March 3rd, 2005

Yellow head

All About ECT (Electro-Convulsive Therapy)

Even though I worked on the acute psychiatric ward right next to the ECT suite for years, I'd never actually seen the process until this week. Now I'm a student nurse rather than a health care assistant, I got the chance to observe the process as part of my training on Tuesday morning.

On Tuesday, the ward had two patients due to have the procedure and I went down with the second one, which was the depressed sixty year-old lady, who is the constant smoker I wrote about a few entries back. This poor lady is extremely retarded in her thinking, finding it very difficult to concentrate or even string a sentence together. She's suffering from an agitated depression, which means that she's very restless, not being able to sit still for more than a few minute. All she does on the ward is chain-smoke cigarettes, asking for one after another. We've been keeping her cigarettes in the office in an attempt to reduce her smoking to at least one every half an hour. When she's well, I'm told the chain-smoking lady hardly ever smokes at all.

The last time the Chain-Smoking lady had ECT she responded well, coming around after six sessions and revealing herself to be an articulate and witty woman, transformed by the treatment.

The procedure goes like this. The patient is asked to wear loose clothing or night clothes and to remove any jewellery or false teeth. The treatment takes only a few minutes. The anaesthetist gives the patient both an anaesthetic injection and a muscle relaxant. In the bad old days before people were given muscle relaxant, the fit could be so bad that it wasn't unknown for the patient to break a limb or even damage their spine.

The patient is given some oxygen to breathe as they go under.

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 appears to enhance the levels of a chemical called serotonin in the brain. Serotonin acts as a chemical messenger between brain cells and its increase seems to speed up brain activity and bring it back to more normal levels. Having said that, theories about how exactly ECT works abound with no definite conclusion. All that's known about the procedure for sure is that it does work in a majority of cases.

Watching the Chain-Smoking lady having the treatment was a little disturbing for me. The recently qualified nurse who'd escorted the patient down from the ward, declined to even look. There were a lot of people crowding around the patient. An anaesthetist, two doctors, the two ECT nurses, and even the patient's consultant psychiatrist was in the room.

The lady, who was out cold by this time, twitched a little when the ECT paddles were administered. However, having observed the treatment, the watching doctors believed that the fit hadn't been of a long enough duration, so another jolt was given. The psychiatrist who was reading the patient's notes, noticed that the lady had been given a tranquilliser the night before to aid her sleeping (she gets no rest, this poor woman), and he was less than pleased that this, as it can effect the ECT treatment, I was told.

Some of you readers may be cringing at what you're reading here, thinking the ECT process barbaric in this day and age. Which it is, of course, but if we could think of something better we'd use that instead. It's a terribly invasive procedure, but so is open-heart surgery. Should we stop using that too?

The risk of serious injury or death with ETC is rare and occurs in about one in 50,000 treatments, which is much lower than those reported for childbirth. There are side-effects. Some confusion and short term memory loss in the days following the treatment. These problems fade in time, although a few patients continue to have memory problems for several months.