Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. This information can be made available in a range of formats on request (eg Braille, audio, larger print, BSL, easy read or other languages). Please contact the Patient Information Centre Tel: 0191 223 2545 Electroconvulsive Therapy (ECT) Patient Information Leaflet Published by the Patient Information Centre 2015 Copyright, Northumberland, Tyne and Wear NHS Foundation Trust Ref, PIC/187/0815 August 2015 V6 www.ntw.nhs.uk/pic Tel: 0191 223 2545 Review date 2018 Follow us @ntwnhs www.facebook.com/ntwnhs Shining a light on the future 12
Contents Page Introduction 3 What is Electroconvulsive Therapy (ECT)? 3 Why has ECT been recommended? 3-4 What will happen if I have ECT? 4-5 How will I feel immediately after ECT? 5-6 How many treatments are usually necessary? 6 What are the benefits of ECT? 6 Are there any risks associated with ECT? 6 What are the side effects of ECT? 6-7 What other treatments could I have? 7 Will I have to give my consent? 7 Can I refuse to have ECT? 7-8 Are there risks in not having ECT as recommended? Outpatient ECT 9 Locations where ECT takes place 9 Useful resources 10 9 What if I have a comment, suggestion, compliment or complaint about the service? If you want to make a comment, suggestion, compliment or complaint you can: talk to the people directly involved in your care ask a member of staff for a feedback form, or complete a form on the Trust website www.ntw.nhs.uk (click on the Contact Us tab) telephone the Complaints Department Tel: 0191 245 6672 We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention. - Points of You - available on wards or from staff. Some areas of the Trust have electronic feedback touch screens, staff can help you to use these. - Friends and Family Test - available from staff or online at www.ntw.nhs.uk/fft References NTW(C)51 Electroconvulsive Therapy (ECT) Policy Northumberland, Tyne and Wear NHS Foundation Trust Electroconvulsive Therapy (ECT) - Royal College of Psychiatrists http://www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/ect.aspx The use of electroconvulsive therapy - Understanding NICE guidance information for service users, their advocates and carers, and the public National Institute for Health and Care Excellence http://www.nice.org.uk/guidance/ta59/resources/ta59- electroconvulsive-therapy-ect-understanding-nice-guidance2 What if I have a comment, suggestion, compliment or complaint about the service? 11 References 11 2 11
Useful resources Electroconvulsive Therapy (ECT) - Royal College of Psychiatrists http://www.rcpsych.ac.uk/mentalhealthinfoforall/treatments/ect.aspx The use of electroconvulsive therapy - Understanding NICE guidance information for service users, their advocates and carers, and the public National Institute for Health and Care Excellence http://www.nice.org.uk/guidance/ta59/resources/ta59- electroconvulsive-therapy-ect-understanding-nice-guidance2 Patient Information Centre, St Nicholas Hospital 0191 223 2545 can provide a printed copy of the above publications. Independent Mental Health Advocacy Service Advocacy support for people treated under the Mental Health Act this leaflet is available from wards and departments. Patient Advice and Liaison Service (PALS) can offer help and advice North of Tyne Tel: 0800 032 0202 South of Tyne Tel: 0800 328 4397 Introduction This leaflet will try to answer some of the questions you may have about Electroconvulsive Therapy (ECT). Sometimes it can be quite difficult to concentrate. Do not be concerned if you cannot read though all of this leaflet, just pick out the sections that seem important at the time and come back to it later. You may wish to use it to help you ask questions of staff, a relative or other patients. If you would like someone to explain the information in this leaflet please ask. What is Electroconvulsive Therapy (ECT)? Electroconvulsive Therapy (ECT) is a well-established treatment, which involves a small amount of electric current being passed across the brain for usually 0.2-0.8 seconds. ECT is only given under a general anaesthetic and with drugs to relax the body s muscles. This produces an artificial epileptic fit that affects the entire brain, including the parts which control thinking, mood, appetite and sleep. Repeated treatments alter chemical messages in the brain and bring them back to normal. This helps you begin to recover from your illness. Why has ECT been recommended? ECT is given for many reasons. Your consultant may recommend that you be treated with ECT if: You have had a moderate severe depressive illness for some time and a number of different treatments have been tried without success. You have tried several different antidepressants but have had to stop them because of the side effects. You have responded well to ECT in the past. Your life is in danger because you are not eating or drinking enough, or you feel so bad you may be thinking of harming and or killing yourself. 10 3
ECT is sometimes recommended for the treatment of catatonia or mania (see understanding NICE guidance information for service users ECT leaflet Page 6). For most people, ECT will produce short-term improvement, but it does act more quickly than antidepressant medication. The improvements produced by ECT will usually need to be maintained with medication. What will happen if I have ECT? As you will be having a general anaesthetic, you will be asked to have nothing to eat or drink for a period of time prior to your treatment (you will be advised of this time on an individual basis). You will, however, be able to take certain morning medication as usual, with the minimum amount of water. Your doctor will advise you about which medicines, if any, you should take before ECT. Specific arrangements will be made if you are a diabetic. Your blood pressure, pulse and temperature will also be checked prior to you receiving ECT. Are there risks in not having ECT as recommended? If you choose not to accept your doctor s recommendation to have ECT you may experience a longer and more severe period of illness and disability than might otherwise be the case. Outpatient ECT If you are scheduled to go home on the same day as your ECT treatment you must not drive a vehicle use machinery drink alcohol until at least 24 hours after the anaesthetic sign any legal documents make any important decisions You must have a responsible adult with you during this time. Locations where ECT takes place The treatment, which only takes a few minutes, takes place in the ECT treatment room. No other patients will be able to see you having the treatment. A nurse will take you into the treatment room and introduce you to the team who will be looking after you. You will be asked to lie down on a bed and take your shoes off for treatment. Your treatment will involve certain physical assessments, which require monitoring equipment being attached to your body. Your ECT treatment team will explain the specific reasons for the use of this equipment. Physical Treatment Centre Hadrian Clinic Campus for Ageing and Vitality Westgate Road Newcastle upon Tyne, NE4 6BE Telephone: 0191 246 8663 ECT Department Tranwell Unit Queen Elizabeth Hospital Queen Elizabeth Avenue Sheriff Hill Gateshead, NE9 6SX Telephone: 0191 445 6259 Treatment Centre St Georges Park Morpeth NE61 2NU Telephone: 01670 501 759 4 9
of your consent to ECT will not in any way alter your right to continue treatment with the best alternative methods available. Very occasionally, a person may become particularly seriously ill. This means that they may be suicidal, convinced that they do not deserve to be treated, or possibly eating or drinking too little to stay alive for much longer. In these circumstances ECT may be given to patients without their consent, provided that they have been assessed as being unable to make a decision about treatment for themselves at this time. For this to happen, two doctors and a social worker must agree that the person is so unwell that they need to be kept in hospital under a section of the Mental Health Act 1983. Then another independent psychiatrist, sent by the Care Quality Commission, must agree that the treatment is necessary, and that the person is unable to make a decision for themselves at this time regarding treatment. If your condition is considered to be so severe that any delay would put you at significant risk, then the doctor in charge of your care may decide to start your course of treatment as an emergency while waiting for the independent psychiatrist to arrive. If you are detained in hospital under a section of the Mental Health Act 1983, you will be given a separate leaflet to help you understand your rights with regards to consent and ECT. It is possible that your present condition, or other factors, may affect your capacity to make a decision as to whether you wish to have the treatment. In this event, the treatment may still be given, with the safeguard that your own doctor s decision will be subject to a second opinion by a consultant psychiatrist from another area of the Trust. If you do not have a relative or carer to represent you, an Independent Mental Health Advocate (IMHA) will be appointed to act on your behalf. The anaesthetist will ask you to hold out your hand so you can be given an anaesthetic injection. You will be given some oxygen to breathe as you go off to sleep. Once asleep you will receive your ECT. When you wake up you will usually be in the recovery room area and there will be a nurse with you to make sure that you feel as comfortable as possible. At this point you will still have monitoring equipment attached to your body. Once you are awake you will be offered refreshments before you leave the department. A few practical points before you receive ECT Wear loose clothes Remove any jewellery or hair slides Remove make up and nail varnish Remove your spectacles or contact lenses Remove your dentures Don t wear hairspray or gel Empty your bladder If you have any valuables, they can be looked after by the relative or carer accompanying you for your treatment, or department staff can store them securely until you are ready to leave the department. How will I feel immediately after ECT? Most people feel all right after treatment, although it is common to feel a little drowsy or dizzy and you may possibly have a sore throat. Some people wake up with no side effects at all and simply feel relaxed; others may feel somewhat confused or have a headache. 8 5
Some people experience nausea and muscle ache which if necessary can be treated with medication. The nurse will be there to help you through any problems you may experience. How many treatments are usually necessary? ECT is usually given twice a week. It is not possible to say exactly how many treatments you may need. Some people get better with as few as two or three treatments, others may need up to twelve and occasionally more. What are the benefits of ECT? ECT is an effective treatment and over eight out of ten people who receive ECT respond well to it. Are there any risks associated with ECT? ECT is a low risk procedure with a mortality rate similar to that of anaesthesia for minor surgical procedures. The risk of death is one per 10,000 patients or one per 80,000 treatments. Very rarely, deaths do occur and these are usually because of heart problems. If you do have heart disease it may still be possible for you to have ECT safely as long as the doctor takes special precautions, such as heart monitoring. Your doctor will ask another specialist to advise on this if there is any concern. What are the side effects of ECT? Some patients may be confused just after they wake up from the treatment and this generally clears up within an hour or so. Your memory of recent events may be upset and dates, names of friends, addresses and telephone numbers may be temporarily forgotten. In most cases this memory loss goes away within a few days or weeks. Occasionally some people continue to experience memory problems for several months. Research studies have suggested that a number of people believe they have suffered long-term memory problems as a result of ECT. Your memory will be re-assessed after each treatment session and on-going checks will be made for any signs of memory loss. If you notice memory loss persisting through the days after the treatment, please discuss this with your doctor. What other treatments could I have? Depressive illness can be helped with anti-depressant medication, psychological therapy treatment and counselling, either alone or together. Catatonia and mania are usually managed with medication. Many people with mental health problems benefit from self-help techniques, including support groups. Your doctor will discuss the advantages and disadvantages of other treatments with you and will try to answer any questions you may have. Will I have to give my consent? At some stage before the treatment starts, you will be asked by your doctor to sign a consent form for ECT. Before you sign the form the doctor should explain what the treatment involves, the benefits, any alternative treatments and why you are having it. Also, the doctor should be available to answer any questions you may have about the treatment. When you sign the form, you will be agreeing to have up to a certain number of treatments. Can I refuse to have ECT? You can refuse to have ECT and you may withdraw your consent at any time, even before the first treatment has been given. The consent form is not a legal document and does not commit you to having the treatment. It is a written record that an explanation has been given to you and that you understand to your satisfaction what is going to happen to you. Withdrawal 6 7