Electroconvulsive Therapy

Typically, a course of ECT consists of a total of six to twelve treatments given over two to four weeks, with two or three treatments per week. All treatments are given under general anesthesia with patients being oxygenated and closely monitored. Once patients are asleep, they are given a paralyzing agent so that they can experience a seizure in their brain without motor convulsions. Two electrodes are then applied to the scalp and a brief controlled current is circulated from one electrode to the other through the patient's skull and brain. To minimize risks of confusion, treatment is usually initiated in older patients with unilateral ECT (i.e., with placement of both electrodes over the right-sided nondominant hemisphere). Regardless of electrode placement, a brief-pulse, square-wave current is now routinely used, since its efficacy is similar to a sine-wave current but it is less likely to induce significant adverse cognitive effects. Similarly, optimization of current intensity, based on a systematic determination of each patient's seizure threshold, has been shown to improve efficacy and to decrease cognitive impairment. ECT is typically discontinued once a patient's mood is back to baseline or when it reaches a plateau after two consecutive treatments. Once the acute course of ECT is completed, the majority of patients are given psychiatric medications to maintain their improvement and prevent relapses. In a small number of selected patients who exhibit a good response to ECT but relapse rapidly despite adequate continuation pharmacotherapy, the use of ECT can be continued. Typically, this consists of ECT given on an outpatient basis every two to four weeks for several months or years.