"Shock" Therapy 1|2

COSTS

Although the cost of ECT may vary widely depending on where it is administered, it is generally estimated to be between $700-$1,000 per treatment. These charges cover the psychiatrist, anesthetist, and other hospital charges. With the average number of treatments being eight, a course of ECT can be quite expensive. For this reason, ECT has gained a reputation for being a treatment which only the rich can afford. However, it has been suggested that the cost of ECT may be “relatively low” when compared to life long drug therapy or potential full-time hospitalization. Furthermore, ECT is covered by most insurance providers, while anti-depressive medications are often quite costly for the patient.

INFORMED CONSENT

The idea of informed consent is founded on “the principle that a physician has a duty to disclose to a patient information that allows the patient to make a reasonable decision regarding his or her own treatment.”¹⁴ With this in mind, the American Psychiatric Association has recommended informed consent guidelines for the use of ECT. Under these guidelines the psychiatrist “explains in clear language what ECT involves, what other treatments might be available, and the benefits and risks these procedures may entail.” ECT can be administered only after the patient, or a court appointed guardian, has given their consent, and consent may be withdrawn at anytime during the course of treatment.

What happens when a patient is not capable giving consent, or a patient withholds consent despite the advice of physicians and relatives? There is debate in the medical community as to whether or not a patient should be deemed incompetent to give or withhold consent. Some believe that patients who have an irrational aversion to ECT, for example, should be deemed unable to withhold consent. Others feel that the “presumption is best made against coercion, and thus patients should not be forced to receive ECT unless absolutely necessary.”¹⁵ When making these arguments, it is necessary to balance the possible benefit received from ECT treatment, with the value of individual autonomy.

ONE PRACTITIONER’S PERSPECTIVE

Dr. Jennifer L. Wright, Director of ECT Services at Central State Hospital in Milledgeville, Georgia, shared her insight into ECT in a recent interview. ¹⁶ The main indications for the use of ECT, says Dr. Wright, are severe depression (especially when associated with active suicidal ideation or psychotic features such as hallucinations or delusions), catatonia of both psychiatric and medical origins, mania that has been unresponsive to medications, and some cases of refractory schizophrenia. Dr. Wright says that ECT is particularly necessary when the effects of mental illness are life threatening; when, for example, a patient is not eating or drinking because they are in a severely depressed or catatonic state. This would be the only circumstance under which a patient might be treated with ECT involuntarily, after the treatment has been recommended and ordered by two physicians. Patients are also able to request ECT for themselves, or it can be advised by their doctor and consented to by themselves or their guardian.

Dr. Wright outlined the typical “acute treatment series” of ECT as 2-3 treatments per week (and in rare cases 5 treatments per week, when immediacy of response is an issue) continuing until there is a plateau in the patient’s improvement, with an average of 8-10 treatments in the acute series. Her experience has shown that patients usually begin to show signs of improvement after 4 or 5 treatments (if in fact they are going to respond),such as an improvement in sleep, appetite, appearance, or interaction with others. In preparation for ECT Dr. Wright recommends that patients visit the dentist to check for loose or missing teeth, have a baseline electrocardiogram to check the status of their heart, have electrolyte levels measured (with particular attention to sodium, potassium, calcium, and glucose), and that elderly patients with the potential for spinal fractures have their spines x-rayed. Along with a complete medical history, physical exam, and neurological exam by the anesthesiologist, these precautions are taken as part of the pre-anesthesia evaluation even though modern ECT is a very safe procedure.

When asked about the possible side effects associated with ECT, such as memory loss, Dr. Wright said that while there is sometimes memory loss for events in the 24-48 hours surrounding the treatment, she has never seen extended memory loss in any of her patients.

Dr. Wright revealed that the main point about ECT that she would like to convey to the general public is that: “For the right patient, in the right cases, [ECT] can be, and is, a lifesaving treatment...I have seen this in my own practice….it is a shame that many people still have negative impressions of the treatment.”

With over 100,000 Americans reported to receive ECT, this treatment is clearly here to stay.¹⁷ Were it not for the stigma and misconceptions associated with the treatment, many more might benefit from this potentially lifesaving treatment. Thus, it is important that potential ECT patients and their loved ones educate themselves about the benefits and risks associated with the treatment, instead of giving in to irrational fears from the past.

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¹⁴  The Columbia Electronic Encyclopedia, Sixth Edition. Copyright © 2003, Columbia University Press. Viewed on 7/27/05, at www.cc.columbia.edu/cu/cup

¹⁵  Ethics in Electroconvulsive Therapy. Pg. 39.

¹⁶  Wright, Jennifer. Personal Interview. July 19, 2005

¹⁷  "Electroconvulsive therapy: Dramatic relief for severe mental illness." Taken from www.mayoclinic.com Viewed on 7/19/05.