PENN ELECTROCONVULSIVE THERAPY (ECT) TREATMENT PROGRAM

The Electroconvulsive Therapy (ECT) Program at The University of Pennsylvania offers state-of-the-art outpatient and inpatient-based ECT for severe psychiatric disorders. ECT has proven effective as a treatment for depression and other psychiatric conditions. Advancements in the technique have improved significantly ECT’s tolerability and safety profile.

The Psychiatry Department at the University of Pennsylvania is one of the leading ECT programs in the U.S. and has extensive clinical experience with ECT. Our service is directed by experts on mood disorders and neuromodulation to ensure adequacy of treatment and to maximize the chances of treatment response.

ABOUT ECT AT PENN

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. ECT has proven effectiveness in the treatment of Catatonia and Depression (unipolar and bipolar) with treatment resistance or who required a rapid response due to the severity of symptoms and it is approved by the U.S. Food and Drug Administration (FDA).

Initial Assessment

Patients are initially seen by a 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 pre-procedure evaluation (i.e., risk stratification by primary care or internist) and to discuss with your prescribing psychiatrist medications changes and adjustments needed to increase ECT effectiveness and to minimize the 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.

Pre-procedure Evaluation (i.e., risk stratification)

A formal pre-procedure medical evaluation and risk stratification for general anesthesia and electroconvulsive therapy is required without exception. The evaluation 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 pre-procedure evaluation can be obtained from your primary care doctor. Other tests or subspecialty clearance (e.g., cardiology, obstetrics, or neurology) may be required on a case-by-case basis.

The day before and morning of ECT

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 the use of hypnotics and anticonvulsants as they may negatively affect your treatment. Those include medications like lorazepam, clonazepam, alprazolam, zolpidem, valproic acid, lamotrigine, topamax, and gabapentin. Hold your nighttime dose of Lithium on nights prior to ECT.

ECT day

ECT is administered at Pennsylvania Hospital located at 800 Spruce Street, Philadelphia, PA 19107. Please arrive at the Spruce building’s short procedure unit (SPU) registration area (1st floor). 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 day of 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 on the day of the procedure due to potential confusion after ECT and anesthesia.

Treatment course

ECT is administered on Monday, Wednesday, Thursday, and Friday 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.

Resources for Patients

NEJM - Depression- Advanced Treatments for Treatment-Resistant Depression

In an interactive perspective recently published by The New England Journal of Medicine, Dr.Cristancho, Dr.Sanacora, and Dr.Nikayin discussed the evolution and current status of some interventional psychiatry treatment modalities including Transcranial Magnetic Stimulation (TMS), Esketamine / Ketamine, Electroconvulsive Therapy (ECT), and Psilocybin. Dr.Cristancho, MD, is an Associate Professor at The University of Pennsylvania and Chief of Penn Interventional Psychiatry where TMS, Esketamine, ECT, Deep brain stimulation (DBS), and Vagus nerve stimulation (VNS) are used to treat complex mood disorders and obsessive-compulsive disorder.