Electroconvulsive Therapy

We do quite a bit of electroconvulsive therapy at my hospital. Although it sounds barbaric, it is a remarkably effective therapy for refractory depression and other psychiatric illnesses. Most days of the week, we have a handful of patients getting ECT treatments with a psychiatrist. Since treatments are frequent, we get to know each patient pretty well. Although I did ECT anesthesia in residency, we use different medications here, which is interesting. It's fun to see how etomidate (which I used in residency) differs from ketamine (which I use now), though outcomes are pretty similar; we can achieve good anesthesia and lower the seizure threshold to obtain effective therapy. The other big difference is that in training, we had two anesthesiologists doing the ECTs; the resident would give the anesthetic and attend to the airway while the attending charted. Now, I have to do both those roles, and I think that's what makes ECT a little exhausting. They start early in the morning, there's a lot of preparation for each one, and it's a lot of work multimanaging all the different tasks. Nevertheless, it's satisfying; one patient who used to be in a catatonic depression, minimally responsive to others, now talks about going to the Shakespeare festival and enjoying her grandchildren.