Electroconvulsive Therapy at Albany Med
What is electroconvulsive therapy (ECT)?
Electroconvulsive therapy is a form of brain stimulation that can safely and effectively treat certain mental illnesses. It is one of the most effective treatments available for severe depression. Many studies have shown that a majority of patients with severe or treatment-resistant depression experience significant improvement.
Electroconvulsive therapy is performed by delivering a controlled and personalized dose of mild electric current to the brain, which produces a brief seizure. Because patients are asleep under anesthesia and receive a muscle relaxant, they do not feel the seizure or experience convulsions during treatment. Treatment is delivered across a series of individual sessions. While the exact way in which ECT works remains an active area of research, it is hypothesized to support the function of brain circuits that are specifically altered in mental illness. ECT is a safe, controlled, and well-tolerated procedure.
Referrals should be made for patients with conditions for which ECT is an established treatment and for whom the referring clinician believes ECT is an appropriate next step in care.
Questions about ECT at Albany Medical Center can be directed to Elisa Finch at 518-262-5511.
More information can be found below.
Like other medical procedures, the use of ECT is justified primarily for a certain set of illnesses. Depression, arising from either major depressive disorder or bipolar disorder, is the most common use of ECT. Additional conditions for which ECT may be appropriate include catatonia, mania, and psychosis. Typically, ECT brings about improvement faster than most medications. Patients and families who are interested in learning whether ECT may be appropriate should first discuss this option with their treating psychiatric provider.
At Albany Medical Center, ECT is offered for conditions for which there is strong clinical evidence supporting its effectiveness. ECT is generally not offered for poorly established indications.
Patients most appropriate for ECT include those who are unable to tolerate medications used to treat their condition, or whose symptoms persist despite adequate courses of treatment. The use of ECT is particularly efficacious in older patients with depression, especially when accompanied by delusions or other psychotic symptoms. Other conditions for which ECT is strongly recommended include catatonia not responsive to medication, severe depression during pregnancy, and suicidal thoughts.
Individuals with longer duration of depression, history of many unhelpful medication trials, and accompanying personality disorders, especially borderline personality disorders, have lower likelihood of benefit from ECT for depression. It must be kept in mind that ECT may not be effective for any individual patient, regardless of whether they have these characteristics.
Many patients begin to notice improvement after several treatments, often within the first one to two weeks. However, response varies from person to person, and the full course of treatment is usually needed to achieve the best results.
After reviewing the ECT referral to confirm appropriateness for ECT, patients undergo an evaluation with the ECT psychiatrist to review their symptoms, prior treatments, and medical history. In some cases, medical testing such as blood work or an electrocardiogram (EKG) may be required to ensure the procedure can be performed safely. Not all patients referred for ECT will ultimately receive treatment. The ECT psychiatrist will review the referral and determine whether ECT is an appropriate option.
ECT is only performed after a thorough evaluation and a formal informed consent process. The treatment team will review the risks, benefits, and alternatives with you before treatment begins.
Each ECT session is scheduled first thing in the morning. You may not eat or drink anything after midnight the evening prior to your ECT session. If you take morning medication, you will discuss with your ECT team which of these, if any, to take with small sips of water the morning of the procedure. Please wear comfortable, loose-fitting clothing.
At Albany Medical Center, ECT is performed in a procedure room within the Post-Anesthesia Care Unit (PACU), the area of the hospital specialized in taking care of patients immediately after receiving anesthesia for a variety of procedures. Your treatment team includes a psychiatrist, an anesthesiologist, and a nurse, all with extensive experience performing ECT. As a teaching hospital, resident physicians and medical students are also important parts of your treatment team. After meeting with these individuals and having your questions answered, the following steps will occur:
1. An IV is placed in your arm, which will be used to administer medication during the procedure.
2. Electrodes are connected to your head, chest, and arms, which will enable continuous monitoring of your vital signs and heart rhythm throughout the procedure to ensure your safety. Monitoring electrodes will also be connected to the ECT machine to monitor your brain activity during the procedure.
3. You will be put to sleep using one or more medications, followed by administration of a muscle relaxant to ensure your body remains relaxed during the procedure.
4. A mild electric current will be applied to the head via electrodes for up to 8 seconds, inducing a brief seizure. In almost all cases, the seizure stops on its own and typically lasts for no more than 60 seconds. The muscle relaxant greatly reduces visible muscle movement during the seizure.
5. You wake up and are monitored in the recovery area. When you are ready, you are discharged home with your driver.
The ECT procedure itself lasts only a few minutes, but most patients spend about 1–2 hours at the hospital including preparation and recovery time.
A responsible adult must accompany you and drive you home after each treatment.
For depression, most patients will receive and benefit from 6 to 12 sessions. These are administered two or three times per week, called an “index series”. Patients receiving ECT for other conditions may require more or less treatments than for depression. In some cases, spreading out the frequency of treatments and continued treatment at much longer intervals, called maintenance ECT, may help sustain benefits received from the initial ECT series.
Like all medical procedures, ECT has potential side effects. These include:
- Headache and muscle aches, which can be treated with over-the-counter pain medication.
- Confusion immediately upon awakening from anesthesia.
- Memory loss, which is commonly short-term and improves in the weeks following ECT. More rarely, patients may experience long-term memory loss. Your treatment team will identify the ECT approach with the goal of minimizing memory side effects.
- Risks of general anesthesia, including heart and breathing problems during the procedure. In some cases, the ECT team will ask you to be evaluated by your outpatient specialists to collaboratively identify the safest way to prepare you to undergo ECT.
You may not drive during or for two weeks following an index series of ECT (i.e., when you are receiving ECT two or three times weekly). You cannot drive on the day of a maintenance ECT session. Therefore, any patient receiving outpatient ECT at Albany Medical Center requires a friend or family member to drive them to and from their ECT procedure.
Your ability to resume your work may differ from patient to patient. You will discuss this with your ECT team. Some patients may be advised not to return to work for one to two weeks following completion of an index series.
Our ECT team will verify your insurance coverage prior to moving forward with your ECT evaluation. Most insurance typically covers ECT.
Due to the specialized nature of ECT and the limited number of treatment slots available, referrals are prioritized for patients for whom ECT is clearly indicated. Patients interested in outpatient ECT must be under the care of a psychiatric provider (e.g., MD, DO, PA, or APRN) who will follow the patient throughout the treatment course. Self-referrals will not be accepted. The ECT service does not provide primary psychiatric care. Patients must have an established psychiatric provider who will continue to manage their treatment outside of ECT. Psychiatric providers can refer patients for outpatient ECT by completing a referral form.
Electroconvulsive therapy at Albany Medical Center can also be performed on an inpatient basis, with patients being treated on the inpatient psychiatry unit or in the general hospital. Psychiatric providers at outside hospitals may refer patients for inpatient ECT by also completing the referral form.
Referrals should be made for patients with conditions for which ECT is an established treatment and for whom the referring clinician believes ECT is an appropriate next step in care.