Electroconvulsive Therapy
电休克疗法(ECT)是一种治疗方法, 在全身麻醉下完成, 小电流通过大脑, 故意触发简短的, controlled seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.
当其他治疗方法都不成功时,电痉挛疗法通常是有效的, particularly with conditions such as treatment-resistant depression (TRD) or catatonia.
电痉挛疗法仍然有很大的耻辱, largely because treatments in the mid-1900’s involved high doses of electricity administered without anesthesia, 并经常导致失忆, 骨折和其他严重的副作用. Modern ECT is much safer. 尽管任何电痉挛疗法都可能产生一些副作用, it now uses electric currents given in a controlled setting to achieve the maximum treatment benefit with the fewest possible risks or side effects.
Why it's done
电休克疗法(ECT)可以提供快速, significant improvements in severe symptoms of several serious mental health conditions. ECT is used to treat:
- Severe depression, 特别是当伴有脱离现实时(精神病), 想要自杀或拒绝进食的欲望.
- 难治性抑郁症(TRD), a severe depression that doesn't improve despite trials of multiple medications or other treatments.
- Severe mania, 极度兴奋的状态, 躁郁症的躁动或多动症状. 躁狂症的其他症状可能包括决策能力受损, 冲动或冒险行为, 药物滥用和精神病.
- Catatonia, 不动的以缺乏运动为特征的, fast or strange movements, 不会说话和其他症状. It's associated with schizophrenia and certain other psychiatric disorders. 在某些情况下,紧张症可能是由医学疾病引起的.
- 老年痴呆患者的躁动和攻击性, 哪些是难以治疗并对生活质量产生负面影响的.
ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. 在某些情况下,使用电痉挛疗法:
- During pregnancy, when medications can't be taken because they might harm the developing fetus
- In older adults 谁不能忍受药物的副作用
- 那些喜欢电痉挛疗法而不是服用药物的人
- 当电痉挛疗法在治疗严重症状上取得成功时
Risks
虽然ECT通常是安全的,但风险和副作用可能包括:
- Confusion. 治疗后立即, 你可能会感到困惑, 它可以持续几分钟到几个小时. 你可能不知道你在哪里,也不知道你为什么在那里. 很少情况下,困惑会持续几天或更长时间. 通常在老年人中更明显.
- Memory loss. Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. 这种情况被称为逆行性健忘症. You may also have trouble recalling events that occurred during the weeks of your treatment. For most people, these memory problems usually improve within a couple of months after treatment ends.
- Physical side effects. 在电休克治疗的日子里, 有些人会有轻微的恶心, headache, jaw pain or muscle ache. 这些通常可以用药物治疗.
- Medical complications. 和其他医疗程序一样, 尤其是涉及麻醉的手术, 有医疗并发症的风险. During ECT, 心率和血压升高, and in rare cases, 这会导致严重的心脏问题. 如果你有心脏问题,电痉挛疗法可能风险更大.
How you prepare
Before having your first ECT treatment, you'll need a full evaluation, which usually includes:
- Medical history
- Complete physical exam
- Psychiatric assessment
- Basic blood tests
- 心电图(ECG)检查你的心脏健康
- 讨论麻醉的风险
这些检查有助于确保电痉挛疗法对你是安全的.
What you can expect
The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you're an inpatient in the hospital or as an outpatient procedure.
Before the procedure
为ECT手术做准备:
- You'll have general anesthesia, so you can expect dietary restrictions before the procedure. Typically, this means no food or water after midnight and only a sip of water to take any morning medications. Your health care team will give you specific instructions before your procedure.
- 你可以做个简短的体检. 这基本上是检查你的心脏和肺.
- 你需要插一根静脉注射管. Your nurse or other team member inserts an IV tube into your arm or hand through which medications or fluids can be given.
- 你的头上会有电极垫. 每个垫子大约有一美元银币那么大. ECT can be unilateral, 电流只集中在大脑的一侧, or bilateral, 大脑的两边都能接收到集中的电流.
麻醉和药物
At the start of the procedure, you'll receive these medications through your IV:
- 一种麻醉剂,让你失去意识,不知道手术过程
- 一种肌肉松弛剂,有助于减少癫痫发作,防止受伤
你可能会接受其他药物治疗, depending on any health conditions you have or your previous reactions to ECT.
Equipment
During the procedure:
- A blood pressure cuff placed around one ankle stops the muscle relaxant medication from entering your foot and affecting the muscles there. 当手术开始时, your doctor can monitor seizure activity by watching for movement in that foot.
- 监视器会检查你的大脑、心脏、血压和氧气使用情况.
- 你可以通过氧气面罩吸氧.
- You may also be given a mouth guard to help protect your teeth and tongue from injury.
Inducing a brief seizure
当你从麻醉剂中睡着,肌肉放松的时候, 医生按下电痉挛治疗机上的按钮. This causes a small amount of electric current to pass through the electrodes to your brain, 导致癫痫发作通常持续不到60秒.
- Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you're having a seizure may be a rhythmic movement of your foot if there's a blood pressure cuff around your ankle.
- 在内部,你的大脑活动急剧增加. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, 脑电图信号的活动增加预示着癫痫发作的开始, 然后平稳下来,表明癫痫发作结束了.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you're monitored for any potential problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.
Series of treatments
In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments. The number and type of treatments you'll need depend on the severity of your symptoms and how rapidly they improve.
You can generally return to normal activities a few hours after the procedure. However, 有些人可能会被建议不要回去工作, make important decisions or drive until one to two weeks after the last ECT in a series, or for at least 24 hours after a single treatment during maintenance therapy. Resuming activities depends on when memory loss and confusion are resolved.
Results
Most people begin to notice an improvement in their symptoms after about six treatments with electroconvulsive therapy. 完全改善可能需要更长的时间,尽管电痉挛疗法可能对每个人都不起作用. Response to antidepressant medications, in comparison, can take several weeks or more.
No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. 这些化学变化可能相互影响, somehow reducing symptoms of severe depression or other mental illnesses. That's why ECT is most effective in people who receive a full course of multiple treatments.
即使在你的症状好转之后, 你仍然需要持续的抑郁症治疗来防止复发. 正在进行的治疗可能是频率较低的电痉挛疗法, but more often, 它包括抗抑郁药或其他药物, 心理咨询(心理治疗).
安排电休克治疗
如果你对电痉挛疗法有疑问, one of our friendly intake coordinators would be happy to assist you in scheduling a consultation with one of our physicians. 每天24小时拨打(205)971-6190与他们联系. 所有通话都是保密的.