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Electroconvulsive Therapy (ECT)

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Introduction This leaflet contains information about Electroconvulsive Therapy (ECT) and what is likely to happen in treatment, the effects and side effects of what to expect and the risks and benefits of the treatment. It should hopefully answer any questions you may have about ECT and will help you to make an informed choice. What is ECT?

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ECT is a therapeutic intervention used in mental health services. It is a procedure where a very small electrical current is passed through the brain. What is ECT used for and why has it been recommended for me? ECT may have been recommended for you if you have been suffering from one of the following mental health problems:

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• Severe depression requiring rapid treatment or failing to respond to other therapy

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• Moderate depression failing to respond to other therapy • Catatonia

• A prolonged or severe manic episode • Other conditions are treated outside NICE guidelines (NICE 2003; 2009) Usually your Doctor or Psychiatrist will have tried other treatments first to treat depression, such as anti-depressants. If you have not responded well to those or if ECT has worked for you in the past then ECT could be considered. If your depression has been considered as life threatening with suicidal feelings then this may be the first treatment recommended.

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How does ECT actually work? No-one really knows how it works (but also true of other psychiatric treatments) however, there are a number of theories which include the following: • People with depression and epilepsy felt better following a fit • ECT "jumpstarts" the brain - boosts electrical activity in the brain

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• It can change the pattern of the blood flow through the brain which may be affected by depression.

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• More recent research suggests ECT works by "turning down" an overactive connection between parts of the brain that govern mood and those responsible for thought and concentration, "hyper connection"

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Can you talk me through the whole process of what will happen to me on the morning of my treatment? Before entering the therapy room, a qualified Nurse will sit down with you and talk you through the process. The Nurse will also be double checking the paperwork your Doctor has prepared and will check that you are consenting to the treatment. You will have been asked to fast prior to receiving ECT, this means you should not have had any food or drink. The Doctor or Nurse will tell you how long to fast for. You will also have been told if you should take any medication prior to having ECT.

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On entering the therapy room, you will notice that there may be a number of health professionals who make up the ECT team. These include the Anaesthetist and Anaesthetic Nurse, the Psychiatrist and the ECT Lead Nurse. On occasions there may be more than one Psychiatrist and also Student Nurses present, however, your consent will be sought before Students Nurses are allowed to stay.

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There will be a bed in the room, the Nurse will assist you on to the bed and ask you to remove your shoes. You will be closely monitored throughout the whole ECT process; this means that you will have your blood pressure and heart rate monitored and you will be attached to monitors for this. As we will be inducing an epileptic seizure (fit) there will also be some monitors placed on your forehead. These may feel slightly sticky but other than that you should not feel any discomfort. Before ECT is administered, you will be given a general anaesthetic and a muscle relaxant through a drip, usually in the back of your hand. This means that you will not feel any of the treatment as you will be asleep.

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Once you are asleep, the Psychiatrist places electrodes on either side of your head. A special ECT machine is used to deliver the electric current across your brain. This only lasts up to around 5 seconds. The aim of the procedure is to induce a controlled epileptic seizure. The seizure observed is usually mild tremors in your hands and feet and can last as little as a few seconds, rarely longer than 30 seconds.

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Most people wake up within 10 to 15 minutes following treatment. You will wake up in a recovery room with a qualified Nurse looking after you. The Nurse will have been monitoring your heart rate, blood pressure and your breathing. On awakening, you may feel very drowsy or confused. This should only last a short time. Once you are awake the Nurse will make you a drink and keep you comfortable until you are ready to return to the ward or to go home if you are an out-patient.

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How many treatments will I need?

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Everybody is different and responds to the treatment at different stages. A course of treatments is usually required and this can be as few as five or six, or can be up to twelve and very occasionally more. Your Psychiatrist will monitor your progress throughout the course of treatments. He or she will need to see you following every two treatments before any further ECT can be prescribed. Will I experience any side effects? Like any treatment, ECT can cause side effects. Short term side effects can include headaches, confusion, feeling sick and general aches and pains. These generally improve within a few hours once you are fully awake and have taken diet and fluids.

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The main long term side effect of ECT is that of memory loss. Some patients report severe memory loss and others less so. It has been difficult to measure the effects accurately. There is ongoing research within the Trust to find an intervention to help prevent or reduce memory loss with ECT. What are the risks associated with ECT?

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Before you are given ECT you will be given a general anaesthetic which carries a small physical risk. This risk of death or serious injury is slight, about one in 80,000 treatments. This is around the same level of risk as dental anaesthesia. Your physical health will be assessed prior to attending the ECT suite. You will have blood tests, an ECG (heart trace) and a physical examination will be carried out. Can ECT be given against my wishes?

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ECT has been given against people's wishes, however, this only happens when the Psychiatrist feels that the person is too poorly to make decisions for themselves about their own health and welfare and their condition may be life threatening. A second opinion is sought from another Psychiatrist in this instance and the Mental Health Act or Mental Capacity Act is usually implemented. It can also be discussed with your family. We will also check if you have an advanced statement about your treatment wishes. If you are deemed to have the capacity to make decisions about your own health and welfare and decide that you do not wish to have ECT, regardless of whether you are under the Mental Health Act or not, then ECT cannot be given against your wishes. What are the alternatives to ECT? There are alternative treatments available. If you decide not to go ahead with ECT then your Psychiatrist/Doctor will discuss these with you. These may include medications or psychological therapies.

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Further information on ECT can be found from the following: National Institute for Health and Clinical Excellence (NICE) • Guidance on the use of Electroconvulsive Therapy (Technology Appraisal TA59) • Depression: The Treatment and Management of Depression in Adults (Update) (Clinical Guideline CG90) ECT Accreditation Service (ECTAS)

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This service was set up by the Royal College of Psychiatrists to provide an independent assessment of the quality of ECT services. ECTAS awards ECT clinics an accreditation rating if they meet the essential standard. Please feel free to ask the ECT suite staff if they have been awarded accreditation.

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Royal College of Psychiatrists 17 Belgrave Square London SW1X 8PG Tel: 020 7235 2351

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Email:[email protected] Website:www.rcpsych.ac.uk

The Care Quality Commission (CQC) have produced a leaflet on your rights to say yes or no to ECT, this can be found at: www.cqc.org.uk/sites/default/files/media/documents/20120906_isl392_11_ your_rights_to_say_yes_or_no_to_ect_easy_to_read.pdf

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Other sources of information:

Contact Details:

The Mental Health Helpline This provides an information and listening service for people in Lancashire. It is available between 7:00pm and 11:00pm Mondays to Fridays and from 12:00 noon until 12:00 midnight on Saturdays and Sundays. Other sources of information: Freephone 0500 639000. Tel: 01282 657203 Clinical Treatment Team Pendle House Leeds Road Nelson BB9 9TG

The Mental Health Helpline provides an information and listening service for people in Lancashire. It is available between 7.00pm Customer Care and 11.00pm Mondays to Fridays and from 12.00 noon until 12.00 If you wish to pay639000. a compliment about the Trust’s midnight on Saturdays and Sundays. Freephone 0500

services, make a comment, raise a concern or complaint,

01282 474178 or 07507 857345

01772 695315, freephone 0808 144 1010 or email [email protected]

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The Patient Advice and Liaison Service provides advice and please contact the Customer Care Department on information. Please contact East Lancashire PALS on:

print, audio book or Braille.

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