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The Use Of Electroconvulsive Therapy In The Elderly

What you should know

  • Electroconvulsive therapy, also called ECT, is a type of shock therapy that may be used in the elderly. An elderly person may be defined as someone who is 60 years of age or older. ECT is a treatment where a small electric shock is sent to your brain to make a seizure (convulsion). The seizure may increase blood flow and release chemicals in your brain. These effects may make the cells of your brain work better. ECT is used to treat certain conditions that do not get better after medicines or other therapies have been tried. It is also used when other treatments cannot be given. ECT may also be used when symptoms need to be treated quickly, such as not wanting to eat or drink.
  • ECT in the elderly is mainly used to treat depression (a very deep sadness). This includes depression with insomnia (trouble sleeping), weight changes, or thoughts of hurting or killing yourself (suicide) or others. The depression may be severe (very bad), last a very long time, or go away and then come back again. ECT may also be used to treat movement disorders, such as Parkinson Disease, or long-lasting pain. Mental disorders that affect the way a person thinks, acts, or talks with others may also be treated with ECT. ECT may be used with other treatments, such as medicines or therapy.
  • With ECT, a device produces an electric current that travels through two electrodes. The electrodes may be placed on each side of your head or with one on the crown (top) of your head. When and how often you get ECT, and the strength of the electric current depend on your condition. You may need ECT treatments several times a week, or less often. You may need fewer than 12 treatments, or treatments may continue for years. Your caregiver will tell you how many treatments are best for you, and when you should have them done. Over time, ECT may help you feel happier or calmer, or decrease other symptoms such as shaking or pain.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

  • Common problems after ECT include confusion (trouble thinking clearly) and trouble remembering things. Confusion may last for an hour or longer after an ECT treatment. Memory often gets better two weeks after the treatment, but some memories may be forgotten forever. You may have nausea (upset stomach), vomiting (throwing up), a headache, tooth, gum, or mouth injury, and muscle aches. Your blood pressure may increase, or the rhythm of your heartbeat may change. ECT may not help treat your condition, or you may need more sessions before you feel better. Your problems or symptoms may come back after having ECT treatments.
  • If you have certain medical problems, your risk of problems after treatment with ECT is higher. The risk for problems may be higher in older adults, and if your health is poor. If you use heart medicine, this can also increase your risk of problems. You should not have ECT if you have had a recent stroke or heart attack, or if you have certain kidney tumors. You may not have ECT if you have high pressure in your brain caused by a tumor or blockage. Talk with your caregiver if you are worried or have questions about your treatment, medicine, or care.

Getting Ready

The week before your treatment:

  • Ask a family member or friend to drive you home after your treatment. Do not drive yourself home.
  • If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your procedure. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before the procedure. You may need to check your blood sugar more often before and after having your procedure.
  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  • You may need to have blood tests, x-rays, an ECG, or other tests. Brain imaging tests, such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) may also be done. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your treatment:

  • You may be given medicine to help you sleep.
  • You may need to fast overnight. This means you are not allowed to eat any solid food after midnight. You may have water up to one hour before your treatment to take your medicine. You have a fever.

The day of your treatment:

  • Write down the correct date, time, and location of your procedure.
  • What to bring: You may want to bring items such as a toothbrush and bathrobe.
  • An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  • You may be given medicine to help prevent side effects caused by ECT, such as headaches.
  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

You will be asked to change into a hospital gown. You will be given medicines to calm you, make you sleepy, or relax your muscles. You will be taken to the room where the treatment will be done. Medicine called general anesthesia will be given to keep you asleep during the treatment. When you are asleep, electrodes will be applied to your head and a shock will be given. You will wake up within 5 to 10 minutes after the treatment.

After your treatment:

You will be taken to a room where you can rest. Caregivers will watch you closely for any problems. When they see that you are OK, you may be allowed to go home. If they want you to stay in the hospital, you will be taken back to your hospital room. Do not get out of bed until your caregiver says it is OK.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your treatment on time.
  • Your skin is itchy, swollen, or has a rash.

Seek Care Immediately if

  • You have a fever.
  • You have trouble breathing or your heart feels like it is beating faster than normal.
  • Your signs and symptoms are getting worse.
  • You feel like hurting or killing yourself or others.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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