Today we share with you an interview with Dr. Patricio Ferreira, a psychiatrist at the Sisters Hospitallers of Braga, who combines an outstanding academic background with a vast professional experience in the field of mental health. Graduated in Medicine from the Faculty of Medicine of Coimbra in 2004, he did his general internship at the District Hospital of Figueira da Foz and his specialization in Psychiatry at the Hospital of Braga. His career includes more than a decade as an assistant physician in Psychiatry at the Alto Minho Local Health Unit and a period as a visiting professor at the University of Minho, where he taught the Mental Health module.
Currently, Dr. Ferreira leads innovative treatments in interventional psychiatry, highlighting electroconvulsive therapy (ECT), an advanced technique that has revolutionized the management of severe psychiatric disorders. This blog explores ECT in depth, its benefits, applications and how the Sisters Hospitallers of Braga have implemented a comprehensive and humanized approach for the patients who receive it.
What is electroconvulsive therapy (ECT) and in which cases is it recommended as a treatment?
ECT is a type of treatment used in psychiatry that is included among the physical therapies used in this specialty.
Much less widespread and used than psychopharmacological therapies, it was and continues to be the subject of controversy by the anti-psychiatry movements, perhaps due to its misuse in the past and the way it was administered.
In recent years, this treatment has become highly specialized, safe and effective, provided it is applied in the appropriate pathologies or with an unequivocal indication for this type of treatment.
The treatment consists of the application of an electrical stimulus, under general anesthesia of short duration, with the aim of provoking a small convulsive crisis. Several positive effects on brain neurotransmission have been demonstrated, and although the overall mechanism of action is not yet fully understood, more and more is known about the effects of ECT on the brain.
Although it is not yet used as first line, and many clinicians consider it only when other therapies fail, there are clear indications where this treatment should be one of the first choices.
One example is severe, melancholic depression with associated psychotic symptoms and/or catatonia.
Catatonia, a motor symptom that also appears in other psychiatric pathologies such as schizophrenia, is another case in which ECT should be considered as a priority.
Depression during pregnancy is also a classic indication demonstrating the safety of this treatment.
Why is ECT used in psychiatric emergencies, such as suicide risk or during pregnancy?
Compared to other classical pharmacological treatments for depressive conditions, ECT shows a greater speed of action and such safety that, even in cases of depression during pregnancy, it is the treatment of choice when considering the risk-benefit ratio versus the use of psychotropic drugs in this population.
How is ECT performed and what safety precautions are taken?
First, it is important to highlight the advances that have taken place in recent years in the devices used to administer ECT (sine wave vs. short pulse wave) and the use of general anesthesia as well as other medications that minimize the negative impact that the seizure could have on the patient.
In addition to the normal precautions that should be taken when administering brief general anesthesia (as in performing an endoscopic examination, for example), there are no absolute contraindications to performing this treatment. Measures are also taken to protect the dentition.
What are the benefits of ECT compared to other treatments for psychiatric disorders?
Undoubtedly, its rapidity of action, but also its efficacy, provided it is administered in the indicated pathologies.
What are the effects of ECT on the brain and how does it help to reduce the symptoms of disorders such as depression and psychosis?
More and more has been discovered about the effects of ECT on the brain, although the definitive mechanism responsible for the therapeutic action is not yet fully understood. However, there is consensus on its effect on neurotransmitters, synaptic receptors, neuropeptide secretion, and even gene expression and protein synthesis. Neuroendocrine theory also suggests that ECT corrects dysfunctions in the hypothalamic-pituitary axis associated with mood disorders.
What other techniques does interventional psychiatry include in addition to ECT?
In interventional psychiatry or neuromodulation, in addition to ECT, Transcranial Magnetic Stimulation (TMS), Transcranial Electric Current Stimulation and the use of esketamine or ketamine are included.
How to choose between ECT and other interventional techniques, such as Transcranial Magnetic Stimulation (TMS)?
For most psychiatrists, and therefore for patients, the main factor of choice remains the availability of these techniques. Not all centers have this type of treatment available. Nevertheless, ECT is still used in the most severe cases of depression with psychotic symptoms.
What are the usual outcomes for patients undergoing ECT and how long does it take to see improvement?
The clinical outcome of the treatment depends essentially on a correct prior diagnosis and, therefore, on the appropriate indication for this type of treatment. If this is fulfilled, the results are evident at the end of the first week of treatment. The results are usually quite sustained over time, although some patients may need maintenance treatment. After the acute phase, with 3 weekly sessions for 3-4 weeks, they can move on to a transition phase with monthly treatments for an indefinite period of time.
What advances have been made in recent years in the use of interventional therapies for the treatment of severe mental illness?
The most recent approach has undoubtedly been esketamine, which has shown excellent results in cases of depression resistant to conventional treatments. Although it is not yet funded in Portugal, it is already used in other European countries with a great impact on patients’ quality of life. In Portugal, the results in the population that has had access to the treatment have been very positive and sustained. The Sisters Hospitallers is an authorized center for this intervention therapy.
How does the hospital approach of the Sisters Hospitallers influence the treatment and accompaniment of patients receiving ECT?
The ECT unit of the Sisters Hospitallers of Braga has been in operation for several years, with a number of monthly treatments comparable to that of large psychiatric centers worldwide. It is, therefore, an experienced unit, with a trained team capable of performing these treatments with great safety. It is equipped with the most advanced technology available. The entire team is prepared and oriented to involve patients and their families in the treatment, explaining the procedure and reassuring them about it.
