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ECT and Other Procedures for Schizophrenia

Reviewed by Smitha Bhandari, MD on February 21, 2021

If you have schizophrenia, your psychiatrist or psychologist probably began your treatment with psychotherapy and medications. But sometimes medications are not successful enough in controlling hallucinations and other symptoms of schizophrenia.

In that case, your doctor may recommend brain stimulation therapy to support or replace medications. This type of therapy tries to either stimulate or ease certain brain activity with electrical impulses (which are either carried to electrodes in your body or generated by magnetic fields applied to your head). The best known and longest-used is electroconvulsive therapy (ECT), but any of several other therapies may be recommended. Common stereotypes about brain stimulation therapy are not realistic, so if you’re worried about things you’ve heard about these therapies, be sure you get the facts from your doctor.

Electroconvulsive Therapy (ECT)

ECT is most commonly used to treat depression, but doctors also recommend it to help with schizophrenia. Compared with medications, it starts to work faster (often within a week), especially with older people. ECT can reduce chances of relapse as long as you undergo follow-up treatments. In one study, 77% of people with schizophrenia responded favorably to ECT.

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Before an ECT treatment, you’ll get a general anesthetic and a muscle relaxant to keep you from moving during the procedure. A medical team monitors your breathing, heart rate, and blood pressure throughout.

Electrodes are placed at precise locations on your head. For about a minute, a small electric current passes from electrodes into your brain and intentionally triggers a seizure. Thanks to anesthesia, you shouldn’t feel pain or even be aware of electrical impulses. You awaken a few minutes after the treatment. Any grogginess typically wears off after an hour.

Usually, ECT treatments are given about three times weekly until symptoms subside. Then, ECT might be needed as often as once a week or as infrequently as every few months to help prevent symptoms from returning. Your psychiatrist may also prescribe medication for your schizophrenia during this time.

Side effects of ECT treatments that affect your mental alertness are usually mild and brief. The most common are:

  • Confusion, usually lasting from a few minutes to a few hours afterward
  • Temporary memory loss, which could involve events just before ECT or those during the weeks of treatment
  • Physical discomforts like headaches, muscle aches, nausea, jaw pain, or an upset stomach

Transcranial Magnetic Stimulation (TMS)

Medical researchers who looked back over 15 years of treatment concluded TMS (sometimes called repetitive TMS, or rTMS) can be effective in treating schizophrenia symptoms, especially hallucinating sounds.

You won’t need anesthesia with TMS treatment. During the procedure, you’ll have an electromagnetic coil held against your forehead, near a part of your brain involved with mood regulation. Then, short electromagnetic pulses are sent from the coil into your brain. In turn, these pulses trigger small electrical currents that stimulate nerve cells in that part of the brain.

A session of TMS usually lasts 30 to 60 minutes. You may feel a slight knocking or tapping sensation in your head as pulses are administered. Some doctors favor TMS treatment because it focuses on a more specific area of your brain than ECT can, which minimizes side effects.

Those side effects can include:

  • Mild to moderate headaches or scalp discomfort
  • Tightening of or tingling in muscles of your scalp, jaw, or face during treatment
  • Brief lightheadedness
  • Ear issues caused by the machine’s sounds (earplugs can help)

Deep Brain Stimulation (DBS)

DBS involves a type of brain surgery reserved for people who can’t control symptoms with medications. Before surgery, doctors do tests to make sure the procedure is appropriate for you. They’ll also use an MRI or other brain-imaging study to map the area of your brain where electrodes will be implanted.

During surgery prep, you’ll have your head shaved. You may be kept unconscious throughout brain surgery with general anesthesia or stay awake with a local anesthetic used on your scalp. A sturdy frame will hold your head to prevent movement during surgery. For the second part of the procedure -- chest wall surgery -- you receive general anesthesia.

The surgeon drills two holes into your skull and inserts slender tubes, through which electrodes are placed on either side of a particular part of your brain. During the chest wall operation, the surgeon attaches wires to those electrodes, which connect to battery-operated generators implanted in your chest. Starting a few weeks after surgery, the generator is activated to send electrical pulses to the electrodes. Those pulses can be continuous, or you can turn them off at certain hours.

As with any surgery, DBS carries certain risks, such as:

  • A stroke during the procedure
  • Infection
  • Feelings of disorientation or confusion
  • Involuntary movements or mood changes
  • Lightheadedness

Vagus Nerve Stimulation (VNS)

VNS also involves surgery, which your doctor may recommend if medications or ECT haven’t proved effective. It can be done on an outpatient basis, but you may need to stay in a hospital overnight instead.

Before surgery, you may need to stop taking medications and avoid eating the night before. You also get a physical exam and blood tests, and you may take antibiotics to help prevent infection during surgery.

Surgery normally takes about 90 minutes. You either get general anesthesia and stay unconscious throughout or get a local anesthetic and stay awake.

Your surgeon makes two cuts (incisions): one on your chest or armpit and the other on the left side of your neck. Then, they implant a stopwatch-sized device called a pulse generator in your chest. That device is connected to a wire, which the surgeon then connects to a long nerve running from your brainstem to your chest and abdomen. A few weeks after surgery, your doctor activates the pulse generator to deliver electrical impulses (of different durations and frequencies) to the nerve, which in turn sends messages to your brain.

A VNS procedure comes with risks, such as pain around the surgical cuts, infection, and temporary paralysis of your vocal cords. Some possible side effects are:

  • Hoarseness and voice changes
  • Throat pain and difficulty swallowing
  • Coughing
  • Headaches

Magnetic Seizure Therapy (MST)

MST is similar to TMS in that it uses magnetic pulses rather than electricity. But like ECT, it is intended to trigger a seizure, so general anesthesia and a muscle relaxant are needed. MST is in early stages of testing for mental disorders, but medical researchers are encouraged with initial results. Side effects are similar to those with ECT, but go away sooner.

Understand Your Options

The different brain stimulation therapy options for treating schizophrenia vary a lot in technique and history. Do research on your own and ask your doctor lots of questions as you craft a treatment plan that best fits your circumstances.

WebMD Medical Reference

Sources

SOURCES: 

Cleveland Clinic: “Schizophrenia.”

Mayo Clinic: “Schizophrenia.”

Current Opinion in Psychiatry: “Electroconvulsive therapy (ECT) in schizophrenia: a review of recent literature.”

Mayo Clinic: “Electroconvulsive therapy (ECT).”

American Psychiatric Association: “ECT Effective for Treatment of Schizophrenia.”

Dana Foundation: “Tackling Schizophrenia’s Symptoms with Transcranial Magnetic Stimulation.”

Innovations in Clinical Neuroscience: “Efficacy of Transcranial Magnetic Stimulation (TMS) in the Treatment of Schizophrenia: A Review of the Literature to Date.”

EBioMedicine: “Deep brain stimulation in treatment resistant schizophrenia: A pilot randomized cross-over clinical trial.”

Brain & Behavior Research Foundation: “Progress is Reported on Research Exploring Use of Deep-Brain Stimulation for Psychosis, Schizophrenia.”

Mayo Clinic: “Deep brain stimulation.”

Journal of Neurology, Neurosurgery & Psychiatry: “Approaches to neuromodulation for schizophrenia.”

Mayo Clinic: “Vagus nerve stimulation.”

National Institute of Mental Health: “Brain Stimulation Therapies.”

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