PsychEd Episode 39: Electroconvulsive Therapy with Dr. Wei-Yi Song

Oct 18, 2021

In this enlightening discussion, Dr. Wei-Yi Song, a leading psychiatrist and ECT services director, demystifies electroconvulsive therapy. He shares the history of ECT, debunks widespread myths, and explores its efficacy for severe mental illnesses like depression and bipolar disorder. Dr. Song also dives into the neurobiological mechanisms at play and the safety of the procedure. With a focus on personalized patient management, he emphasizes the importance of education to reshape perceptions of this misunderstood treatment.

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INSIGHT

Modern ECT is safe and controlled

Modern ECT is conducted with anesthetics and muscle relaxants, ensuring no pain or physical injury.
Death is extremely rare with ECT; it has a lower mortality rate than general anesthesia.

ADVICE

Educate to reduce ECT stigma

Overcome stigma by educating patients and the public about ECT's safety and effectiveness.
Address misconceptions by sharing that ECT is life-saving and not a barbaric procedure.

INSIGHT

ECT's multifaceted mechanisms

ECT's mechanism involves seizure induction that alters brain blood flow and neurotransmitter systems.
It may increase neuroplasticity and reduce neuroinflammation, though exact mechanisms remain unclear.

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Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers electroconvulsive therapy with Dr. Wei-Yi Song, the Department Head of Psychiatry, Director of Mood Disorder Services, and Director of ECT Services in Victoria, BC, as well as a Clinical Professor at the University of British Columbia, and a past president of the Canadian Psychiatric Association.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to…

Briefly describe the history of ECT from inception to the present.
Debunk common misconceptions about ECT.
Describe the major proposed mechanisms of action of ECT.
Describe the efficacy of ECT for common psychiatric illnesses.
List the indications, contraindications, side effects and risks of ECT.
Understand how the procedure of ECT is performed.

Guest: Dr. Wei-Yi Song

Hosts: Jake Johnston (MS4), Dr. Shaoyuan “Randi” Wang (PGY1), Dr. Arielle Giest (PGY2), Dr. Alex Raben (Staff Psychiatrist)

Audio editing by: Jake Johnston

Show notes by: Jake Johnston

Interview Content:

Introduction - 0:00
Learning objectives - 01:54
History of ECT - 02:45
Common misconceptions - 06:36
Mechanism of action - 12:03
- Summary - 16:06
Indications - 16:47
Contraindications - 20:58
Side effects and risks - 23:31
Efficacy of ECT - 29:00
- Major depressive disorder - 29:13
- Bipolar depression - 33:00
- Schizophrenia - 34:19
- Bipolar mania - 36:16
Procedure - 38:50
- Steps of performing ECT - 39:20
- Considerations for electrode placement - 47:29
- Pulse width - 51:19
Maintenance treatment - 53:32
Closing - 59:09

Resources:

Video showing ECT procedure: https://www.youtube.com/watch?v=9L2-B-aluCE

- One note on the realism of this depiction: an actual patient would not shake uncontrollably due to the muscle relaxants.

Summary of electrode placement and pulse width: https://psychscenehub.com/psychinsights/electroconvulsive-therapy-summary-of-ranzcp-guidelines/

References:

Baldinger, P., Lotan, A., Frey, R., Kasper, S., Lerer, B., & Lanzenberger, R. (2014). Neurotransmitters and electroconvulsive therapy. The journal of ECT, 30(2), 116–121. https://doi.org/10.1097/YCT.0000000000000138
Francois, D. and DellaCava E. (2018). “10 myths about ECT”. Current Psychiatry. Accessed 2021-06-28 from MDedge.
Kane, J., Rubio, J., Kishimoto, T., Correll, C., Marder, S., and Friedman, M. (2021). Evaluation and management of treatment-resistant schizophrenia. UpToDate. Accessed 2021-07-27.
Kellner, C., Keck, P., and Solomon, D. (2021). Bipolar disorder in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
Kellner, C. and Rasmussen, K. (2015). Contemporary ECT, Part 2: Mechanism of Action and Future Research Directions. Psychiatric Times. Accessed 2021-07-08.
Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Overview of electroconvulsive therapy for adults. UpToDate. Accessed 2021-06-28.
Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
Petrides, G., Malur, C., Braga, R. J., Bailine, S. H., Schooler, N. R., Malhotra, A. K., Kane, J. M., Sanghani, S., Goldberg, T. E., John, M., & Mendelowitz, A. (2015). Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. The American journal of psychiatry, 172(1), 52–58. https://doi.org/10.1176/appi.ajp.2014.13060787
Singh, A., & Kar, S. K. (2017). How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 15(3), 210–221. https://doi.org/10.9758/cpn.2017.15.3.210

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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