If you suffer from dementia, severe or treatment resistant depression, severe mania, catatonia or schizophrenia; and conventional drugs do not have the desired effect, you could be a candidate for Electroshock therapy, now more often known as Electroconvulsive Therapy. The idea of having electricity course through your body might be a bit difficult to imagine so this is an attempt to demystify it for you.
What is electroconvulsive therapy?
Electroconvulsive therapy is a procedure done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone.
In the 1930s, Ugo Cerletti, a Roman Neuropsychiatrist was doing research on Epilepsy and using electric shocks to induce seizures in dogs. Cerletti visited an abattoir where electric shocks were used to render pigs comatose prior to slaughter. Inspired by the facts that the pigs were not actually killed by a voltage of 125 driving an electric current through the head for a few tenths of seconds, he decided to experiment on a person.
Cerletti first used ECT in a human patient, a diagnosed schizophrenic with delusions, hallucinations and confusion, in April 1938, in collaboration with Lucio Bini. A series of electroshocks were able to return the patient to a normal state of mind. This experiment indicated that electric shock treatment may hold potential to improve the condition of patients diagnosed with specific diseases. Electric shock treatment quickly replaced insulin and Metrazol as the favourite form of shock treatment… Cerletti and Bini were nominated for a Nobel Prize for Physiology or Medicine for their work on the treatment.
In recent years however, the use of ECT has continued to reduce. There is still marked variation in use, both in prescribing and in standards of administration. The Royal College of Psychiatry and the National Health Service have both produced recent guidelines on ECT use.
In contemporary Psychiatric practice, ECT is used mainly in the treatment of Depression. It is occasionally used in the treatment of disorders such as Schizophrenia.
What happens during ECT?
When undergoing modern ECT, a patient is given an anesthetic and a muscle relaxant. A brief pulse electric current is of about 800 mill amperes is passed between two electrodes on the head for several seconds, causing a seizure. The resulting convulsion is modified by the muscle relaxant. ECT is usually given on an inpatient basis, although about one in five treatments are given on an outpatient basis. The treatment is usually given twice a week (occasionally thrice a week) for a total of 6-12 treatments, although courses may be longer or shorter.
ECT is often used with informed consent as a last line of intervention for major for major depressive disorder, Mania and Catatonia. A round of ECT is effective for about 50% of people with treatment-resistant major depressive disorder. Follow-up treatment is still poorly studied, but half of the people who respond relapse within 12 months.
Electroconvulsive therapy differs in three ways; electrode placement, frequency of treatments and the electrical waveform of the stimulus. These three forms of application have significant differences in both the adverse side effect and symptom remission. Placement can be bilateral, in which the electric current is passed across the whole brain, or unilateral, in which the current is passed across one hemisphere of the brain. Bilateral placement seems to have greater efficacy than unilateral, but also carries greater risk of memory loss. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT.
Despite decades of research, the exact mechanism of ECT remains elusive. Although It has been found to have the side effect of confusion and memory loss, it is considered the least harmful treatment option available for severely depressed pregnant women.
ECT has been found most useful in the treatment of:
- Major depression
- Psychotic depression or psychotic mania
- Severe risk of suicide
- Bipolar Disorder
- Catatonic stupor
- Rapid treatment response, such as in pregnancy.