Modified Electroconvulsive Therapy (M ECT)

Modified Electroconvulsive Therapy (M ECT) is a treatment modality in Psychiatry, which involves administration of a small electric charge to the patient’s brain to produce a seizure activity. When such a small electric charge is administered under general anesthesia along with muscle relaxant, the treatment is referred to as Modified Electroconvulsive Therapy (M ECT).

How Is it given?

Subsequent to a thorough Psychiatric and Medical evaluation and obtaining a written Informed consent from the patient and/or the nominated representative (legal guardian), a small electrical charge is administered to the patient, through electrodes placed on scalp under the effect of brief general anesthesia, with continuous monitoring of cardio-respiratory system and the CNS for seizure activity. Patient is then closely monitored until full recovery from the effects of general anesthesia and seizure.

When is M ECT given?

M ECT is administered across a number of psychiatric and medical disorders which include

  • Depression: Especially useful in severe depression, patients with high suicide risk, depressive stupor, catatonia, psychotic depression, and treatment resistance or intolerance.
  • Catatonia due to various disorders
  • Bipolar Disorder (Manic excitement, Depression and Mixed states)
  • Highly useful for Catatonia, florid psychosis, high suicide risk, risk of harm to others, and treatment resistance or intolerance.
  • Other psychosis including acute psychosis, schizoaffective disorder and schizophreniform psychosis
  • Exceptional Cases including neuroleptic malignant syndrome; a life threatening situation, MECT can be life saving
  • Medical conditions like Parkinsonism, Intractable seizure disorder, and delirium.

What are the Contraindications of M ECT?

  • Raised intracranial pressure

Other relative contraindications include:

  • Recent myocardial infarct Large aneurysms
  • Space occupying lesions in brain

What happens before the M ECT administration?

  • The Informed consent of the patient/legal guardian is taken for MECT and Anesthesia.
  • Patient is investigated thoroughly for relevant blood investigations, fundus, ECG examination and pre-anaesthetic check up.
  • PAC- fitness obtained
  • Patient is kept on an overnight fast (minimum6-8 hrs of fasting).
  • Any loose tooth or dentures are removed.

What happens during the M ECT administration?

  • Patient is asked to empty the bladder.
  • Patient is taken to the MECT room and assisted onto the MECT table.
  • The treating team includes a Psychiatrist, personnel experienced in anesthesia, and nursing staff trained in the use of MECT.
  • An IV line is put by the doctors/nursing staff to administer medications as well as additional fluids.
  • A blood pressure cuff, heart monitor, pulse oximeter are put in place.
  • Injection anesthetic and muscle relaxant are given.
  • Bilateral electrodes are placed on the scalp.
  • A small electrical charge is administered to produce seizure with monitoring of seizure activity and vital signs.

What happens after the M ECT?

  • The patient is continued on ventilation till the commencement of spontaneous breathing.

The patient is then wheeled to the recovery room where he/she is monitored till consciousness is fully regained.

What are the Alternatives to M ECT?

A wide variety of treatment options are available for people with mental illness which apart from MECT include-

  • Pharmacological agents (Medications).
  • Psychological interventions.
  • Psychosocial interventions
  • Deep transcranial magnetic stimulation
  • Repetitive transcranial magnetic stimulation
  • Ketamine therapy
  • Deep brain stimulation
  • Psychosurgery

What are the Benefits of M ECT?

M ECT confers upon the patient the following important benefits-

  • Proven and scientifically established efficacy
  • Fewer long-term adverse effects
  • Rapid recovery with patients returning to functional state within hours to days.
  • Lowers suicide risk (often life saving)
  • Useful in patients with catatonia, depressive stupor – Facilitates response to ongoing drug treatment and so hastens remission
  • Useful in those with intolerable medicinal adverse effects

What are the adverse effects/ risks?

M ECT is a relatively safe treatment option with risk of severe adverse effects as low as 1/1000 and risk of death as 1/10,000 similar to that of any procedure under general anesthesia.

Main adverse effects of M ECT and Anesthesia are:

  • Neurological – Headache, reversible memory deficits (for hours to days), prolonged seizure, delirium
  • Cardiac-Tachycardia, arrhythmias
  • Respiratory- Prolonged apnoea, exacerbation of COPD/asthma, respiratory arrest
  • Musculoskeletal-Myalgia, fracture, dental injury
  • Gastrointestinal – Nausea, Vomiting
  • Psychiatric-Manic switch

M ECT does not lead to irreversible or permanent brain damage.

In case of any adverse event developing during the treatment course, it is treated appropriately and further MECTS are withheld until the condition completely reverts to normal.

What is the duration of treatment?

The duration and frequency of M ECT is decided on an individual basis by the treating Psychiatrist and depends on the response, adverse effects, and relapse. Average number of M ECTS is around 6-12 with a frequency of two to three M ECTS per week. No stipulated/fixed number of MECT’s for a given condition recommended.

M ECT is discontinued after:

  • Remission of target symptoms
  • No further response on 2-3 consecutive treatment trials
  • Intolerable adverse drug effects
  • Withdrawal of consent of patient/NR

MECTS are also used beyond the acute illness, in continuous and maintenance phase treatment. There is no maximum or lifetime number of MECTS recommended.

Tulasi Healthcare offers Modified Electroconvulsive Therapy (MECT). If you are looking than contact us at +91-8800000255.