Brain Stimulation Therapies (ECT, TMS, MST, DBS)

The most common form of brain stimulation therapy that is used in the mental health system is electroconvulsive therapy (ECT). This works by passing an electric current through the head and inducing a seizure. Transcranial magnetic stimulation (TMS) can work in a more directed manner, stimulatng or suppressing specific brain regions, or the magnetic field can be used to induce a seizure in a similar manner to ECT. This is called magnetic seizure therapy (MST). TMS and MST are not usually available outside of clinical trials at this time, as is the case for direct brain stimulation (DBS). Electroconvulsive Therapy (ECT) is a highly effective treatment which is useful in acute and life- threatening mental illness because of a relatively rapid onset of action and a limited number of side effects. It is indicated in the treatment of severe depression (particularly when physical health is at risk and when the risk of suicide is high). It is most commonly used to treat depression but can also be used to treat a psychotic illness or sometimes treatment-resistant mania. ECT can also be used as maintenance treatment in people with depressive disorder, where other maintenance treatments have not been effective. ECT is usually given by a psychiatrist with nursing staff and an anaesthetist present. The patient has to be fasted (nothing to eat or drink) prior to the anaesthetic. The anaesthetic is of short duration and a muscle relaxant is given to prevent physical injury.  The treatment is usually given twice weekly and it is normal to receive six to twelve treatments in the first instance. Maintenance treatments are given less frequently (weekly, fortnightly or monthly are possible) depending on each individual’s response. The effectiveness of ECT is related to its ability to produce a seizure of sufficient duration but the exact mechanism of how it produces this effect is not known. SIDE EFFECTS The main side effects of ECT relate to the administration of an anaesthetic. Nausea, vomiting, muscle stiffness, tiredness and headache can occur. There can be initial disorientation on waking from the anaesthetic and in some people short term memory loss. This can be for events which occurred in the past or for the period of ECT treatment itself. Persistent memory loss is also reported by a small number of patients and can be reduced by varying the way ECT is administered
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