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Two separate items here. The first is the patient information leaflet of the Royal College of Psychiatrists- which may be reproduced so long as it is attributed to them, and is unaltered. The second is an extract from a leaflet produced by MIND UK, a mental health charity here in the UK.
The Royal College of Psychiatrists PATIENT FACTSHEET
ECT (ELECTROCONVULSIVE THERAPY)
Introduction
This leaflet will try to answer some of the questions you may have about
ECT. You may wish to know what is ECT? Why is it used? What is it like to have
ECT and what the risks and benefits may be?
When you are depressed, it is often quite difficult to concentrate. Don't be concerned if you can't read through all of the leaflet. Just pick out the sections that seem important at the time, and come back to it later. You may wish to use it to help you ask questions of staff, relatives or other patients.
Why is ECT used?
Most people who have ECT are suffering from depression. Although we have
tablets for depression some people do not recover completely and others take
a long time. ECT is often used for these patients. In severe cases of depression
ECT may be the best treatment and it can be life saving.
Why has ECT been recommended
for me?
ECT is given for many reasons. Some of the commoner ones are listed below.
If you are not sure why you are being given ECT, don't be afraid to ask. It's
sometimes difficult to remember things when you are depressed, so you may need
to ask several times.
ECT is most commonly used to treat severe depression It may be helpful if you can't take anti-depressant drugs because of the side effects
It may help if you have responded well to ECT in the past
It may be helpful if you feel so overwhelmed by your depression that it's difficult to function at all.
What will actually happen when
I have ECT?
For the treatment, you should wear loose clothes, or nightclothes. You will
be asked to remove any jewellery, hairslides or false teeth if you have them.
The treatment takes place in a separate room and only takes a few minutes. Other patients will not be able to see you having it. The anaesthetist will ask you to hold out your hand so you can be given an anaesthetic injection. It will make you go to sleep and cause your muscles to relax completely.
You will be given some oxygen to breath as you go off to sleep. Once you are fast asleep, a small electric current is passed across your head and this causes a mild fit in the brain. There is little movement of your body because of the relaxant injection that the anaesthetist gives. When you wake up, you will be back in the waiting area. Once you are wide awake, you will be offered a cup of tea.
What will happen immediately
before the treatment?
An ECT treatment involves having an anaesthetic. You will need to fast (have
nothing to eat and drink) from about midnight the night before each treatment.
This will involve having no breakfast on the morning that you have ECT.
How will I feel immediately
after ECT?
Some people wake up with no side effects at all and simply feel very relaxed.
Others may feel somewhat confused or have a headache. There will be a nurse
with you when you wake up after the treatment to offer you reassurance and make
you feel as comfortable as possible.
How does ECT work?
During ECT a small amount of electric current is sent to the brain. This
current produces a seizure which affects the entire brain, including the centres
which control thinking, mood, appetite and sleep. Repeated treatments alter
chemical messages in the brain and bring them back to normal. This helps you
begin to recover from your illness.
How well does ECT work?
Over 8 out of 10 depressed patients who receive ECT respond well making ECT
the most effective treatment for severe depression. People who have responded
to ECT report it makes them feel "like themselves again" and "as if life was
worth living again". Severely depressed patients will become more optimistic
and less suicidal. Most patients recover their ability to work and lead a productive
life after their depression has been treated with a course of ECT.
What is a course of ECT?
ECT is usually given two or three times a week. It is not possible to say
exactly how many treatments you may need. Some people get better with as few
as two or three treatment sessions, others may need as many as twelve and very
occasionally more.
What ECT cannot do?
The effects of ECT will relieve the symptoms of your depression but will
not help all your problems. An episode of depression may produce problems with
relationships, or problems at home or at work. These problems may still be present
after your treatment and you may need further help with these. Hopefully, because
the symptoms of your depression are better, you will be able to deal with these
other problems more effectively.
What are the side effects of
ECT?
Some patients may be confused just after they awaken from the treatment and
this generally clears up within an hour or so. Your memory of recent events
may be upset and dates, names of friends, public events, addressees and telephone
numbers may be temporarily forgotten. In most cases this memory loss goes away
within a few days or weeks, although sometimes patients continue to experience
memory problems for several months. ECT does not have any long term effects
on your memory or your intelligence.
Are there any serious risks
from the treatment?
ECT is amongst the safest medical treatments given under general anaesthesia,
the risk of death or serious injury with ECT is rare and occurs in about one
in 50,000 treatments. For example, this is much lower than that reported for
childbirth. Very rarely deaths do occur and these are usually because of heart
problems. If you do have heart disease, it may still be possible for you to
have ECT safely with special precautions such as heart monitoring. Your doctor
will ask another specialist to advise if there are grounds for concern.
What other treatments could
I have?
Anti-depressant drugs may be available to treat your particular condition
and it is possible that some of them may work as well as ECT. The advantage
and disadvantages of other treatments should be discussed with you by your doctor.
Will I have to give my consent?
Can I refuse to have ECT?
At some stage before the treatment, you will be asked by your doctor to sign
a consent form for ECT. If you sign the form, you are agreeing to have up to
a certain number of treatments (usually 6). Before you sign the form, the doctor
should explain what the treatment involves, and why you are having it, and should
be available to answer any questions you may have about the treatment.
You can refuse to have ECT and you may withdraw your consent at any time, even before the first treatment has been given. The consent form is not a legal document and does not commit you to have the treatment. It is a record that an explanation has been given to you and that you understand to your satisfaction what is going to happen to you. Withdrawal of your consent to ECT will not in any way alter your right to continued treatment with the best alternative methods available.
Very occasionally there are patients who are seriously ill - suicidal, convinced that they are too wicked to be treated, eating and drinking too little to stay alive for much longer.
ECT may be given to patients without their consent under a Section (3) of the Mental Health Act. Even so, an independent psychiatrist, sent by the Mental Health Act Commission, must agree that the treatment is necessary.
Are there any risks in not
having ECT as recommended?
If you choose not to accept your doctor's recommendation to have ECT, you
may experience a longer and more severe period of illness and disability than
might otherwise have been the case. The alternative is drug therapy which also
has risks and complications and drug treatment is not necessarily safer than
ECT.
The Royal College of Psychiatrists
April, 1993 (The above handout may be copied so long as it is copied in
full, and is attributed to the Royal College of Psychiatrists, London.)
on ECT
MIND (National Association for Mental Health (UK)) have given permission for us to reproduce the first three sections of this booklet here:
The Right to Know and Give Informed Consent
MIND believes, in accordance with current legisla-
tion, that people have the right to make an informed
decision on which of a number of treatment options
to pursue and on whether or not to accept the treat-
ment the doctor suggests. In order properly to
consent to a particular treatment, people need infor-
mation to enable them to weight up, in the light of
available evidence, the benefits versus the risks.
In MIND's survey of service users, Experiencing
Psychiatry (available from MIND Mail Order), only
14 per cent of people who had ECT had been given
any information about it and only nine per cent re-
member being told of any adverse effects.(1) In MIND's
recent consultation with older women, no woman was
told the risks associated with ECT. On other as-
pects - the purpose of treatment, what it involves and
the right to refuse, some women were informed and
others not.(2)
In a study of patient perceptions of ECT in one
hospital, almost half the patients who had ECT
thought they could not refuse it and some did not
know whether they could refuse or not. Forty-five per cent
knew that it was possible to refuse but often com-
mented that it was futile to do so as they would end
up getting it anyway. Older people and women were
the least aware of their rights.(3)
For more information about ECT and consent
and details of circumstances in which ECT can be
given without consent, see p.22.
(c)MIND 1995
(1) A Rogers, D Pilgrim and R Lacey (1993). Experiencing
Psychiatry. Macmillan
(2) A Cobb (1995). Older Women and ECT. MIND.
(3) K Malcolm (1989). 'Patients' perceptions and elctrocon-
vulsive therapy'. Psychiatric Bulletin 13. Quoted in: A Cobb
(1993). Safe and Effective? MIND.
Why is ECT so Controversial?
In electro-convulsive therapy (ECT) an electric cur-
rent is passed through the anaesthetized person's
brain so as to produce a seizure (fit), with the aim of
relieving severe depression. It is the most controver-
sial treatment in modern psychiatry. No other form of
treatment has generated such a heated public de-
bate. On the one hand, critics of ECT describe it as a
crude tool of psychiatric oppression and on the other,
its advocates defend it as an effective life-saving
treatment.
There is a polarisation of views amongst people
who have had ECT as to its helpfulness. Almost half
(48.5 per cent) of the people in Experiencing Psy-
chiatry had it, and of these 43 per cent reported
it as helpful or very helpful and 37 per cent reported
it as unhelpful; or very unhelpful.(1) See Users' Views
on ECT on p.17 for a more details discussion of
people's reasons for liking or hating this treatment.
Many psychiatrists are convinced that ECT is an
effective treatment for seriously depressed people for
whom no other treatment is effective or available.
They would argue that it is a suitable treatment when
it is important to have an immediate effect because,
for example, the depressed person has been refusing
food and drink and is in danger of kidney failure.
Controversy rages because there are very differ-
ent opinions about:
* how precisely ECT works;
* whether it is always genuinely used as a treatment
of last resort;
* how effective it is in treating severe mental distress
and preventing suicide;
*the adverse effects of this treatment such as
memory loss and increased psychological distress.
(1) A Rogers, D Pilgrim and R Lacey (1993). Experiencing
Psychiatry. Macmillan
(c)MIND 1995
What is ECT used for?
Historically, ECT has been used to treat all types of
mental distress. It is now most commonly used to
treat severe depression and it is also used to treat
mania, schizophrenia and neuropsychiatric condi-
tions such as epilepsy and Parkinson's disease.
Only two or three per cent of patients receiving
ECT are now given it for mania. The Royal College of
Psychiatrists' ECT Handbook states that ECT may
occasionally be the treatment of choice for severely
manic patients and the ECT should be considered for
less disturbed manic patients who have a slow or
inadequate response to drug treatment. The ECT
Handbook states that 'the growing concern about the
side-effects of neuroleptic drugs and high-dose treat-
ment regimes has prompted a reappraisal of the role
of ECT in schizophrenia.(1) It recommends that ECT
should be limited to patients who are unable to toler-
ate, or respond poorly to neuroleptic drugs and when
psychotic symptoms are found in association with
affective symptoms (mood disorder) and/or altera-
tions of motor behaviour (agitation or immobility).
The ECT handbook states that 'ECT is unlikely
to be effective in the treatment of obsessional com-
pulsive disorders, but that ECT may be of benefit to
some patients with both obsessive-compulsive and
depressive symptoms.'(1)
(1) C P Freeman (ed) (1995). The ECT Handbook - The
Second Report of the Royal College of Psychiatrists' Special
Committee on ECT.
(c) MIND 1995 Reproduced with permission.
MIND (National Association for Mental
Health) Granta House, 15-19 Broadway, London United Kingdom E15 4BQ
telephone: +44(0)181-519-2122.