Mclean Hospital

Guide to ECT Treatment at McLean Hospital

A Resource for Patients and Families

Overview

Electroconvulsive therapy (ECT) is used to treat a variety of psychiatric conditions, including depression, mania, catatonia, and some psychotic illnesses. During the procedure, a mild electrical current is delivered to the brain, which produces a modified seizure. ECT is a safe procedure that causes no pain or discomfort for patients.

The Electroconvulsive Therapy Service is located on McLean’s Belmont campus in the de Marneffe Building, Ground Floor. For more information call 617.855.2356.

ECT treatment
ECT is a scientifically proven clinical treatment

ECT has been clinically proven to work. A vast majority of patients show measurable improvement and many report that they feel “like themselves” again after treatment. Experts believe that the improvements may be caused by the seizure changing the amount of certain chemicals in the brain.

ECT is often preferable for patients who don’t respond well to medications, have excessive side effects from medications, or are actively suicidal. Your clinician will help you decide whether or not ECT might be appropriate and beneficial for you and your symptoms.

Patients are welcome to schedule a visit to the ECT suite before beginning treatment. This helps some people feel more comfortable/less anxious about the procedure.

ECT staff includes psychiatrists specially trained in ECT; anesthesiologists from Massachusetts General Hospital; advance practice nurses specially trained in ECT; registered nurses with special training in ECT and post-anesthesia care; mental health specialists who work with the nurses to provide care; and physicians from the Internal Medicine Department who are on call at all times.

Risks and Side Effects

Before undergoing the procedure, medical clearance is necessary to make sure there are no medical conditions that might interfere with ECT treatment. Some patients may experience changes in heart rate or blood pressure during the procedure, but these changes are usually short-lived and easily treated with medication. More serious problems are rare, but our staff is always prepared to give appropriate medical care as needed.

ECT treatment
McLean Hospital is a leading specialty center for ECT

Memory loss is the most common side effect of ECT. Patients may experience some mild short-term memory loss and forgetfulness during the treatment. This side effect, however, usually ends shortly after the treatment course has ended.

Less frequently, patients have lingering memory loss of events that happened shortly before treatment. The memory loss is usually not significant, but we work hard to limit this side effect.

Other possible side effects are headache, muscle aches, nausea, and vomiting. Most people who have ECT treatment report very few side effects, and most are minor and easily treated.

Preparing for Treatment

ECT can be administered to patients who are in the hospital, living at home, or in a community setting (e.g., nursing home or group home). McLean Hospital has a dedicated ECT Suite located in the de Marneffe Building.

Most patients will have an initial course of 8-12 treatments, which are administered 3 times per week, on Mondays, Wednesdays, and Fridays. This 3-4 week course of initial treatment is usually followed by a taper phase and maintenance treatments may continue—weekly or less frequently—to prevent relapse. Tuesdays and Thursdays are reserved for maintenance treatments.

ECT treatment
ECT clinicians and staff are committed to providing world-class treatment to patients

To prepare for your appointment, you cannot eat or drink anything after midnight on the day of your treatment. This includes water, gum, mints, cough drops, and most medications. If you forget and have something to eat or drink, you MUST tell the staff on your unit or the ECT staff. You also should not smoke the day before or the morning of treatment.

Before coming in for treatment, please dress in comfortable clothing, including a short sleeve shirt or a shirt that can be rolled up easily to check blood pressure and start intravenous (IV) treatment. Do not wear perfume, other scented products, makeup, or nail polish. If you have dentures, contact lenses, or nose, lip, or tongue piercings, they must be removed before treatment.

Please bring an updated list of all your medications to each treatment.

At Your Appointment

Once you arrive at the clinic, let the secretary know you are here. You will remain in the waiting area until an ECT nurse brings you to the treatment area.

While in the treatment area, you will be asked to complete some questionnaires on the computer and do a memory assessment with a nurse. The nurse will also ask about your mood and how you’re feeling physically.

If you are an outpatient, the ECT staff will check your weight, temperature, blood pressure, and pulse and make sure that you haven’t had anything to eat or drink. These things will be checked for inpatients while they’re still on the unit, before staff brings them to the ECT clinic.

At your first treatment, the anesthesiologist will review the medical information in the chart and ask some questions before treatment begins.

A nurse will then put medical monitoring equipment on you just before treatment starts. This equipment will measure your blood pressure, oxygen levels, and heart rate throughout the treatment. Next, an intravenous (IV) catheter for delivering anesthesia will be placed in your arm or hand. To ensure minimal discomfort, a very small catheter is used.

ECT treatment
ECT is a safe procedure that causes no pain or discomfort for patients

Anesthesia will be delivered through this catheter. You will fall asleep in less than one minute and will remain anesthetized for 5 to 10 minutes. After you are asleep, you will be given a medication that relaxes your muscles. This reduces body movement when you have the seizure produced by ECT.

During Treatment

You will be in the treatment room for approximately 10 to15 minutes. You will not feel any pain or discomfort during treatment.

The ECT clinician will begin by placing two small stimulating electrodes on your forehead, which will record your brain waves during treatment. While the ECT clinician is delivering mild electrical current to your brain, the anesthesiologist will help you breathe by giving you oxygen through a ventilation mask. During this time you will be under continuous monitoring.

After the treatment is over, you will be moved into the recovery room. Most patients will wake up a few minutes after they’ve arrived in the recovery room.

Recovery Room

Your nurse will stay with you throughout your recovery and will continue to check your blood pressure, pulse, breathing, and oxygen level. A plastic oxygen mask will be placed over your nose and mouth to give you additional oxygen until you are wide-awake. When you first wake up, you might be slightly confused. This is a normal reaction to treatment. After about 30 minutes, you will be ready for something to drink. Soon afterward, if you are staying in the hospital, staff from your unit will pick you up and bring you back to the unit in a wheelchair. This is just a safety precaution.

After spending 45 minutes in the recovery room, outpatients will need to spend the next hour and 15 minutes in the recovery lounge. (Most patients are ready to leave two hours after treatment.) Just before it is time for you to leave, a nurse will check your temperature, blood pressure, and pulse. A clinician will also evaluate you at this time. Finally, you will be given discharge instructions and an appointment for your next treatment.

After Treatment

Soon after treatment, most people are ready for something to eat. Inpatients can have a meal when they return to their units, and outpatients can have a light meal in the recovery lounge.

Some patients feel sleepy after treatment and will want to take a nap, and others are wide awake and ready to resume their usual activities. Whatever you choose to do, it’s important that a responsible adult be with you for the rest of the day.

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Soon after treatment, patients report that they feel better

You should not exercise vigorously, drive a car, operate machinery, or drink alcohol for the rest of the day. You should take your daily medications, and if you have muscle soreness or a headache, over-the-counter pain relief medication should help.

Most patients will notice a positive change in their mood after they have had five or six treatments. Certain behavioral changes, however, may occur before you start feeling better mentally. If you were not able to sleep or eat, you may begin to sleep better and have an increase in appetite. If you were sleeping too much and had no interest in activities, you might start getting out of bed more and wanting to get involved with friends and family. Family members and/or staff usually notice improvement in a patient’s mood before the patient does. Very soon afterward, the patients themselves report that they’re feeling better.