Electroconvulsive Therapy (ECT): Treating Severe Depression

– [Narrator] The brain
is the most complex organ in the human body. It controls almost everything, but sometimes imbalances
can disrupt normal function, causing any number of
abnormalities and ailments, including mood disorders,
such as depression. ECT is given to
treat depression, and it is sometimes used to
treat other mental illnesses, like catatonia, and
bipolar disorder, when other treatments
have not worked. – Electroconvulsive therapy
involves delivering electricity to the brain to cause
a generalized seizure, and then we do a
series of seizures over two to three times a
week over two to four weeks to treat the
psychiatric condition that brought the
patient into treatment. – [Narrator] The idea that
seizures would help depression came from observing
people with epilepsy. It was observed that
after an epileptic patient woke up from a seizure, the
individual was much calmer, and their behavior
was better controlled. – Essentially it’s
the brain’s response to its anticonvulsant or
its anti-seizure effect, may actually be the
therapeutic element. – [Narrator] But what
exactly is depression? – Depression is not simply
being sad or having a bad day. Depressing is a
medical condition that is a combination
of symptoms. – I would describe
depression as having kind of a great big
gray kind of over you, you feel very dull and heavy. – I was extremely tired a lot. I got increasingly bad tempered. It came on very quick,
and it was quite severe. I clearly was not myself. – My main problem was
depression presenting as anxiety and nervous tension. – I didn’t want
to talk to people, I didn’t wanna hang out anymore. I really became withdrawn. – [Narrator] Depression is
the primary mental illness that is treated with ECT. ECT is often recommended when
antidepressant medications are not effective,
or if they cause unacceptable side effects. – So it’s often used in patients that have tried some of
these other treatments and they haven’t responded well, and so we might go to
electroconvulsive therapy, ECT, to see if that
will work for them. – [Narrator] ECT is also
called for when a patient is dangerously
suicidal and can’t wait the two or three weeks
to see if the medication will be effective. – Before I knew what was
going on I was threatening to kill myself, and that
always gets doctors’ attention. And, my wife said
to me at one stage, I think we ought to go
to the emergency room. – [Narrator] Over the years, ECT has been
improved and refined. The popular novel and movie, One Flew Over the Cuckoo’s Nest, depicted ECT as
painful and inhumane. – The difference is they
used it in the movie as a punishment, very different
than the therapeutic version of ECT that we would do today. – [Narrator] A therapy
that is the best hope for many depressed people. – I really wanted
something that would work quickly and effectively, to
get me back into my life again. – I was really not surprised when they brought
up the suggestion. – Most patients
that come in for ECT need anywhere from
six to 12 treatments to get the full benefit. The number of treatments
an individual patient might need is kind of
dynamically determined based on how they’re
responding to the treatment, and some patients are better within three or four
treatments, and side effects, and so we try to make sure
we get the greatest efficacy with the fewest side effects. – [Narrator] Candidates
for ECT treatments are carefully screened to be
sure their heart is stable and that they are
otherwise healthy enough to go through the
procedure safely. ECT can be done on
an outpatient basis, but not everyone can
go home the same day. A patient will often stay
in the hospital overnight, especially if this is
their first treatment. – I felt that I
was well cared for. Everything was
explained to me well. – [Narrator] When an
outpatient arrives for their ECT treatment, they will arrive at
the Same Day Center, where they will check in. – [Paul] Almost always we
do it early in the morning, and so patients will show up
to the hospital around seven, 7:30 in the morning. – [Diena] I go into
the preparation room and change into
my hospital gown. – [Narrator] A nurse
takes vital signs, and an IV is placed
on the patient’s arm. The anesthesiologist
will use this to administer medications
during the procedure. – I wait for a little while
in the preparation room, and then a nurse
comes and wheels me into the Post
Anesthesia Care Unit, which is right outside
the treatment room. I wait very briefly,
and then am taken into the treatment room. – [Paul] We use a
medication to gently relax the muscles in the body,
so that you don’t get that physical movement. – [Narrator] The relaxant
lasts only a few minutes, and during this time, the patient will need
help with breathing. – And then we give oxygen, so
we make sure that the patient has all the oxygen they
need through the procedure. We’re just gonna give
you some medicine to make you real sleepy. All you have to do is just
keep taking those nice, big, big breaths all the way in, and then all the
way back out again. – [Narrator] Once the team
is sure that the patient is completely unconscious,
and will feel nothing, the procedure begins. – And the treatment involves
two electrodes essentially, that we put at different
places on the scalp. Electricity passes
from one to the other, that then causes the seizure. The seizure lasts anywhere from 30 to 60 seconds
in most cases. – [Narrator] The doctor
reads the EEG tape to ensure the seizure was
long enough and strong enough. – The amount of
electricity actually used to cause the
seizure is very low. You could be touching the
patient anywhere on the body and you would not feel a thing. – [Narrator] When the
doctor is satisfied and the treatment has
caused an adequate seizure, and the seizure is over,
the patient is wheeled into the recovery area. – About a minute or so later,
the patient’s breathing on their own, 10 to 15
minutes later they’re awake, typically oriented, and then
in another 30 to 60 minutes they are able to
leave the hospital. – [Narrator] Often, people
are groggy and confused from the treatment
and the anesthesia, so those who are going
home the same day need to arrange for
someone to drive them. These effects will
wear off quickly. – After my treatment,
I feel as though the heaviness has been lifted. – [Narrator] A patient
usually needs to have four or five treatments before
they start feeling better. Family and friends might
very likely see improvements before the patient
notices a change. – I didn’t notice an
improvement in my mood for I think at least till the
second or third treatment, and then I noticed
a small improvement and then a much larger
improvement after that. – [Narrator] But for
Dr. Richard Nordgren, he noticed a difference
after his first treatment. – Really did make
a big difference, sort of snapped me
out of my symptoms. – [Narrator] ECT does not
necessarily cure mental illness once and for all, a new
episode of depression may come along and require
separate treatment, with therapy,
antidepressants, or ECT. – Know that this works
very quickly for me, and completely, that, it’s
just a great treatment option. – [Narrator] ECT has one
important side effect that patients and family
should consider carefully. – Some patients will have
short term memory loss around the time of ECT, so
have a hard time remembering things that happened,
say, between treatments. Some patients will have
memory loss for things that happened to
them in the past, and so, something, some
event they went to, that they used to
remember very well, they may not remember it
as well as they used to. – [Narrator] These memories
may or may not return. Some additional common
side effects could include headaches, nausea,
and muscle aches, though these can be typically
managed with medication given during the procedure. – What really matters is I
feel reconnected to life, I feel like getting up, and
doing things, and seeing people, and just generally
being active and social. – [Narrator]
Electroconvulsive therapy is an aggressive treatment, recommended when other
treatments haven’t worked, or when a patient
needs immediate help. ECT has brought relief to
hundreds of thousands of people, and it saves lives, preventing
suicide and self neglect. Improvements in anesthesia,
muscle relaxants, and state of the art equipment, have made it a safe procedure, and have reduced the
degree of memory loss. Patients recover quickly, and ECT does not cause brain
damage or change personality. – For someone who would
be looking into ECT but still wasn’t quite
sold on the idea, I’d have them definitely
talk to their doctor. – Ask a lot of questions,
and listen to the answers, and talk to people
who have had it. – With ECT, you often
see 100% improvement, and that’s extremely
gratifying to sort of be able to get somebody from very
dysfunctional, not able to work, hardly able to get out
of bed, to back to, I want to go back to school, I want to go back to
work, I feel fine.

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