What is Electroconvulsive Therapy?
Electroconvulsive therapy is a psychiatric treatment that involves passing small electric currents through the brain to induce a brief seizure while the client is under anaesthesia. It changes brain chemistry to quickly reverse symptoms of mental health conditions.
Why is ECT done?
It is commonly used in patients with severe major depression or bipolar disorder that have not responded to other treatments such as psychotherapy and medications. In these cases, ECT is a valid and appropriate option.
ECT also provides rapid improvements in individuals with severe symptoms. ECT is used for the following mental conditions:
Severe and Treatment-Resistant Depression
- Especially when accompanied with psychosis (detachment from reality), suicidal ideation or refusal to eat.
Severe Mania
- Occurs as part of bipolar disorder.
- Other signs include impaired decision-making, impulsive behaviour, substance abuse, and psychosis.
Catatonia
- A lack of movement and communication
- Can be accompanied by agitation, confusion and restlessness.
- Associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
Agitation & Aggression in People with Dementia
- can be difficult to treat and negatively affect one’s quality of life.
If Medication or Therapy is Not Possible:
- During pregnancy, when medications cannot be prescribed to prevent harming the developing fetus
- In older adults who are unable to tolerate the side effects of certain drugs
- In people who prefer ECT over medications or other forms of treatment
Potential Risks of Electroconvulsive Therapy
ECT has been conducted safely and professionally by many trained professionals. However, there may be some risks involved:
Confusion
- You may experience some confusion following the treatment, which can last from a few minutes to several hours. In some rare cases, it may last several days or longer. It is generally more noticeable in older adults.
Memory Loss
- Some people have trouble remembering events that occurred before treatment (retrograde amnesia). You may also have trouble recalling events that occurred during the weeks of your treatment.
Physical Side Effects
- Some people experience nausea, headache or muscle ache after doing ECT. These generally can be treated with medications.
Medication Side Effects
- For any medical procedure that involves anaesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase.
Should you not be comfortable about this treatment modality, it is recommended to discuss the benefits, risks, and side effects with your clinician thoroughly.
FAQ
1. How do I know which is the right type of professional help to seek?
As a starting point, think about your needs and what you want to achieve out of the therapy process. Research and shortlist a few therapists that you feel can address the issues you have based on their specialisation. You may also approach a family doctor who can refer you to the relevant professionals.
2. When should I seek help?
There are different reasons why one might need psychotherapy [8]:
- Impacts from dealing with severe or long-term stress from a job or family situation, the loss of a loved one, or relationship or family issues.
- Experiencing symptoms with no physical explanation: changes in sleep or appetite, low energy, a lack of interest or pleasure in activities that you once enjoyed, persistent irritability, worry, or a sense of discouragement or hopelessness that won’t go away.
- A health care provider may suspect or have diagnosed depression, anxiety, bipolar disorder, post-traumatic stress disorder, or other conditions or symptoms that may be interfering with your life, and recommend psychotherapy as a first treatment or to go along with medication.
- You may be seeking treatment for a family member or child who has been diagnosed with a condition affecting mental health and for whom a health care provider has recommended treatment.
3. How would I know if my therapist and I are compatible?
The most important factor that influences a successful therapy outcome is the therapeutic alliance, or the bond between client and therapist. Therapists and clients work collaboratively, so the right match is important to allow the facilitation of change and growth. Therapy sessions should feel like a safe space for you to explore and work out your thoughts, emotions and behaviours, and provide feedback based on your experience, and a therapist facilitates that environment. Good “chemistry” with your therapist is critical, so do not be afraid to voice out your want to change a therapist. The process of therapy may not be easy and occasionally uncomfortable when revealing one’s own thoughts/ vulnerabilities, or working on adopting new sets of skills and adapting to different sets of mindsets. So you want to work with someone who you will be comfortable opening up and listening to.
4. What are some red flags to look out for during a therapy session?
Here are some red flags if a therapist is not a good fit:
- You feel judged for the values you hold or the life experiences you have
- You do not feel comfortable being honest and authentic
- Is too gentle or assertive for you — these are neither good nor bad traits, but each person responds differently to therapists’ personas and styles
- You feel that he/ she talks too much about himself/ herself without any therapeutic purpose
- You leave the session feeling lousy about yourself, without any actionable direction
- If he/ she encourages you to rely on him or her to get your needs met as opposed to guiding you to meet your needs independently (i.e., encourages dependency on the therapist.
These red flags might indicate a mismatch between treatment styles and what you are comfortable with. In those cases, it is okay to request for a change of therapist for your next session. That said, it is encouraged for you to be open about these with your therapist. Let them know during the session itself where possible what you find helpful/ unhelpful. Most therapists are open to adapting to your needs.
