In preparation for the ECT people are tested to make sure they are fit for treatment, e.g. a chest X-ray, an ECG (to trace the heart) and blood tests. People are asked not to eat or drink for at least six hours before the treatment. On the day of the ECT they come to the ECT suite and are given further routine checks such as blood pressure and glucose tests. The ECT team who carry out the treatment consists of specialist nurses, an anaesthetist and a psychiatrist. An anaesthetist puts a cannula into a vein, usually in the hand, and sticky pads are attached to the patient to monitor their brain waves. Drugs are given by the anaesthetist to induce a sleep like state and to relax the muscles. This reduces muscle twitching during ECT. Once the patient is relaxed a guard is placed between the teeth so that the person receiving the treatment doesn’t bite their tongue or damage their teeth.
A short electric current is then passed across the head so that the person has a short epileptic fit. The strength of the electric current used varies depending on the patient. The fit normally lasts between ten seconds and ninety seconds. The medical team constantly monitors the person’s blood pressure and heart rate and gives them oxygen during the treatment. Afterwards, the person is given time to wake up in a recovery room where they are also monitored. Patients are usually able to sit up and have a drink twenty minutes after the procedure.
People we spoke to had had one or more courses of ECT treatments. Each course consisted of usually 6-12 treatments with up to 3 treatments given each week. Some had ‘maintenance’ treatments less frequently, for example once a month. ECT was described by some as very ordinary ‘Like having a cataract operation’, though others found it very alien ‘slightly barbaric’.
Alka explains the process of her husband’s ECT treatment.
Tania said having someone with her before the treatment, being in nice surroundings, and having the staff introduce themselves really helps make ECT a less frightening procedure.
The passage of time and the side effect of ECT itself can make it harder to remember the treatment, which for many was a long time ago. Tracy struggled to remember the ECT treatment she had had almost twenty years ago. She also has severe memory loss from around the time of the ECT and before. Tania found that her memory is good generally. However, there are ‘gaps’ in her memory of the months she was receiving regular treatments (see ‘Side effects of having ECT‘ for more). Suzanne only remembers her last treatment. The doctor said to her ‘you know what to do now Suzanne’, but she said ‘every previous thing had been kind of wiped by the ECT.’ Going in for her last treatment felt as if it were her very first.
But some did remember the treatment clearly.
Although Sunil found memory loss the most distressing effect of ECT, he can remember quite a lot of the details of the ECT treatment. Immediately after the ECT, when he was not fully with it’, his wife was there.
John Z remembered step by step the process of having the ECT.
The ECT environment and staff
People talked about how important the environment of the ECT suite and the waiting area was. People were often nervous before their treatment, and some had to wait in a room for a long period of time. Tracy remembered nice details like a bunch of flowers in the treatment room. David Z described the environment as ‘alien’ but said he felt ‘calm and safe.’ For Lorraine the waiting room had felt ‘homely’.
Many people talked enthusiastically about how friendly, kind and professional staff in the ECT suit were. This was vital in helping them feel less nervous. Tania said because of all the controversy about ECT, staff who carry out the ECT are usually aware of the need to make people feel at ease.
Jenny was positively overwhelmed by the way in which ECT was performed, and the kindness of the staff, even though she didn’t find ECT effective for her depression.
Tania was impressed by the kindness and humanity’ of the staff and she felt better after 6 or 7 treatments.
However, others found the hospital environment daunting and unfriendly. Catherine Y said that when she was offered ECT, she found the hospital staff ‘difficult’ and the hospital environment ‘quite unsupportive’. Carys said ‘people, generally speaking, didn’t want to talk to me at all’. Sue said the staff didn’t talk to her during the ECT treatment and that was ‘the worst thing’ for her (for more see ‘Relationship with health and social care’.
David Y said the hospital staff didn’t interact with him or with his partner who was having the ECT.
The effect on others of seeing a person come out of an ECT treatment can also be unnerving, e.g. when others come out of the treatment room ‘drooling’, looking ‘zombified’ or ‘crying and screaming’.
It is possible to have ECT as an outpatient. Steve thought his wife made a better recovery when she received ECT as an outpatient on the NHS and could go home in between treatments (for more on this see ‘Staying in hospital’). Those who had ECT as an outpatient were able to make their own way to and from the hospital accompanied by relatives.
The ECT treatment itself
Some people we spoke to had a positive experience of the ECT treatment itself. Jane described it as a ‘still point in a turning world’. David Z said by the time of his last treatment it was ‘just a normal thing to do twice a week’. But others found it ‘overwhelming’ and ‘horrible.” Being nervous (e.g. feeling ‘like a frightened animal’) before having ECT was a common experience. Sheila’s husband felt strange after his ECT treatments, and usually said he wouldn’t have it again, although he did.
Being well informed about the treatment and being prepared to give it a go seemed to make it less frightening for many. John Z, who was catatonic when he had ECT, said he was told in detail what was going to happen and it was ‘not at all frightening’. David Z had suffered depression since he was a teenager, and when he was offered ECT at age 40 he volunteered for it. He said he was given quite good information and he thought, ‘Okay, this is just the next step and let’s just go for it and see’. He wasn’t frightened or resistant, even though it all felt a bit strange. Many of those who had ECT were so ill they said there was no alternative option (see for more ‘Compulsory detention or treatment‘, ‘Deciding whether to have ECT‘).
It was those who had ECT a long time ago who had the worst memories.
Helen had ECT in 1970 when she was 17 and describes it as a horrific memory. She can remember herself and others being herded into ambulances and taken to another hospital where they were given the treatment.
Yvonne was 18 when she had compulsory ECT and didn’t know what was going to happen. She kept running away from the hospital. In the end, she was kept in a locked room and wheeled down to the treatment room. She said she ‘just couldn’t figure out why putting an electric shock through my brain was going to make me feel better.’ She was ‘absolutely petrified’. Carys’s daughter was 19 when she was sectioned. She repeatedly ran away and ‘loathed it with a passion’. Tracy says when she had ECT in her twenties she was ‘a bit blas‚àö¬©’ about having the treatment but she remembers going down to the room and ‘it was all very sombre and a bit scary’.
Quite a few people talked about having to travel to a different hospital to have their ECT treatment because their local hospital didn’t have the equipment.
Cathy had ECT over ten years ago. She was taken with others in a taxi for treatment at another hospital and was too scared to have further treatments. She struggled to remember recent events.
Sue and Ian’s local centre had closed and Sue had to travel to two other places and never knew which one she had to go to. Rather than a short course of treatment the ECT was spread over months.
Some people talked about the health professionals changing the amount of electricity used for the treatment. Kathleen said that after her first ECT she had a bad headache and sore jaw and she couldn’t eat. She said her ‘seizure threshold’ – the amount of electricity needed to give her a fit – was low and so they adjusted it for future treatments and she was fine after that.
After the anaesthetic some people felt ‘quite knocked out’, ‘groggy’, ‘confused’ or ‘tired.’ Tania remembered ‘the anaesthetist [was] lovely’ and told her to ‘think about something nice’ as she went off. John Z described how the anaesthetic gave him ‘that wonderful feeling of going off’. But Cathy said she stopped having ECT because she ‘couldn’t stand that point between being awake and the millisecond bit’ before going unconscious. Sue felt she didn’t have much choice in it, and said the anaesthetic ‘was sort of like an emotional way of holding me down. And of controlling me.’ She had needed a lot of anaesthetic for her to go under. She felt quite distressed when people seemed to panic: the anaesthetic was slow to take hold, and she worried it might not work.
Some people commented on the way they or their loved ones had looked straight after having ECT. Yvonne felt she had looked like she’d had a stroke, and Lorraine and Annie said their mum’s face had gone red and her hair was sticking up. But this effect on appearance soon wore off. Jane spoke about how she had had ECT in the morning, and competed in a mother’s race at her child’s sports day in the afternoon, even though she fell over at the end of the race (see ‘Side effects of having ECT‘ for a discussion of unwanted effects of ECT).