Why psychiatric medications should be reduced before convulsion-free electroconvulsive therapy

Mechanical Electroconvulsive Therapy (MECT) is a non-pharmacological treatment that is effective in treating certain serious mental and neurological disorders, and is one of the most important treatments in psychiatry today. Compared with medication, it can more quickly control psychiatric symptoms, including schizophrenia, depression, and mania. The principle of electroconvulsive therapy is to achieve the balance of neurotransmitters in the brain by giving the body a short-time electrical stimulation of small electric current, so as to reduce or even disappear the psychiatric symptoms, which is now often used in the acute stage of psychiatric symptoms. Chen Dachun, a psychiatrist at Beijing Huilongguan Hospital

Before MECT, an anesthetic and a muscle relaxant will be injected, which can eliminate the sense of suffocation caused by the use of muscle relaxant alone, and reduce fractures and other disorders due to the sudden and strong contraction of the muscles, which is also known as Modified Electroconvulsive Therapy (MECT).

The course of MECT is generally 6-12 times, usually once a day in the first week, and then gradually reduce the frequency of treatment to 2-3 times a week, according to the needs of the condition of the increase or decrease in the number of treatments, and even as a maintenance therapy for mental illness. In addition, although a course of MECT can end an episode, it is short-lived and cannot prevent a relapse of the disease in the following weeks, months, or years, therefore, it is still necessary to consider the continued treatment after MECT, including medication, psychotherapy, or MECT maintenance therapy.

Despite significant advances in the pharmacologic treatment of mental disorders in recent years, MECT remains the fastest-acting and safest treatment for some types of disorders, especially when used as an alternative to medications that are both ineffective and unsafe, and even to save a patient's life, with MECT being up to 90% effective in treating patients.

Any treatment comes with risks and adverse effects. For most patients, the adverse effects of MECT are relatively few and mild, the risk of death is only about 1 in 10,000 unless the patient has had a previous serious physical illness, serious complications are relatively rare, and with modern anesthesia techniques, fractures and asphyxiation are virtually unheard of, and the treatment is now available to many patients with high blood pressure or heart disease. Any treatment can cause death, but with the widespread use of MECT in clinical practice, its safety has been effectively demonstrated.

The more common adverse effects of MECT include headache, muscle aches, nausea, confusion, and memory problems. Headache, muscle aches, and nausea are usually mild and can be prevented or alleviated with medication. Confusion and memory difficulties can be seen after more than one course of treatment, but the symptoms are reduced and slowly return once treatment is completed. Because mental disorders themselves often impair memory function, some patients successfully treated with MECT have been reported to actually recover memory function.

Overall, MECT is a major treatment in psychiatry and neurology, but because some people don't understand this treatment, when doctors refer to it, people have a deep fear that it is a punitive treatment or that it is highly dangerous, so they avoid it, and such misunderstandings delay treatment. I hope that the above introduction can eliminate the misunderstanding that people will be this effective treatment method.