Electroconvulsive Therapy (ECT) is a noninvasive brain stimulation technology. The ECT device delivers predetermined electrical pulses to the brain resulting in a controlled generalized seizure that exerts biological effects that translate into clinical benefit.
Patients are initially seen by a board certified psychiatrist with expertise in mood disorders and neuromodulation. The initial assessment includes a diagnostic and treatment evaluation focusing on determining the appropriateness of ECT as the next step in your treatment, as well as its risks, benefits, and other available treatments for your condition. The most common indications for ECT in our service are treatment resistant unipolar or bipolar major depression with or without psychosis and catatonia. Other indications include mania and treatment refractory psychotic disorders. Patients are carefully screened for the presence of medical conditions or underlying risk factors that might make the administration of ECT unsafe clinically. If ECT is deemed to be safe and appropriate for your case, you will be instructed to obtain a medical clearance for ECT and to discuss with your prescribing psychiatrist medications changes and adjustment needed to increase ECT effectiveness and to minimize potential for side effects (e.g., gradual taper off anticonvulsants if feasible). Our patient access team will determine your insurance eligibility to receive treatment at our service.
A formal medical clearance for general anesthesia and electroconvulsive therapy is required without exception. The clearance should include a complete history and physical, an electrocardiogram (ECG), and blood work including a complete blood count (CBC), and a basic metabolic panel (BMP). This medical clearance can be obtained from your primary care doctor. Other test or subspecialty clearance (e.g., cardiology, obstetrics, or neurology) may be required on a case by case basis.
Don’t drink or eat after midnight with the exception of necessary medications taken with a small sip of water. This is important to avoid anesthesia related complications. Avoid use of hypnotics and anticonvulsants as it may have a negative effect in your treatment and decrease its effectiveness. Those include medications like lorazepam, clonazepam, alprazolam, zolpidem, valproic acid, lamortrigine, topomax, and gapapentin. Hold your night time dose of Lithium on nights prior to ECT.
ECT is administered at Pennsylvania Hospital located at 800 Spruce St, Philadelphia, PA 19107. Please arrive at the spruce building’s short procedure unit (SPU) registration area (1st floor). Occasionally, ECT is performed in the main hospital. You will be informed of that change in advance. Once registration is complete you will be transferred to the holding area where you will be seen by the ECT team (Nurse, anesthesiologist, and ECT physician).
After a pre procedure evaluation you will be transferred to the procedure room where ECT takes place. Once the effects of the anesthesia wear off you will be transferred to the recovery area. Once you are fully awake and tolerating food you will be transferred back to the holding area for discharge to your companion.
Outpatients, with no exception, should have an appropriate companion for the procedure day. Patients cannot drive and may need assistance the day of the procedure due to potential confusion after ECT and anesthesia.
ECT is administered on Monday, Wednesday, and Fridays mornings. An adequate initial course of ECT requires 12-15 sessions depending on the diagnosis and its severity. Our patients are reassessed for clinical progress and need for treatment optimization by an experienced psychiatrist at every session.
If you do benefit from ECT, we will discuss how best this improvement can be sustained, including the possibility of intermittent maintenance ECT sessions with a frequency that gradually decreases from 1 per week to 1 per month or longer. If no clinical benefit is achieved after an adequate trial of ECT, we will recommend potential treatment options to be discussed with your outpatient psychiatrist.
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