Find us at Prospect Park Hospital
Electro convulsive therapy
The help and treatments available at Prospect Park Hospital,
Reading
This booklet was produced by the ECT Department,
Pimpernel Suite, Prospect Park Hospital.
If you need this information in another language or
format please contact us on 0800 0281215.
L037/V1/January 2012
© Berkshire Healthcare Foundation Trust, 2012
What is Electro Convulsive
Therapy (ECT)?
Does ECT work?
Is ECT safe?
Electro convulsive therapy (ECT) can
be part of the treatment for severe
episodes of major depression, mania,
and catatonia, in line with guidance
from the National Institute for Health
and Clinical Excellence (NICE). It is
rarely used in schizophrenia.
Although there have been many
advances in the treatment in mental
disorders in recent years, ECT
remains effective, fast and safe in
most cases, particularly when
alternatives such as medication aren’t
working.
All treatments have risks and sideeffects. The same can be said for
having no treatment at all.
ECT uses a brief electrical current to
produce a seizure within the brain.
This is believed to bring about
biochemical changes that may cause
your symptoms to diminish or even
disappear.
Your doctor will discuss with you why
ECT has been recommended and
what alternatives might be available.
Generally between six and 12
treatments, given at the rate of two a
week, are required to produce such
an effect. You can have ECT either
as an in-patient or as an out-patient.
We might see improvement after four
or five treatments. You will be
reassessed after every two
treatments. However, treatment will
stop if you recover or if you withdraw
your consent.
The treatment itself is given by a
team of doctors and nurses with
specialist training and experience.
Treatment is given in the Pimpernel
suite at Prospect Park Hospital,
Reading.
This unit was assessed by the ECT
Accreditation Services who awarded
the clinic with Excellence in 2010.
ECT is most effective in depression,
especially among older people, who
see major benefits. Success rates
can be as high as 80-90%, though
this depends on the individual.
Still, there is no guarantee that ECT
will work for every patient.
And although ECT may bring an
episode of illness to an end, it will not
in itself prevent another episode from
occurring weeks, months, or years
later.
For this reason, you and your doctor
will need to consider additional
treatment to follow any ECT. This
generally means medication,
psychotherapy or – occasionally–
further ECT.
We will advise with you about the
risks and benefits before you agree to
have treatment. Serious complications,
which are also quite rare, include:
• Reactions to the medications used
at the time of the treatment
• Injuries to muscle, bone or other
parts of the body
• Greatly prolonged seizures, or
seizures recurring after the ECT,
which may need to be treated.
However, ECT does not cause
epilepsy.
For most patients, the side-effects of
ECT are relatively minor. Between
10% and 50% of people may
experience side-effects, though we
don’t know for certain. They include:
• Headaches, the most common side
effect, can be treated with
paracetamol or ibuprofen
• Memory problems, which are also
relatively frequent
• Muscle soreness and nausea
though these are rare
• Confusion for a few hours following
treatment - this is more common in
older people
When memory problems do occur,
they vary considerably from patient to
patient. They are usually worse when
more ECT treatments are given or
when both sides of the head are
stimulated (bilateral ECT). If memory
loss is a problem, bilateral ECT may
be changed to unilateral. You will be
asked for consent to this change in
treatment.
ECT-related memory problems can
be of two types:
1. Difficulty remembering new
information
2. The loss of some memories,
particularly from the recent past
(such as during and just before
ECT)
Your ability to learn and remember
new information commonly returns to
its normal level over a period of days
after ECT.
Surveys indicate that most patients
receiving ECT are not greatly
disturbed by memory effects. NICE,
in its recent guidance on ECT, says:
“ECT may cause short- or long-term
memory impairment for past events
(retrograde amnesia) and current
events (anterograde amnesia). As
this type of cognitive impairment can
also be a feature of many mental
health problems it may sometimes be
difficult to differentiate the effects of
ECT from those associated with the
condition itself.”
The extent of memory loss after ECT,
and the perception of this loss, also
varies from person to person.
However, some people do find their
memory loss very damaging and feel
this outweighs any benefit from ECT.
Some patients feel their personality
has changed.
We recommend that important life
decisions be postponed during the
course of ECT and until any major
effects of ECT on their memory
have worn off. Please seek advice
from your Doctor.
You are also advised not to drive
during this time and until advised
by your doctor.
Finding out about ECT and
giving your consent
We can only give you ECT with your
consent. The only exception to this is
if you lack the capacity to consent to
this treatment. In this event the
treatment will be discussed at length
with all involved including you, prior
to treatment commencing and may
involve a second psychiatrist opinion.
If you do give your consent, you may
withdraw it at any time later. Even if
you do give your consent on ECT,
please do find out more about it.
Please feel free to ask your doctor or
nursing staff any questions. A wide
variety of information is available,
including leaflets, videos and material
on the internet. Websites such as
www.nice.org.uk/guidance/TA59
provide detailed information on ECT.
However, please treat the internet
with caution, as some websites might
not be authentic, reliable or run by
knowledgeable people.
The best way to get a balanced view
is to use several sources of
information before making your
decision to consent to ECT.
Alternatives to ECT
ECT is rarely the first treatment
option and is generally offered when
medication has failed. In some cases,
counselling or psychotherapy might
have also been tried unsuccessfully.
However, scientific evidence shows
that ECT is still the most-powerful
treatment for severe depression.
NICE agrees with this.
Getting ready for ECT
As for any treatment requiring a
general anaesthetic, before ECT, we
will do a medical check, blood tests
and an ECG to make sure the
treatment can be carried out in the
safest, most effective manner.
You will be given information leaflets
and be invited to the unit to meet the
staff, look around and ask questions.
Your medication may also be
adjusted to minimize the risk and
maximize the effectiveness of the
treatment.
Preparing you for ECT
ECT is usually given twice a week.
You must not eat or drink after
midnight the night before each
treatment. This includes not chewing
gum. You may be asked to take
relevant pills on the morning of
treatment with a small amount of
water.
Please bring a change of clothing
with you, due to the slight risk of
incontinence.
The anaesthetist will place a small
cannula in a vein (usually on the
back of your hand) so the
medications to put you to sleep and
relax your muscles can be given
If you are an in-patient, a ward nurse
who knows you will bring you to the
suite. If you are an out-patient, we’ll
ask a friend or relative to do this. The
treatment itself is given in a separate
area of the suite.
The ECT nurse will ask if you are
willing to have treatment and check
that you are prepared. You will be
brought into the treatment room and
asked to lie down on a comfortable
bed, before we put a blood-pressure
cuff on your arm.
We will put a number of electrodes
on your scalp and chest so that the
brain waves (EEG), heart waves
(ECG), and body-oxygen levels can
be monitored, and so that the
electrical stimulus can be given after
you are asleep.
You will be given oxygen to breathe
through a mask, and within a minute
of the injection of the anaesthetic
medication, you will be asleep. We
will then give you medication to relax
your muscles.
ECT when you are an out-patient
If you are an out-patient, you will be
given additional forms to sign, as will
your relative/carer or supervising
adult when you attend the clinic for
treatment.
You will be asked to arrive about 15
minutes before your appointment.
How ECT works
When you are asleep, a controlled
electrical stimulus is given between
two electrodes placed on the
temples (bilateral ECT) or on the
right temple and the top of the head
(unilateral ECT).
Unilateral ECT is thought to cause
fewer memory problems than
bilateral, but may take more
treatment to resolve your
depression. We will discuss the
treatment type with you at consent.
Occasionally it may be changed
during the course to increase your
recovery rate or to reduce memory
problems if they occur.
The electrical stimulus will trigger a
seizure within the brain and
throughout the body which typically
lasts less than a minute. The
relaxing drug greatly reduces muscle
movement, so you stay fairly still.
ECT without consent
Prospect Park Hospital
Appointments
ECT may occasionally be given
under the Mental Health Act, without
the patient’s consent. This may be
when a patient is too ill, and so lacks
the capacity to consent.
ECT department 8am-1pm, Tuesday
and Friday only
0118 960 5008
Please arrive 15 minutes before your
appointment time)
Your ward, Bluebell, Daisy or Rowan
Via switchboard
01189 605000
Day:
This will only be after careful
assessment by the patients team
and may involve a second opinion
from an independent psychiatrist.The
patient’s family will have been
involved in the decision to treat, and
they and the patient will have the
right to appeal against treatment.
For Wexham Park
Ward 10
Via switchboard on
References
A Programmed Text 2nd Edition.
Beyer Weiner Glenn.
Within a few minutes of the seizure,
when you are breathing well on your
own, we will move you to a recovery
room where you will wake up with a
nurse caring for you. Because of the
anaesthetic drug and the effects of
the seizure, you will feel a bit groggy
for a while.
NICE guidelines: National Institute
for Health & Clinical Excellence.
Usually within 15-25 minutes of
leaving the treatment room, you will
go to the sitting area where you will
be offered something to eat and
drink.
Further information
You will be allowed to leave once
you have met the discharge criteria.
Scottish ECT Accreditation Network
(SEAN) www.sean.org.uk
Websites
http://www.rcpsych.ac.uk
www.nice.org.uk
National Institute for Health and
Clinical Excellence (NICE)
www.nice.org.uk/guidance/TA59
ECT Accreditation Services (ECTAS)
www.rcpsych.ac.uk
..........................................................
01753 633000
For St Marks Hospital
Charles Ward
01753 638540
Date:
In order for us to offer the most
effective care, we need to know
about the things that may affect your
treatment – for example if you are
pregnant, have a heart condition or
are taking drugs or alcohol.
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Patient advocacy
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Leaflets and information are available
in the ECT suite.
Other languages and
formats
If you would like this information in
another language or format, such as
large-type, please contact the ECT
team at Prospect Park Hospital.
Booklet design
Prospect Park ECT team with service
user involvement.
Review date: January 2013
Time: