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Schizophrenia and Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is typically used to treat severe depression, but it occasionally is used for other mental illnesses such as schizophrenia. During ECT, an electric current is briefly applied through the scalp to the brain while the patient is asleep under general anesthesia, inducing a seizure.

 

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Why Is ECT Used?

ECT is one of the fastest and most effective ways to relieve symptoms in severely depressed or suicidal patients or patients who suffer from mania or other mental illnesses. ECT is generally used when severe depression is unresponsive to several or more medications or other forms of therapy, or when these patients pose a severe threat to themselves or others and it is dangerous to wait until medications take effect.  ECT is also often considered the safest and most effective treatment for mood disorders in women who are pregnant.   

In schizophrenia, ECT is often extremely effective for a subtype of illness called catatonia, where the patient may not speak, have periods of excitement, or appear motionless and have repetitive, unusual or rigid muscle movements.  ECT is also sometimes used for other core symptoms of schizophrenia, such as delusions, hallucinations, or disorganized thinking, but its use is less well-established than for the treatment of mood symptoms.

 

How Is ECT Performed?

Prior to ECT treatment, a patient is put to sleep using general anesthesia and given a muscle relaxant. Electrodes are placed on the patient's scalp and a finely controlled electric current is momentarily applied, which causes a brief seizure in the brain.

Because the muscles are relaxed, the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment and awaken minutes later, not remembering the treatment or events surrounding it. The patient is often confused for a short period after treatment. ECT is usually given up to three times a week for two to four weeks.

A course of ECT is usually followed by psychotherapy and medicine under a psychiatrist's care.

Controversy Surrounding ECT

ECT remains misunderstood by the general public even though it has been used since the 1940s. Many of the risks and side effects have been related to the misuse of equipment, incorrect administration, and improperly trained staff. There is also a misconception that ECT is used as a "quick fix" instead of long-term therapy or hospitalization. Unfavorable portrayals in movies or television shows and misrepresentation in media coverage have added to the controversy surrounding this treatment. In fact, ECT is safe and among the most effective treatments available for depression.

Making an Informed Decision About ECT

Before ECT is considered, you should discuss all available treatment options for your condition with your doctor. If ECT is recommended, you should receive a complete medical examination including a history, physical and neurological exams, an ECG (heart test), and lab tests. Your medication history should be carefully evaluated and monitored.

If you are considering ECT as a treatment option, be advised that it may provide temporary improvement but has a high relapse rate unless a medicine or other treatment is then used to prevent relapse. Many doctors advocate follow-up treatment that includes medicine or ECT given at less regular intervals, called "maintenance ECT." Short-term memory loss is the major side effect, although this usually goes away within a few weeks after treatment ends.

You should be educated and informed about ECT and any treatment prior to receiving it. Ask for educational materials and have an honest discussion with your doctor about ECT's potential benefits and side effects.

 

 

WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on February 13, 2014
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