What is the procedure of electroconvulsive therapy (ECT) ?
ECT is conducted by a group of trained medical technicians, anaesthesiologists, and psychiatrists. Before the procedure, the patient undergoes a pre-ECT evaluation, is informed about the procedure, and provides consent. During the procedure, the patient will be given anaesthesia to make the patient unconscious and unaware of the procedure and muscle relaxants to minimize the seizure and prevent injury. The doctor will place two electrodes on the scalp. Then a controlled amount of electrical current is passed between the electrodes to induce a brain seizure. The dose of electricity given affects the efficacy, response speed, and adverse cognitive effects. The stimulus of ECT is either a brief pulse (0.5ms to 2.0 ms) or an ultra-brief pulse (less than 0.5 ms) waveform. Even though the brief pulse is the standard one, the ultra-belief pulse is more tolerable. A brief pulse requires fewer treatments but an ultra-brief pulse has fewer cognitive adverse effects. The stimulus is determined by three methods: • Empirical titration: the most precise method for determining seizure threshold. Higher doses are given during the initial session until the seizure threshold is reached. • Formula based titration: dose depends on factors such as age, gender, and electrode placement. • Fixed dosages: the dosage is standard and given regardless of any factor.
