Electroconvulsive therapy (ECT) is a treatment that uses a brief electric current under general anesthesia to cause a short, controlled seizure. It works well for severe or treatment-resistant depression, catatonia and some cases of mania or psychosis.
Key symptoms
- Severe depression not helped by medicines
- Refusal to eat or drink, or high suicide risk needing a fast response
- Catatonia: not moving, not speaking, rigid postures
- After treatment: headache, muscle aches, nausea and short-term memory gaps
What you find on exam
- Baseline vital signs, heart and lung exam
- Mental status and suicide risk
- Dental check, since the bite block can harm loose teeth
- Assess decision-making capacity for consent
Tests
- Pre-anesthesia check with ECG and labs based on age and health
- Review of medicines that affect seizures or anesthesia, such as lithium or benzodiazepines
- Pregnancy test when relevant
- Brain imaging only if a neurological problem is suspected
Treatment basics
- Written informed consent after explaining benefits, risks and options
- Nothing by mouth before the session, IV access and removal of jewelry and dentures
- Short-acting anesthetic and a muscle relaxant such as succinylcholine, with oxygen and monitoring
- Recovery care: airway, vital signs, reorientation and fall precautions
- Usually 2 to 3 sessions a week for a course of 6 to 12, then maintenance treatment
Red flags
- Prolonged seizure lasting over 2 minutes
- Breathing problems or low oxygen after anesthesia
- Severe or worsening confusion after the session
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Sources: NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs); Open RN, Nursing Fundamentals 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.