ECT information for referring providers

The first step of the process is a consultative appointment to determine whether ECT is indicated. The risks, benefits, or alternatives are reviewed at this appointment. Appropriate patients will require a comprehensive physical examination before starting ECT. Patients will also be evaluated by a Certified Registered Nurse Anesthetist (CRNA) before the treatment. The patient and his or her family will have an opportunity and are encouraged to ask questions as part of this process.

Treatment Procedure
ECT involves a series of treatments, which may be given on an inpatient or outpatient basis. It is administered under general anesthesia. The patient fasts overnight for the morning procedure. During the procedure, the patient receives a short-acting anesthetic agent. Once the patient is completely anesthetized, a muscle relaxant is administered. When anesthesia and muscle relaxation are achieved, a small, carefully controlled electric current is administered to the patient’s head. The treatment typically causes a 30-90 second-long generalized seizure. Because a muscle relaxant is given, we typically see minimal muscle movements during this. Heart rate and rhythm, blood pressure and O2 saturation are closely monitored during the entire procedure. An EEG monitor is used to demonstrate the presence and termination of the seizure. 

A typical course of ECT (Acute Phase) is 6 to 12 treatments and is usually administered two to three times per week. Once symptoms are resolved, ECT is usually discontinued. However, because psychiatric disorders are chronic, relapses can happen after an episode. Continuation / maintenance ECT is recommended for those patients who have had a good response to ECT in acute phase, and then seem to respond poorly to pharmacological interventions or can’t tolerate side effects from medications.

Primary use: When a rapid treatment response is needed, as when patients are severely ill or at risk to harm themselves or others, primary use of ECT should be considered.
Other considerations for the first-line use of ECT involve the patient’s medical status, treatment history, and treatment preference (ECT should not be reserved for use only as a “last resort”).

Secondary Use: The most common use of ECT is with patients who have not responded to other treatment. During the course of pharmacotherapy, lack of clinical response, intolerance of side effects, deterioration in the psychiatric condition, or the appearance of suicidality are reasons to consider the use of ECT.

ECT is indicated in major depression, mania, catatonia, schizophrenia, and schizoaffective disorders. Recently, ECT has been studied as a potential intervention for medication refractory verbal and physical agitation in patients with developmental disability, Autism and traumatic brain injuries.

• ECT is the most effective treatment that currently exists for depression. Treatment response rate in patients with Non-treatment Resistant Depression (NTRD) is as high as 90%.

• ECT is highly effective for patients with Treatment-Resistant Depression (TRD) who have not responded adequately to at least two antidepressant trials of adequate doses and duration. Response rate to ECT in patients with TRD is 50% to 60%.

• ECT is safe, painless and works quickly, which is why it is ideal for profoundly depressed and suicidal patients. ECT reduces acute suicidal risk. In the CORE (Consortium for research in ECT) study, ECT reduced suicidal thoughts by 38% after one week and 80% overall.

• ECT Shortens the duration of psychiatric illness. The rapid response most patients have to ECT, sometimes as fast as after the first or second treatment, makes it incredibly valuable.

• ECT is associated with improved quality of life and function as early as two weeks after the conclusion of ECT.

• Our ECT service is led by experienced and board certified psychiatrists who are credentialed after demonstrating competence and who work in collaboration with Certified Registered Nurse Anesthetists and Psychiatric Nurses.

• Patients receive a comprehensive psychiatric evaluation that includes diagnostic clarification, discussing different treatment options and alternatives to ECT, and identifying programs that would be beneficial to the patient. Appropriate referrals will be done accordingly.

• During the course of ECT, patients will be evaluated by a psychiatrist before each treatment to assess treatment response, cognitive and memory status, suicidal risk and overall psychiatric condition. Appropriate intervention will be taken upon clinical assessment. Progress is measured using the Montgomery-Asberg Depression Rating Scale and cognitive side effects are measured with a Mini-Mental Status Examination.

Please call 207.973.6419 or fax your ECT consultation request to 207.973.6340. The following information should be included, if available: 

• Psychiatric progress notes

• Medical History and Physical

• Laboratory studies including CBC, CMP, TSH, and EKG

This information is then used to determine if further medical workup is necessary prior to start of ECT.