Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief, controlled seizure. ECT似乎会引起大脑化学物质的变化,从而迅速逆转某些心理健康状况的症状.
ECT often works when other treatments have been unsuccessful, 尤其是治疗难治性抑郁症(TRD)或紧张症.
There remains significant stigma attached to ECT treatments, 很大程度上是因为20世纪中期的治疗方法是在没有麻醉的情况下使用大剂量的电, and often lead to memory loss, fractured bones and other serious side effects. Modern ECT is much safer. Although any ECT may still cause some side effects, 现在,它使用在受控环境下的电流来实现最大的治疗效果,同时尽可能减少风险或副作用.
Why it's done
Electroconvulsive therapy (ECT) can provide rapid, 若干严重精神健康状况的严重症状显著改善. ECT is used to treat:
- Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
- Treatment-resistant depression (TRD), 一种严重的抑郁症,尽管多种药物或其他治疗方法的试验没有改善.
- Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania may include impaired decision-making, impulsive or risky behavior, substance abuse and psychosis.
- Catatonia, characterized by lack of movement, fast or strange movements, lack of speech and other symptoms. 它与精神分裂症和某些其他精神疾病有关. In some cases, catatonia may be caused by a medical illness.
- Agitation and aggression in older adults with dementia, which can be difficult to treat and negatively affect quality of life.
当药物不能耐受或其他形式的治疗无效时,电痉挛疗法可能是一个很好的治疗选择. In some cases, ECT is used:
- During pregnancy因为药物可能会伤害发育中的胎儿,所以不能服用
- In older adults who can't tolerate drug side effects
- In people who prefer ECT treatments over taking medications
- When ECT has been successful in treating severe symptoms in the past
Risks
Although ECT is generally safe, risks and side effects may include:
- Confusion. Immediately after treatment, you may experience confusion, which can last from a few minutes to several hours. You may not know where you are or why you're there. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
- Memory loss. 有些人很难记住治疗前发生的事情或治疗前几周或几个月发生的事情, rarely, from previous years. This condition is called retrograde amnesia. 你也可能很难回忆起治疗期间发生的事情. For most people, 这些记忆问题通常在治疗结束后的几个月内得到改善.
- Physical side effects. On the days of an ECT treatment, some people experience minor nausea, headache, jaw pain or muscle ache. These generally can be treated with medications.
- Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.
How you prepare
在进行第一次ECT治疗之前,你需要一个全面的评估,通常包括:
- Medical history
- Complete physical exam
- Psychiatric assessment
- Basic blood tests
- Electrocardiogram (ECG) to check your heart health
- Discussion of the risks of anesthesia
These exams help make sure that ECT is safe for you.
What you can expect
电痉挛治疗过程大约需要5到10分钟,加上准备和恢复的时间. 电痉挛疗法可以在住院期间进行,也可以作为门诊手术.
Before the procedure
To get ready for the ECT procedure:
- 你会被全身麻醉,所以手术前你的饮食会受到限制. Typically, 这意味着午夜之后不吃东西或喝水,只喝一口水来服用任何早晨的药物. 你的医疗团队会在手术前给你具体的指导.
- You may have a brief physical exam. This is basically to check your heart and lungs.
- You'll have an intravenous (IV) line inserted. 你的护士或其他团队成员在你的手臂或手上插入一根静脉注射管,通过它可以给你药物或液体.
- You'll have electrode pads placed on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electric currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electric currents.
Anesthesia and medications
在手术开始时,你会通过静脉注射这些药物:
- An anesthetic to make you unconscious and unaware of the procedure
- A muscle relaxant to help minimize the seizure and prevent injury
You may receive other medications, 这取决于你的健康状况或你之前对电痉挛疗法的反应.
Equipment
During the procedure:
- 在一个脚踝周围放置一个血压袖带,可以阻止肌肉松弛药物进入你的脚,影响那里的肌肉. When the procedure begins, 你的医生可以通过观察那只脚的运动来监测癫痫发作的情况.
- Monitors check your brain, heart, blood pressure and oxygen use.
- You may be given oxygen through an oxygen mask.
- 你也可能会得到一个口腔保护,以帮助保护你的牙齿和舌头免受伤害.
Inducing a brief seizure
When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. 这会导致少量电流通过电极到达你的大脑, producing a seizure that usually lasts less than 60 seconds.
- 由于麻醉剂和肌肉松弛剂的作用,你保持放松,没有意识到癫痫发作. 如果你的脚踝上有一个血压袖带,那么你癫痫发作的唯一外在迹象可能是你的脚有节奏地运动.
- Internally, activity in your brain increases dramatically. 一项被称为脑电图(EEG)的测试记录了你大脑中的电活动. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, 短效麻醉剂和肌肉松弛剂的作用开始消失. 你会被带到一个恢复区,在那里你会被监视是否有任何潜在的问题. When you wake up, 你可能会经历一段时间的困惑,从几分钟到几个小时或更长时间.
Series of treatments
In the United States, ECT治疗通常每周进行2到3次,持续3到4周,总共进行6到12次治疗. 你需要的治疗次数和类型取决于你的症状的严重程度以及它们改善的速度.
手术后几个小时你就可以恢复正常活动了. However, some people may be advised not to return to work, 做重要决定或开车,直到最后一个ECT系列的一到两周后, 或在维持治疗期间单次治疗后至少24小时. 恢复活动取决于记忆丧失和混乱何时得到解决.
Results
大多数人在大约六次电休克治疗后开始注意到症状的改善. Full improvement may take longer, though ECT may not work for everyone. 相比之下,对抗抑郁药物的反应可能需要几周或更长时间.
没有人确切地知道电痉挛疗法如何帮助治疗严重的抑郁症和其他精神疾病. What is known, though, 在癫痫发作期间和之后,大脑功能的许多化学方面都发生了变化吗. These chemical changes may build upon one another, 以某种方式减轻严重抑郁症或其他精神疾病的症状. 这就是为什么电痉挛疗法对那些接受了全套多种治疗的人最有效.
Even after your symptoms improve, you'll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, and psychological counseling (psychotherapy).
Scheduling Electroconvulsive Therapy Treatments
If you have questions about ECT treatments, 我们的一位友好的接待协调员会很乐意帮助您安排与我们的一位医生的会诊. They can be reached 24 hours per day by calling (205) 971-6190. All calls are confidential.