ECT – Electroconvulsive Therapy

The ECT (Electroconvulsive Therapy) Program at the University of Alabama at Birmingham was established more than 30 years ago. UAB Psychiatry is a major site for ECT referrals in Alabama and surrounding states. Hundreds of treatments are performed each year.

ECT is used in the treatment of severe depression and other psychiatric disorders. At the University of Alabama, ECT is conducted under the direct supervision of a psychiatrist and anesthesiologist, and we apply modern monitoring devices and anesthetic medications to provide safe and effective treatments.

Our team of health care professionals consists of attending psychiatrists, ECT nursing staff, anesthesiologists, certified nurse anesthetists, and office support staff. Services provided include complete inpatient or outpatient ECT evaluations. Through our outpatient program, we can provide ECT treatments for many patients. Contact our ECT Program Coordinator for more information or to arrange a referral or evaluation by calling our Access Department at 205-934-7008.

Patients are referred to the ECT service by referring psychiatrists and the psychiatric attendings on the various psychiatric units at UAB. Patients undergoing ECT treatment will receive a complete medical evaluation, including anesthesia consultations. Psychiatrists and anesthetists supervise the administration of ECT. Both inpatients and outpatients can receive ECT treatments.

Your physician has recommended that you receive treatment with Electroconvulsive Therapy (ECT). Prior to your signing an Informed Consent, your physician will review your medical history and evaluate the risks and benefits of ECT treatment for you. In addition, the physician performing the treatment will provide an opportunity for any questions you might have about ECT.

The following information was prepared to generally inform you about ECT:
You will receive treatments to treat your psychiatric condition. Whether ECT, or an alternative treatment i.e. medications or psychotherapy, is most appropriate for you depends on your prior experience with these treatments, the nature of your psychiatric condition, and other factors. Your physician will discuss all of this with you and explain why ECT has been recommended as the treatment choice for you.

ECT involves a series of treatments. Treatments are performed in the morning, and since general anesthesia is required, you should not eat or drink anything after midnight the night before your treatment. An IV will be placed so that the anesthesia drugs can be given and will be removed prior to your going home. Since you will be asleep from the anesthesia, you will be observed in a recovery area until you are fully awake and alert.

To prepare for ECT treatments, a monitor will be placed on your chest and finger to measure your heart rate, blood pressure, and oxygen concentration in your blood. After you are asleep, a carefully controlled amount of electricity will be passed between two electrodes that have been placed on your forehead. When the electrical current passes through your brain, you should experience a short generalized seizure, approximately 30 seconds in duration. Since you will have been given a medication to relax your muscles, contractions of your body, which normally occur during a seizure, will be minimal.

The number of treatments that you receive will depend on your psychiatric condition, how quickly you respond to the treatments and the medical judgment of your psychiatrist. Typically, six to twelve treatments are given, three to four times per week. The number of treatments you receive will vary based on your individual response.

The potential benefit of ECT is that it may lead to an improvement of your psychiatric condition. As with all forms of medical treatment, some patients will recover quickly, while others recover only to relapse again and require further treatments and others fail to respond at all.

Like any other medical procedure, ECT involves some risks. For example, when you awaken you may experience some short-term confusion that should resolve. You could also experience headache, muscle shortness, or nausea, but these side effects usually respond to simple treatments. More serious medical complications that are rare, but may also occur are joint dislocations and/or fractures, dental problems and irregularities in heart rate and/or rhythm. Very rarely, heart attack or stroke can occur. And, as with anesthetic procedure, there is also a remote possibility of death.

To reduce the risk of medical complications, your physician will complete a medical evaluation prior to the ECT treatment. However, in spite of all precautions, there is a small chance that you will experience a medical complication. Should this occur medical care and treatment will be administered. You will be responsible for the cost of any necessary treatment, whether through private pay or through medical insurance coverage. No compensation will be paid for lost wages or other consequential damages.

A common side effect of ECT is reduced memory functioning. These memory difficulties related to ECT have a characteristic pattern, with problems being more pronounced shortly following treatments. After the treatment course is completed, memory function improves, although you may experience difficulties remembering events that happened before and immediately following the ECT treatment course. The intermittent memories of past events may extend to several months following the ECT course, however, you may experience permanent gaps in memory, particularly for events that occur close to the time you receive the ECT course. In addition, for a short period following the ECT course, you may experience difficulty in learning and remembering new information. This difficulty informing new memories should be temporary and will most likely subside within several weeks following the ECT course.

Because of the possibility of problems with confusion and memory, it is best that you not make any important personal or business decisions during or immediately following the ECT course. After the treatment course, you will begin a convalescence period which will vary from patient to patient. During this period you should refrain from driving, transacting business or engaging in any other activity for which impairment of memory may be problematic. Alcohol beverages, as well as illicit substances, are also prohibited during this period.

Please understand that you should feel free to ask questions at any time during and after the ECT course. Your decision to receive ECT treatments is being made on a voluntary basis and you may withdraw your consent at any time and the ECT treatments will be stopped.

REFERRALS:
For ECT evaluations, please contact the Access Department at 205-934-7008.  A clinical summary of the patient’s course of illness, along with a record of therapies tried, is extremely helpful for the evaluation.