates. You will want to know if there are any medical conditions that would preclude you from having ECT. Your doctor will explain what those are and why.
2) Are there less-invasive alternatives to ECT? While ECT is considered very safe and very effective, it is still a major medical procedure requiring general anesthetic. It would be wise to know if alternatives are available in your area. Transcranial magnetic stimulation (TMS) is one such procedure that is gaining in popularity and availability. Your doctor can tell you more.
3) How many treatments will I need? How long will the benefits last? ECT is not a “one and done” procedure. Patients typically require somewhere between six and 12 treatments. Also, periodic maintenance treatments may be required for some patients to retain benefits.
4) What kind of results can I expect? ECT is not a magic wand. The primary goal is to return you to your most recent highest level of functioning. That will be different for different people depending upon the severity and length of the depression.
5) How frequently do you perform ECT? Will you be the doctor performing the procedure? You want a doctor who has lots of experience, training and supervision for his or her work with ECT.
6) What are the potential short-term side effects? Long-term side effects? Most patients experience some short-term side effects including headaches (most often seen in people with a history of headaches), muscle soreness and memory loss. Your psychiatrist will be able to explain the list of side effects that may affect you and what you can do to mitigate them.
7) Do you use bilateral pulse stimulation or unilateral pulse stimulation? Bilateral stimulation involves both hemispheres of the brain whereas unilateral involves only one. Typically, patients respond better to bilateral pulse stimulation, requiring fewer treatments in the long run. Your doctor can explain what he or she uses and why.
You may want to print out this list of questions to take with you to your initial appointment. Feel free to add some of your own. No question is too insignificant or foolish to ask. If you have concerns, feel free to express them. A good psychiatrist will take the time to explain the answers and calm your fears. Armed with accurate information, you will be able to make the best decision for you or a loved one.
Neurostar (for information on transcranial magnetic stimulation)