Will I get Unilateral or Bilateral ECT?

Re: UL or BL (bitemporal) treatment. This is decided by the ECT psychiatrist and depends on your diagnosis and severity of illness. UL ECT causes less memory impairment than BL ECT, however BL ECT is more effective. If you have Major Depression, you will likely be started on UL ECT. If you have a response with UL, you will remain on UL as long as your are responding. If you are not responding or responding, but very slowly, you will be switched to BL ECT. You should have a discussion with the ECT psych if this switch to BL is going to be recommended. Re: energy, there are specific parameters for energy settings that depend on your seizure threshold (the minimum amount of energy needed for the individual to have a seizure) with BL ECT. All patients treated with UL ECT are treated at 100% energy because lower energies have not been shown to impart any benefit with regard to memory impairment, and 100% energy is the most effective for UL ECT.

People with bipaolar disorder are usually started with bilateral ECT. People with bipolar disorder respond significantly better to bilateral ECT.

The roles of the ECT Psychiatrist and Primary Outpatient Psychiatrist trist

The roles of your ECT psychiatrist and your primary psychiatrist (pp): these roles ideally will be interconnected. The ECT psychiatrist will be monitoring your response to ECT treatment to treatment and will be make the recommendations re: your treatment schedule. Your pp will remain responsible for your medication management and overall care. The ECT psych will manage specific side effects of the ECT and communicate any recommendations for changes to your medications during the course of treatment to you pp. Some primary psychiatrists have a very "hands-off" approach when their patients are having ECT and this can create issues for the patient's care.

I am still worried about memory. Tell me more.

I can tell you that permanent memory impairment is very rare. Temporary short term memory problems during the course of treatment are very common. Most people report that by 6 months after their last treatment, they have no memory impairment. Short term memory and newly learned info are a couple of the areas of difficulty.This can present problems during the course of treatment. I encourage people to start journaling prior to the treatments regarding the ECT information they are given as well as the symptoms and specifically how the symptoms are impacting their lives and functioning. Sometimes a person will get such an improvement after @ 9 treatments, that they may want to abruptly stop because they are all better. We find that symptoms can recur very quickly and sometimes a complete relapse occurs within a few weeks. As a result, the whole series must be restarted. So for example, journaling "even though I feel better I may need to continue treatments to prevent recurrence of my symptoms". This is also an area where your support person will be vital as well as your trust in your treatment team.

I also encourage a journal of computer passwords and other very important info that no one else knows, should you forget these. If your memory becomes impaired to the point where you are distressed with it, you need to speak with the ECT psychiatrist prior to your next treatment. Sometimes the incredible mood benefits outweigh the troublesome nature of the memory issues, but should this not be the case, be sure to mention it.

What about Memory Problems?

The memory impairment with ECT usually concerns short term memory, not long term memory. In very rare cases, there is long term memory impairment. These are case reports from individuals. There has been no research that supports this experience, but because it is reported we consider it a possible, but rare side effect. Of course there are many other things that can cause long term memory loss, and it needs to be studied taking all the variables into consideration.

I can say that in my experience, I have seen only one patient who reports memory loss of events occurring about 20 years prior to ECT. This person is a reliable and truthful person. This person has returned for ECT despite her reported memory loss when her depression has gotten bad. She sees the benefits of the treatment outweighing the risk for her.

The short term memory impairment concerns events occurring shortly before and during treatment. Some people will not remember the referral process or how badly they felt when they started treatment. There are adjustments to the ECT treatment itself (lead placement, energy) as well as frequency of ECT that can ameliorate memory problems. For most patients, normal memory function returns within 6 months of discontinuing treatment. This has been very consistent in my experience.

Frequently asked questions about ECT/FAQs

Does my employer need to know that I am receiving ECT? I am afraid that my co-workers and supervisors will view me differently.

You do not have to provide your employer with any specific information, other than to state that you are taking time off for medical reasons. Your doctor does not have to be specific in his note either. He should use generic type letterhead, not anything stating he is a psychiatrist, to protect your privacy if this is your wish

I understand your concern regarding be viewed differently by those you work with in the context of your illness. Consider though that they may already sense that you are not yourself and may view your getting help on a positive rather than negative way. Certainly, if you have a good response to the ECT they will notice a change! Many people have friends and family members who have dealt with depression and truly can be supportive.

During my ECT evaluation, the psychiatrist did not seem to be familiar with my history......

Ideally, the ECT psychiatrist would be very familiar with your history, however I don't think it is unreasonable that he agree to start ECTon the recommendation of your psychiatrist. The ECT MD may well be aware that your doctor typically refers appropriate candidates. You do have the right, however, to get information regarding how likely it is that ECT will work FOR YOU. In order to tell you this, the doctor would HAVE TO know your history: symptoms and responses to medication trials.

I just started ECT and I feel worse. How can this be?

You may experience increased depressive symptoms and anxiety as you go through this process and start treatments. This is largely due to the incredible stress of this decision, but may also be due to emergence of manic symptoms

Be sure to report any increase in your symptoms to your ECT psychiatrist and regular psychiatrist. Suicidal thoughts or wish to be dead should always be resported immediately.

Information provided on this site is not intended to be used as medical advice.