TOPIC 9 - ELECTROCONVULSIVE THERAPY (ECT)

• Electroconvulsive Therapy (ECT)


  An effective treatment for depression that consists of inducing a grand mal (tonic-clonic) seizure by passing an electrical current through electrodes that are attached to the temples
• ECT

  • The administration of a muscle relaxant minimizes seizure activity, preventing damage to long bones and cervical vertebrae
  • The usual course is 6 to 12 treatments given two to three times per week
  • Maintenance ECT once a month may help to decrease the relapse rate for the client with recurrent depression
  • ECT is not a permanent cure
• ECT is not necessarily effective in clients with dysrhythmic depression or those with depression and personality disorders, those with drug dependence, or those with depression secondary to situational or social difficulties
• At-risk clients include those with recent myocardial infarction, cerebral vascular accident, or cerebral vascular malformation, or clients with intracranial mass lesions
• When ECT is indicated

  • When antidepressant medications have no effect
  • When there is a need for a rapid definitive response, such as when a client is suicidal or homicidal
  • The client is in extreme agitation or stupor
  • The risks of other treatments outweigh the risk of ECT
  • The client has a history of poor medication response, a history of good ECT response, or both
  • The client prefers it
• Preprocedure


  1. Explain the procedure to the client

  2. Encourage the client to discuss feelings, including myths regarding ECT

  3. Teach the client and family what to expect

  4. Informed consent must be obtained when voluntary clients are being treated

  5. For involuntary clients, when informed consent cannot be obtained, permission may be obtained from the next of kin, although in some states the permission for ECT must be obtained from the court

  6. NPO after midnight or at least 4 hours prior to treatment

  7. Baseline vital signs are taken

  8. The client is requested to void

  9. Hairpins, contact lenses, and dentures are removed

  10. Administer preoperative medication if prescribed; glycopyrrolate (Robinul) or atropine sulfate may be prescribed to prevent the potential for aspiration and to minimize brady dysrhythmias
• During the procedure


  1. Place a blood pressure cuff on one of the client's arms

  2. An IV line is inserted, and EEG and ECG electrodes are attached

  3. A pulse oximeter is placed onto the client's finger

  4. Blood pressure is monitored throughout the treatment

  5. Medications administered may include a short- acting anesthetic such as methohexital sodium (Brevital Sodium) or thiopental sodium (Pentothal) and a muscle relaxant such as succinylcholine (Anectine)

  6. 100% oxygen by mask via positive pressure is administered throughout the procedure

  7. An airway or bite block is placed to prevent biting of the tongue

  8. Electrical stimulus is administered, and the seizure should last 30 to 60 seconds
• Post procedure

  1. The client will be transported to a recovery room with the blood pressure cuff and oximeter in place, where oxygen, suction, and other emergency equipment are available

  2. Once the client is awake, talk to the client and take vital signs

  3. The client may be confused; provide frequent orientation (brief, distinct, and simple) and reassurance

  4. The client returns to the nursing unit when a 90% oxygen saturation level is maintained, vital signs are stable, and mental status is satisfactory

  5. Assess the gag reflex prior to giving the client fluids, food, or medication
• Potential side effects of ECT

  • Major side effects with bilateral treatment are confusion, disorientation, and short-term memory loss
  • The client may be confused and disorientated upon awakening
  • Memory deficits may occur, but memory usually recovers completely, although some clients have memory loss lasting up to 6 months
• Administration of a muscle relaxant

  1. Minimizes seizure activity

  2. Prevents damage to long bones and cervical vertebrae
• Usual course of ECT

  6 to 12 treatments given two to three times per week
• Maintenance ECT


  1. Given once a month

  2. Helps to decrease the relapse rate for the client with recurrent depression
• ECT is not a permanent cure
• Clients for whom ECT may not be effective

  • Those with dysrhythmic depression
  • Those with depression and personality disorders
  • Those with drug dependence
  • Those with depression secondary to situational or social difficulties
• At-risk clients for ECT

  • Those with recent myocardial infarction
  • Those with cerebral vascular accident
  • Those with cerebral vascular malformation
  • Those with intracranial mass lesions
• USES

  1. Clients with major depressive and bipolar depressive disorders, especially when psychotic symptoms are present such as delusions of guilt, somatic delusions, and delusions of infidelity
  2. Clients who have depression with marked psychomotor retardation and stupor.
  3. Manic clients whose conditions are resistant to lithium and antipsychotic medications and clients who are rapid cyclers (a client with a bipolar disorder who has many episodes of mood swings close together)
  4. Clients with schizophrenia (especially catatonia), those with schizoaffective syndromes, and psychotic clients
• Indications for use

  1. When antidepressant medications have no effect
  2. When there is a need for a rapid definitive response, such as when a client is suicidal or homicidal
  3. The client is in extreme agitation or stupor
  4. The risks of other treatments outweigh the risk of ECT
  5. The client has a history of poor medication response, a history of good ECT response, or both
  6. The client prefers it