Proof: My badge

I also work on the locked down units where patients not receiving ECT are. I've been a psychiatric RN for 7 years. I've worked for four major healthcare organizations in four different psychiatric hospitals. I've also taught psychiatric nursing for vocational schools (as a lecturer) and universities (as a clinical instructor). I have a double bachelor's degree in psychology and nursing.

I love what I do and would like to shed some light on mental illness for anyone with any questions.

Edit: I've gotten a couple PMs asking how much I get paid. I get $67.70 an hour, not counting shift differentials for working swing or graveyard shifts (ECT is only done during weekdays and in the mornings and afternoons).

Edit 2: Alright, it's been fun! I hope I was able to shed some light on the subject and hopefully erase some of your preconceived notions about the alleged brutality that is ECT. I'll still answer questions later if more come in.

Comments: 118 • Responses: 31  • Date: 

Fat_Dumb_Americans17 karma

If you are truly psychiatric, then tell me - what card am I thinking of?

sensicle24 karma


maschine018 karma

Is that what they call electro shock therapy now days? How far we have come!

sensicle13 karma

Exactly. This is why I decided to do this AMA, to shed some light on the treatment. You should know a couple things:

  1. There's always an informed consent for the procedure. It's never done against the will of the patient.

  2. Anesthesia is involved. The patient feels no pain.

  3. It's never used as a primary form of treatment. It's only considered when other options are not sufficient.

  4. I've seen it work. It can be extremely effective for some. Why suffer from an illness when there's a safe and effective way to treat it?

maschine013 karma

Thank you. Although I don't agree I appreciate the answer. If it helps people it helps people. If they choose it then I cannot judge.

sensicle4 karma

You're welcome. I'm glad I could inform you.

TheTallestOfTopHats-4 karma

Never? I think it can if they're involuntarily committed, no?

Is it just not done involuntarily at the place you work? or is it never done? am I mistaken?

Also, honestly, looking at the memory impairments, I think its far better to say the procedure is safer then depression, not that it is safe.

sensicle4 karma

Even patients admitted involuntarily have inherent rights to their treatment. They have a right to choose which treatments they will undergo. They have a right to refuse treatment. The only time medications would be forced on a patient is if they are involuntarily committed AND pose a serious threat to themselves and someone else OR if they are deemed incompetent by the state and have been appointed a conservator and are refusing medications that would be in their best interest to take. This decision is also determined by the court and is called a Riese Hearing.

damnnphoreal6 karma

I am currently double majoring in psychology and nursing. I don't know what to do with my psych degree. What other options are there? What is a typical day like for you? What is something I should know before going into psych nursing?

sensicle8 karma

If you like psychology and have an interest in medicine, I'd definitely recommend you try being a psychiatric nurse.

A typical day for me at ECT involves being in a room right next to an anesthesiologist, psychiatrist, and another nurse. This room is where the actual ECT is done. Following the procedure, the patient is wheeled over to me on a bed and they have an IV in. I immediately get their oxygen saturation level (providing oxygen via a simple mask if needed), blood pressure, and other vital signs and document results to a computer. I do this every five minutes until I have three sets of vital signs.

I also document their alertness and other factors using what's called the Post Anesthesia Aldrete metric. Once they're stable and can state their name and where they are, I wheel them over to the observation nurses who get two more sets of vital signs thirty minutes apart and offer them food and fluids.

On the units, when I'm not doing ECT, I have a patient assignment where I'm given a group of patients to care for through the day. I talk to them and find out where they're at mentally, documenting findings to a computer. Preparing for discharge and doing admissions are also part of the process. This is, of course, an abbreviated version of what we do - just to give you an idea.

It's an awesome job and I wouldn't want to do anything else when it comes to nursing. Psychiatric patients will always give you some story to tell when you get home. They'll make you laugh, cry, and realize what it is to be human, to be different.

TheHeroYouNeedNdWant5 karma

What is ECT?

sensicle8 karma

It's basically an outpatient procedure used on patients that are not responding well to medications and/or therapy. Depressed patients, patients with mania (from bipolar disorder), or patients that are catatonic or have other severe forms of psychosis are all considered good candidates for the therapy.

They are put under general anesthesia and given a muscle relaxer or hypnotic agent and are basically given a "controlled" seizure using electrodes. It lasts a few minutes and the idea behind it is that the brain chemistry resets for awhile and relieves the patient from their illness, albeit temporarily.

TicklesMcFancy4 karma

How safe is it to cause a seizure?

sensicle10 karma

The actual ECT procedure itself is fairly safe. The biggest risk, however, is making sure the patient maintains an airway during and after the procedure since general anesthesia is used. We use the same agent that killed Michael Jackson, called Propofol. It is a type of general anesthesia that wears off in about half an hour or less.

TicklesMcFancy3 karma

Generally how long do the seizures that are provoked last?

sensicle3 karma

The procedure lasts about 7-10 minutes and the patient convulses (or seizes) intermittently throughout it. A tongue guard is placed in their mouth to prevent them from biting themselves.

TheHeroYouNeedNdWant3 karma

Thats amazing, is it anything like those electrocuting machines in the movies?

sensicle5 karma

Nothing at all like an electric chair meant to kill. Watching ECT, you're basically looking at a person laying down in a hospital bed, wearing their own clothes, and they have two wires with electrodes on the end on both sides of their head. They also have a mouth guard in place to prevent biting themselves. Then they basically move around, like having a seizure, then stop. Then move around, stop. It's over pretty quickly and there's really nothing sexy about how it's done.

TheHeroYouNeedNdWant3 karma

Is it painful?

sensicle6 karma

General anesthesia is used, so no. If there's any pain, however, it's from the after effects of the muscles tensing up (like when you workout). It's mild to moderate in most cases (if they experienced it at all) and most patients walk away perfectly fine 45 minutes after the procedure. We still make sure they have a ride, though. They're advised not to drive for 24 hours following treatment.


Hi and thanks for doing this AMA!

Do you work with occupational therapists ? If yes, how do you collaborate with them ?

Have you seen improvements in patients receiving ECT ?

sensicle2 karma

I personally don't work with occupational therapists. Our patients may receive outside referrals for occupational therapy, however, and post discharge follow up appointments to them.

I have seen considerable improvement in patients receiving ECT. Being that the clinic is part of the hospital, some patients that are admitted for a stay at the hospital come to the clinic and then return to their units following the procedure. What's cool about this is that you get to know them better because you may be assigned to them on a Monday and then see how the ECT effects them on a Tuesday. The other ECT patients that are not also hospital patients, you don't get to know very well or see how they are prior to ECT since they come from home and go back afterwards.

I've seen patients sitting around in a catatonic stupor one day and able to actually have a meaningful conversation with me the next day. It's remarkable. The ones that benefit from it really swear by its efficacy.

interplanetarycat4 karma

Hi, thanks for doing this AMA. I've been an inpatient twice and I really respect your profession :)

Have you ever felt like you were in danger on a ward? What do you do to relax after a challenging day?

sensicle6 karma

Thanks! Yes, I've definitely felt in danger before, but I really don't show it. When dealing with an aggressive patient that's acting out, I like being one of the first nurses on the scene. People have always told me I'm really chill and easy to talk to - a great "skill" to have as a psychiatric nurse. I first find out what's wrong and why the patient is upset, then I usually offer to take a walk with them to talk it out. I can usually resolve the issue without anyone throwing punches. Fortunately, I've never been hurt on the job yet though I have had a former professional boxer take a left hook to my face before. He had dementia and there was no reasoning with him. Lucky for me, he didn't hit me very hard.

I really like to just go home, throw on some music, and maybe have a glass of wine or spend time with my girlfriend. She's a psychiatric health care worker too and just finished up nursing school. It's nice to be able to vent and share stories with someone who knows the field.

King-Troll3 karma

Is there ever a time when you get emotionally attached to patients. Perhaps their background... Or patients that simply can't be help for the most part. Is it hard not to get emotionally attached ? ...Remorse etc

sensicle8 karma

I tend to be good at separating myself emotionally from my patients without compromising my ability to be empathetic and show compassion. Some nurses are clearly in it for the money and social connections and it shows in their shitty attitudes towards patients, unfortunately. The place I work at now, however, isn't like this. The people are all really cool, helpful, and caring towards not just patients but staff as well.

Our hospital does house minors with troubled lives though and it's really hard not to get attached to them. I recently provided care for a sweet little eight year old girl that had a history of having been sexually abused and it was just awful to think that somebody would violate this precious child's innocence. With the minors, especially being that young, you really want to show you care and let them know they can trust you and that their lives can be better despite whatever horrendous things may have happened to them.

If children can't trust the healthcare providers assigned to look out for their best interests, what else do they have? A lot of them come from some pretty fucked up households.

Socky_McPuppet0 karma

I recently provided care for a sweet little eight year old girl that had a history of having been sexually abused and it was just awful to think that somebody would violate this precious child's innocence.

while I agree with the sentiment, given that you say

There's always an informed consent for the procedure.

How can eight year old give informed consent about ECT?

sensicle7 karma

She didn't get ECT. I wasn't sure if your question was limited to the ECT setting or a general question about psychiatric patients I work with.

RedditMayne2 karma

Is ECT a long-term solution, like a procedure one has done every so often as a preventative measure to ensure the depression is kept in check? Too,do you have any opinions or observations on the use of Transcranial Magnetic Stimulation to treat depression?

Thank you for doing this IAmA, by the way.

sensicle5 karma

ECT is done frequently, as frequent as 3 times a week for some. It can also be done less frequently, but ultimately - it depends on the patient. The benefits of it are not long lasting, however, and this is a major downside to the treatment. It's a process. You can't eat or drink anything the night before the procedure, you're given a shot an hour before (Robinul) that prevents your body from producing secretions (this is to minimize the risk of aspirating, or choking). Then the procedure itself with the anesthesia and hypnotics and 1 hour observation period following it, it's all very time consuming and expensive. We charge $1,249 each time. Better have insurance.

TMS is also something that we do, as well as ketamine injections. As far as efficacy, ECT works better for some whereas TMS and/or ketamine works better for others. There's no way of knowing which is best without trial and error, unfortunately.

UncleTentacles2 karma

what attracted you to an ect clinic compared to other places?

how well-funded is the clinic?

do you feel sorry for patients?

are ppl innately evil or good?

sensicle8 karma

The clinic is part of the psychiatric hospital where I work. Being involved in the ECT part was something I did as part of my orientation to the job. They want RNs to be able to do several things, one of which is knowing what to do in the ECT clinic. So I'm frequently assigned to that job for the day when I'm not doing other things. It depends on what the staffing needs are.

The company I work for offers outstanding pay, probably the best in the world when it comes to RN compensation. This is, of course, a big reason why I went to work for the organization - but loving what I do and the patients I care for comes from my passion to be a good nurse (no matter where I'm working). Our organization is very well funded. It's a huge company that employs 11,000 people just in my metropolitan area. They receive 300,000 applications for employment annually.

Do I feel sorry for the patients? Sometimes. Especially when working with minors that have done no wrong and come from heinous situations.

Are people innately good or bad? I say both. We all have a "shadow" (as Carl Jung called it), which is our dark side. We also have the capacity to do good, especially when it's of interest to us or benefits us in some way. But really, "good and evil" are subjective ideas and need to be defined and examined in cultural and societal context.

Zoyid2 karma

Have you witnessed anything on the job that has really affected you as a person?

sensicle10 karma

What affects me most is when patients are mistreated. I've had patients come in to the hospital before after having spent hours in an ER prior to their arrival and the first thing I always ask is Are you hungry? Are you thirsty? Would you like me to get you some food or drink?

I'm shocked and saddened by how many of them tell me nobody asked them that all day. Come on. While in the care of other nurses in the ER, nobody bothered to feed these patients? Fucked up. I'd always tell my students, if it's one thing you get from my course, let it be that you should never treat psychiatric patients any differently from other patients. They get hungry, thirsty, and have feelings too.

ooleyboo2 karma

Doesn't ECT erase memories?

sensicle4 karma

Temporarily, especially when bitemporal (electrodes on both sides) ECT is performed. It's difficult to determine to which extent the ECT is responsible for the amnesia as compared to the drugs used in the process since you would never perform ECT without anesthesia and a hypnotic, both of which cause temporary memory loss and confusion.

Danny_Notion1 karma

How painful is EC therapy, based on your patients' reactions and/or post-commentary?

sensicle2 karma

The actual convulsions are not felt and are therefore not painful at all. Propofol, a general anesthetic, is used prior to the procedure. Some patients do experience a mild to moderate pain afterwards, however, much like somebody would feel after an intense workout. This is caused by the after effects of the muscles tensing up and releasing lactic acid. This pain quickly subsides and only occurs in a small percentage of patients. Most are fine and able to walk away within 45 minutes of coming to me.

JubilationLee1 karma

What kind of advancements have there been to electroshock therapy in general recently? Over the last 50 years?

sensicle2 karma

From /u/wenkebach 's statement above:

Hollywood and Mr Ken Kesey have done a major disservice to the layperson by portraying this therapy as it has (tied down, leaving people as vegetables). This is a very good therapy for Major Depressive Disorder which has not responded to first/second line medications.

Memory disturbance and confusion were the only major reported cognitive side effects reported in the 50s, which has been improved by different methods to deliver the electric current (constant vs brief pulse, improvements in localization). Secondly, the use of anesthesia has allowed the seizures to not cause bone fractures that happened in the unmodified form back in the 40s. Leaving people as vegetables sound like the lobotomies performed, as u/sensicle stated. Thirdly, possibly most importantly, is the importance of informed consent nowadays; it makes sure nobody gets something they don't. I have seen nobody refuse ECT, especially those who want to get better.

jkeller40001 karma

dose low voltage transcranial stimulation provide the same effects as ect if done for long times?

sensicle2 karma

It depends on the individual patient. We offer TMS and ketamine injections as well as ECT. Every body's different.

MyUsernameIsNowTaken1 karma

What are the long term effects of ECT?

sensicle2 karma

Memory and learning deficits in some patients. It's important to way the benefits of treatment over the adverse effects and make an informed decision based on the research available.

makeitworkmoment1 karma

My mom is turning 70 in January, bipolar and suffers from fibromyalgia and chronic migraines. She's been on tons of antipsychotics her whole life and tried other treatments but nothing has "truly" worked for her. Now her family doctor and psychiatrist are recommending ECT. Have you had any patients her age do the treatment?

sensicle1 karma

Yes, one of the patients I had on Monday was 87. I hope your mother improves.

Doc_America1 karma

I have a question for you that you may or may not be able to answer. I'm a combat vet that was hurt in Afghanistan. I had surgery and had a neurotransmitter place in my spine to control damaged nerves in my left thigh. Is there anything long term that could hurt me by having this is? It's such a pain sometimes but removing it may make my situation worse.

sensicle2 karma

First of all, I'm sorry you ever had to see combat and even more sorry you were severely injured. I have the utmost respect for you.

That being said, you may wish to consider other options, man. ECT is helpful for people with severe depression and psychosis when other treatments don't work. It's for psychiatric illnesses and not to manage pain. I'd recommend you see a pain specialist and a psychiatrist if you're having any PTSD or other issues concerning your mental well being.

Piece_of_garbage1 karma

What's a crazy bi-polar disorder case you can talk about? Like dual personalities?

sensicle4 karma

People confuse bipolar disorder with dissociative identity disorder (multiple personalities) all the time. Bipolar disorder is when a person undergoes mood shifts between being very depressed and very elated (to the degree that it interferes with their life, this is known as mania or a manic state). An example of something one might do during a manic state is gamble away their life savings at a casino or spend it all on art supplies thinking they'll be a successful artist or something. It's an extreme form of elation. Bipolar implies the entire spectrum and its polar opposites: severe depression and severe mania.

As far as dissociative identity disorder goes, it's extremely rare that anyone actually has it and if someone says they have it, they don't.

Flying_Birdy1 karma

What is the typical process for helping patients with amnesia? Do memories usually just return or is there some stimulus doctors use to accelerate the process?

From what I understand, some successful treatments result in a patient relapsing shortly after. How are the relapses measured (what counts as a relapse?)

Are there any guidelines to making sure the patients are accepting treatment without negatives pressures from their family or friends? I know consent is mandatory, but it's also entirely possible that patients are pressured into decisions they don't like.

sensicle2 karma

As far as amnesia, there's no tried and true method that I know of to stimulate memories. I'm with the patient from the moment they're done with treatment until they can state their name and where they are. You can practically see their memory come back before your eyes. They're always somnolent on arrival and then just minutes later, they open their eyes, start looking around, and sit up. I talk to them and remind them what just happened and try to orient them to their surroundings. Within minutes, they're fully awake and alert. I'm not with them long enough to know of how it affects their memory beyond that point, however.

A relapse would just be reverting to the mind set that was intended to be treated by ECT and following a period of "remission". It remains a problem with the treatment as there's no way to know for sure how, why, or when this will happen.

As for family pressure, social workers and nurses work closely with the patients and their loved ones and if they (we) suspect any form of coercion, we investigate further and call Adult Protective Services if necessary. I haven't had to do this myself, nor do I know of a time this was necessary in regards to an ECT consent. One of the ways in which patients are highly protected in psychiatry on a federal level, however, is that they can choose who gets information about them and who doesn't. Even if someone has a power of attorney that was legally processed, if the patient chooses not to grant that person information about their case, we are obligated to respect their wish. The exception to this is if the patient is deemed incompetent by the state and has a conservator appointed to them.

Kufflink381 karma

Is it safe for a person with COPD and sleep apnea to undergo this treatment?

sensicle3 karma

There's not much research in this area but it's a great question! It's recommended that patients with severe COPD use their inhaler the morning of the treatment but every patient undergoing ECT also receives an injection of Robinul intramuscularly to prevent secretions from forming. If a patient is on theophylline, a drug used to treat COPD, ECT would likely not be recommended due to the increased chances of a post procedure seizure.

fetalfeast1 karma

Hello, I am a pre-med student primarily interested in pursuing a career in psychiatry. I recognize that the practice of nursing and medicine differs in many ways and your psychology degree may benefit your practice in a different way than it would mine, but do you think it would be beneficial to pursue advanced psychology classes during my undergraduate years?

To what extent do you use the principles you learned in your psychology classes in everyday practice?

Thanks in advance!

sensicle2 karma

Just like technology is applied science, I say psychiatry is applied psychology. A degree in psychology isn't necessary but is certainly useful to have. I'd say one of the best uses of the degree is to better understand research methodology and be able to discern good research from faulty research.

FireDiscoPenguin1 karma

I've read that ECT is one of the few "somatic" treatments of psychiatric disorders that actually works, though it has apparently only been demonstrated to make a significant difference in patients with depressive disorders. Does this chime with your experience of the therapy? Is it being prescribed for anything else?

sensicle2 karma

It's also used to treat mania (bipolar disorder symptom) and psychosis (specifically catatonia). Depending on the person, they can see marked improvement in symptoms from ECT.

shigogaboo0 karma

This is a serious question and not meant to be offensive; this sounds an awful lot like the shady stuff that left folks as vegetables in the 50's. How is this any better than their methods?

wenkebach12 karma

Hollywood and Mr Ken Kesey have done a major disservice to the layperson by portraying this therapy as it has (tied down, leaving people as vegetables). This is a very good therapy for Major Depressive Disorder which has not responded to first/second line medications.

Memory disturbance and confusion were the only major reported cognitive side effects reported in the 50s, which has been improved by different methods to deliver the electric current (constant vs brief pulse, improvements in localization). Secondly, the use of anesthesia has allowed the seizures to not cause bone fractures that happened in the unmodified form back in the 40s. Leaving people as vegetables sound like the lobotomies performed, as u/sensicle stated. Thirdly, possibly most importantly, is the importance of informed consent nowadays; it makes sure nobody gets something they don't. I have seen nobody refuse ECT, especially those who want to get better.

I'm a fourth year medical student who has spent a month in an inpatient psych unit and seen how ECT is used nowadays. But honestly, you could have just googled and found an answer to this question.

sensicle3 karma

Thank you.

sensicle8 karma

If you look at data, ECT is actually pretty effective for some patients that do not respond well to other treatments. It is hardly, if ever, used as a primary form of treatment. You may be thinking of lobotomies, which were actual surgeries involving the removal of a major part of the brain.