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Landmark procedure in operation theatre

35-year-old psychiatric patient of severe depression was the first to receive ECT in-country

Electro-Convulsive Therapy A 35-year old woman became the first patient to undergo an electro-convulsive therapy (ECT) yesterday at the operation theatre of Thimphu referral hospital.

Since 2004, she had suffered severe depression that led to fear of being harmed or killed by anyone who was beside.  But her illness was to date being suppressed by medication.

The procedure inside the OT, where Choden, in a green gown, undergoes treatment, gets recorded, as entry is restricted for outsiders. The video shows that Choden first receives general anaesthetic and a muscle relaxant before the ECT procedure.  It was her third sitting.

ECT involves passing a carefully controlled electric current through the brain, from electrodes placed, one, on one side of the scalp and the other on the back of the head.  The current affects the brain’s electrical activity, relieving severe depression and other psychotic symptoms, said one of the psychiatrists.

“After passing this small amount of electric current, a brief seizure, lasting around 25 seconds, is produced, indicating that the procedure is successful,” Professor Norman James from Australia, who brought the ECT into the country, said.

However, the patient doesn’t feel anything, because of the anaesthesia and the muscle relaxant during seizures, Professor Norman James said. “Her illness had become life threatening, despite the heavy dose of medication she was taking,” he said, explaining why she was given an ECT.

After her procedure completed in about 15-20 minutes, another patient, a 54-year old man was wheeled into the OT.  He suffers from severe depression and catatonia, an abnormal movement or behaviour arising from a disturbed mental state that led to dehydration.  He was not in the condition to talk.

Psychiatrist Dr Damber Kumar Nirola said ECT is recommended when the high dose of medication, a patient has been on for a long time, fails and when the situation became life threatening.  It is however not a cure, but can be useful since it works quicker than antidepressants or other medications.

“A small amount of electric current measured in millicoulombs, according to one’s age, is given to a patient during the ECT procedure,” he said.  The patient is required to undergo similar treatment about ten times to prevent a relapse in the future, he said.

Psychiatrist Dr Chencho Dorji said ECT is also used, when absolutely necessary, with full consent from the patient. “It’s a safe and effective method to relieve severe forms of depression despite medication therapy,” he said.

Despite being a safe method of treatment, ECT has some side effects, such as brief memory loss about immediate events, low blood pressure, headache, nausea and confusion, among others. “The side effects wear off with a few hours,” he said.

When Choden woke up from the procedure after less than an hour, her husband looked happy, since she looked relaxed after a long time, and was even smiling. “I feel calm, and my heart doesn’t beat frantically, like it did before the treatment,” she said.

 By Thinley Zangmo

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