Electroconvulsive therapy (ECT) is a psychiatric procedure in which brief electrical pulses are applied to the scalp to stimulate underlying brain cells. The brain cells directly stimulated by these pulses activate which, in turn, activate the brain, in general. During this period, called a “modified seizure,” numerous changes happen in the brain which can result in alleviation of certain psychiatric illness, including depression, catatonia, mania and schizophrenia. The procedure is performed under anesthesia using medications which help our patients sleep through the procedure and stay comfortable.
ECT is typically considered by patients who have tried and have had insufficient relief from at least two to three medication trials of sufficient duration. At times, ECT is considered early in a person’s treatment when symptoms are severe. Given ECT’s chance for success (for example, up to 80 percent of people with depression experience relief with ECT), it should not be considered a treatment of last resort, but incorporated into a person’s treatment when adequate relief of suffering has not been established with traditional therapies (e.g., medication trials).
Logistics
ECT can be administered either on an inpatient or outpatient basis. Prior to initiating ECT, a person undergoes a consultation with one of our expert psychiatrists to talk about their illness, learn about what has been tried, talk about potential side effects and answer any questions. If a person chooses to incorporate ECT into their treatment, the next step would be routine medical clearance which consists of lab work, a physical exam and an EKG.
ECT is typically delivered twice a week or three times a week in a series of six to twelve treatments. If medically advised, some people choose to have a tapering course of ECT following the initial series of treatments and some go on to have “maintenance ECT,” which is ECT delivered on a regular schedule (e.g., once a month) to continue to treat symptoms.
Treatment Approach
As with any procedure, many people who incorporate ECT into their treatment have some anticipatory anxiety. While modern day ECT bears little resemblance to how it was practiced at its outset in the 1930s and no resemblance to how it is portrayed in many media depictions, it is normal to experience some anxiety. Our treatment approach is trauma informed, patient centered, collaborative and allied with you. We are happy to answer any questions to you help you understand the procedure and help you feel secure in your decision.
General Eligibility
- Target population – healthy adults (at least 18 years old) with treatment-resistant psychiatric illness that does not respond to traditional therapies
- Eligibility interview – 1-hour long
- Cost – ECT is covered by insurance
Outpatient Eligibility (in addition to general eligibility)
- Discharge supervision– patients will need a responsible adult (friend or family member) to transport and supervise the patient upon discharge
- Location – ECT is be performed at Brigham and Women’s Faulkner Hospital in the morning
- Time allocation – While ECT is a relatively brief procedure (five to ten minutes), patients should allocate one to two hours to check in, have the procedure and recover.
- Referral process – referrals must be made through the patient’s providing psychiatrist or nurse practitioner
Referring psychiatrist/psychiatric nurse practitioner:
- If you are in the Mass General Brigham network, please use the AMB REFERRAL TO BWFH PSYCH INTERVENTIONS (REF5111) order in the Epic EMR.
- For providers outside the network, please complete this form (also available as a Word doc) and fax it to 617-983-4688. If you have any questions, contact Psychiatry Interventions at 617-983-7973.
Thank you for considering Brigham and Women’s Faulkner Hospital as your partner in collaborating in your care.
