Electroconvulsive Therapy UK: How It’s Used For Mental Health
Electroconvulsive therapy (ECT) can make a significant difference in some cases of severe mental illness, but it’s an often misunderstood treatment. Because this treatment involves anesthesia and is done in a medical setting, some may worry that it’s a harmful way to treat mental illness. However, done safely, electroconvulsive therapy can be a helpful option for many. Below, explore electroconvulsive therapy, what it’s used for, and ways to get help for mental illness or mental health challenges.
What is electroconvulsive therapy (ECT)?
Electroconvulsive therapy is a medical procedure designed to stimulate various areas of the brain via a mild electric current. This stimulation may reduce symptoms of treatment-resistant depression or other mental disorders.
What is electroconvulsive therapy (UK) used for?
In 2021, 1,835 adults in England, Wales, and Ireland received acute electroconvulsive therapy, and more than 1,000 benefited from this treatment. ECT can be highly effective, though this treatment is typically not a first-line treatment for mental disorders. This option is often reserved for severe cases of depression, schizophrenia, catatonia, or bipolar disorder with mania. Psychiatrists typically only recommend ECT when medication and therapy have not been effective or when a person’s life is at risk.
What is the preparation for ECT?
Before each ECT treatment, individuals typically undergo a series of tests, including blood and urine tests. Specifically, doctors may order a metabolic panel, blood count, and kidney and thyroid function tests. They may also order imaging tests of the skull, spine, and brain and an electrocardiogram (EKG). These tests verify the patient's health to reduce the risk of the procedure.
What happens during the procedure?
Before the procedure, an anesthesiologist administers general anesthesia so patients are asleep during the procedure. After the patient is asleep, a doctor places electrodes on the head with a conductive gel to prevent skin irritation or burning. There are three types of ECT: bilateral ECT, right unilateral ECT, and bitemporal ECT. These refer to the placement of the electrodes, which doctors determine depending on a person’s symptoms.
Using the electrodes, a psychiatrist stimulates the brain with a mild electric current, which causes a brief seizure. The current usually only lasts a few seconds, and the seizure typically lasts between 30 and 90 seconds. If a seizure lasts longer, a doctor can administer an injection to stop it. The seizure induced by the electrical current typically changes the way certain areas of the brain function, which can lead to significant improvement in mental health symptoms for some people.
What does the literature say about ECT?
The National Institute for Health and Care Excellence recommends that ECT be used for depression only if a person has had positive results with ECT in the past, if other treatments haven’t helped, or if a person’s life is at risk.
In recent years, researchers have found ECT to be effective for severe depression. The Royal College of Psychiatrists has an Electroconvulsive Therapy Accreditation Service (ECTAS), which has created one of the most extensive datasets on ECT in the world. The ECTAS tracked more than 1,800 adults who had undergone ECT in 2021. The Royal College of Psychiatrists stated, “Of those who received acute ECT, 68% were found to be ‘much improved’ or ‘very much improved’ following the treatment.” Also, 41% of patients who received ECT for depression experienced complete remission. Full remission is defined as the absence or near absence of depression symptoms, as measured by clinical rating scales.
Researchers in the United States have also found ECT to be effective. The American Psychiatric Association states, “Clinical evidence indicates that for individuals with uncomplicated but severe major depression, ECT will produce substantial improvement in approximately 80% of patients. The treatment is also used for other severe mental illnesses, such as bipolar disorder and schizophrenia.”
Mental health therapy for depression
Many people who experience depression never undergo ECT, as therapy and medication tend to be recommended first. Therapists may use approaches like cognitive-behavioral therapy (CBT) to treat depression symptoms. In some cases, people take medication in conjunction with therapy. Medication may help people get the most from psychotherapy. However, consult a doctor before starting, changing, or stopping any medication.
The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional.
Online therapy for mental health conditions
For some people experiencing depression, leaving home for therapy sessions can be challenging. However, mental health support is still available through online counselling. With online counseling through a platform like BetterHelp, you can be matched with a credentialed therapist who has experience treating depression or other mental disorders. You can communicate with a therapist via audio, video, or live chat. In addition, you can reach out to your therapist at any time via in-app messaging, and they’ll respond as soon as they can. This option may be useful for days when you experience more severe symptoms of depression.
Online therapy has been shown to be effective for numerous mental disorders. In one meta-analysis and systemic review published in 2020, researchers found that electronic cognitive-behavioral therapy (eCBT) was just as effective as in-person therapy. After looking at 17 studies, the authors concluded, “Our results demonstrated that eCBT was more effective than face-to-face CBT at reducing depression symptom severity.”
Takeaway
Electroconvulsive therapy (ECT) is sometimes recommended for cases of severe depression, schizophrenia, or other mental disorders. Research shows that ECT can make a significant difference in cases of severe depressive illness. If you’re experiencing depression, you may benefit from speaking with a credentialed mental health professional, either in person or online.
Frequently asked questions
What is the success rate of electroconvulsive therapy (ECT)?
According to Yale Medicine, ECT is effective for approximately 60% of patients. While this statistic may not seem high, the response rate to the first antidepressant people take is typically only 30%. For this reason, and because ECT is usually used for people who don’t respond to other options, this treatment can be highly valuable.
What are the pros and cons of ECT?
Contrary to what is sometimes portrayed in movies and media, ECT is considered a safe treatment. The procedure is performed with general anesthesia, so the patient doesn’t feel the brief electric currents applied to the brain. In addition, current ECT treatments work faster than transcranial magnetic stimulation (TMS).
Despite the advantages, there is a risk of physical brain damage leading to memory loss, but this effect tends to be temporary. ECT services can also cause skin irritation due to the electric currents, but doctors typically use a conductive gel to reduce the risk of skin irritation. Other cons of having ECT may include the treatment frequency, as ECT typically requires two or three sessions per week for up to four weeks. In addition, some people may not be allowed to drive or work for two weeks post-treatment.
What does the Mental Health Act 1983 say about electroconvulsive therapy (UK-specific)?
The Mental Health Act 1983 states that a person can refuse ECT treatment. Individuals can only be given ECT if they accept it or if there is an emergency and they cannot decide for themselves. In the latter case, an independent doctor will evaluate the person and talk to health professionals at the hospital who know them. However, individuals who have made a binding advance decision not to receive ECT will not be given the procedure.
Where can you get ECT in the UK?
There are various ECT clinics and hospitals that perform ECT throughout the UK. If you’ve taken medication for depression, you might consider asking the prescribing doctor if you qualify for ECT and where you can have the procedure done.
How much does ECT cost in the UK?
According to the National Institute for Clinical Excellence, six sessions of ECT cost approximately £2475. This figure does not include inpatient costs, which are around £171 per day.
Does insurance cover ECT therapy?
Insurance usually covers ECT therapy in the United States. The NHS in the UK may cover ECT therapy in some situations. Health and Social Care in Northern Ireland may also cover ECT.
Can you live a normal life after ECT?
Treatment outcomes can vary from person to person. Most patients experience symptom improvement shortly after treatment and go on to live normal lives. Many professionals believe the possible benefits outweigh the potential side effects.
Who is not a good candidate for ECT?
People who have certain conditions, such as brain tumors, seizure disorders, pneumonia, heart problems, and diabetes, may not be good candidates for ECT. Discuss your treatment options with your primary care provider for further information.
Is ECT worth the risk?
Whether ECT is in your best interests is a personal decision that should be discussed with your doctor. In general, much of the risk associated with ECT has to do with receiving a general anaesthetic. There is also an increased risk of temporary memory loss and challenges with learning. Talk to your provider about how many treatments would be right for you, and ask about potential side effects of which to be aware.
What is the most serious side effect of electroconvulsive therapy?
Electroconvulsive therapy (ECT) is a physical treatment that is usually only employed when multiple other treatments haven’t been effective or have only led to short-term improvement. It tends to be most effective in those who are severely ill.
ECT involves passing small electric pulses through the brain to induce a seizure while the day patient is under anesthesia and a muscle relaxant. A mouth guard is placed in the patient’s mouth so their teeth are not damaged during the treatment. Often, two electrodes are placed on the same side of the head to make ECT work more effectively and decrease the risk of side effects. ECT seems to change a person’s brain waves and brain chemistry, relieving various mental health symptoms.
Research suggests that this can be an effective treatment, but it can also have side effects. Confusion, memory loss, nausea, headaches, jaw pain, muscle aches, decreased oxygen levels, and increased heart rate and blood pressure may occur. There is a very low risk of life-threatening complications.
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