Electroconvulsive Therapy (ECT)

Definition

Electroconvulsive therapy or the shock treatment is used to treat depression in clients who do not respond to antidepressants or those patients who have intolerable adverse reactions at administered therapeutic doses. Despite the controversy about the therapy, it is proven to be effective for certain patients. Many depressed (major) clients, particularly those with psychotic symptoms, don’t respond to medications but do respond to ECT.

Indications
Nowadays, ECT is not only used for major depression, but also for the treatment of:
  • mania (in bipolar disorder)
  • catatonia
  • quick relief for self-destructive behavior (suicide attempts)
ECT may only be indicated for the treatment of severely depressed clients that needs fast relief. Suicidal clients may be given ECT. Giving antidepressant medication may take weeks before the full effects to occur. That is an enough time for a self-destructive client to harm himself.
Can pregnant women undergo ECT?
Pregnant clients can also undergo an electroconvulsive therapy. The treatment poses no harm or injury to the fetus. Thus, pregnant self-destructive women may undergo ECT to provide quick relief of depression and self-directed violence. This prevents a fetus from suffering if an untreated the mother tries to hurt herself while waiting for the medication to take full effect.

Contraindications and precautions
ECT stimulates a seizure episode to occur, however it does not cause a seizure disorder and patient with a seizure disorder may undergo the therapy. No absolute contraindications are noted with ECT but a few conditions have been associated with morbidity and mortality rate which includes the following:
  • recent myocardial infraction
  • stroke
  • sever hypertension
  • presence of intracerebral mass

Mechanism of action
The therapy induces a therapeutic tonic seizure (a seizure where the person loses consciousness and has convulsions) which lasts for about 15 seconds. To do this, electrodes are applied to the head of the client which will deliver an electrical impulse in the brain that causes a seizure. It is believed that the shock intensifies brain chemistry to correct the chemical imbalance in depression (decrease serotonin and norepinephrine).
Frequency of treatment
A series of about 6-15 treatments are scheduled three times a week. Six treatments are needed to observe a sustained improvement of depressive symptoms. Maximum effect or benefit is achieved in 12 to 15 treatments.

Side Effects
  • Confusion or Disorientation
  • Fatigue
  • Headache
  • Short-term memory impairment (temporary)

Nursing Interventions
Before ECT
  1. Informed consent should be signed.
  2. NPO post midnight.
  3. Remove fingernail polish.
  4. IV line initiation.
  5. Administration of short-acting anesthetic.
  6. Administration of a sedative or muscle relaxant (succinylcholine).  Atropine is also given to decrease bronchial secretions which could block the airways during seizures.
  7. Let the client void before the procedure.
During ECT
  1. Place electrodes on the client’s head on one side (unilateral) or both (bilateral).
  2. Brain monitoring through electroencephalogram (EEG).
  3. Oxygen administration with an Ambu-bag.
After ECT
  1. When the client is awake, reorient the client.
  2. Obtain vital signs.
  3. Assess client for the return of gag reflex.
  4. Allow the client to eat (with a positive gag reflex).

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