Electric shock therapy involves running a small current of electricity through a patient's brain, inducing a thirty to sixty second seizure. ECT was developed by an Italian neurologist named Ugo Cerletti in 1937 who noticed that patient's moods tended to improve following seizures. By the early 1940s, ECT therapy was in widespread use in the United States.
ECT, as it was originally practiced, was a brutal procedure. Much larger currents of electricity were used, and the treatment was usually performed on conscious patients. Although it was intended as a treatment for mood disorders, in some asylums it became an instrument of punishment and control.
With this background, it is little wonder that electroconvulsive therapy fell out of favor in the 1970s. However, in recent years, it has seen a resurgence in popularity--although in a form almost unrecognizable from the instrument of social control it once was. This article examines how ECT is used today and examines its pros and cons.
Why is ECT Used?
Electroconvulsive therapy is usually used for depression that has proven resistant to other forms of treatment or depression so severe that the risk of suicide is very high and there is no time to wait for medication or talk therapy to take effect. It has also been used in people who cannot take antidepressants such as pregnant women.
More rarely, ECT is used to end episodes of uncontrollable mania or to ease the hallucinations and delusions of schizophrenia.
Statistics and Effectiveness of ECT
In the United States, data is not collected on the use of electric shock therapy, so it is unknown how many people actually undergo ECT. According to some psychiatrists' estimations, electroconvulsive therapy is performed on between 100,000 and 200,000 patients per year, but others believe that these statistics are inflated.
Studies suggest that more than 80% of people who undergo a full course of treatment (usually between six and fifteen shocks administered at the rate of three shocks per week) report at least temporary relief of their symptoms.
How is Electroconvulsive Therapy Performed?
Before a patient receives electroconvulsive therapy, he or she is given a thorough medical screening including an electrocardiogram to ensure that the heart is healthy.
The next step is informed consent. Ideally, the person receiving the treatment will be able to understand the pros and cons and he or she can make an informed decision on whether to accept or refuse the treatment. If a person is incapable of understanding the treatment options, a durable power of attorney for healthcare or a legal guardian may sometimes give consent on the person's behalf. In some cases, courts order patients to undergo ECT. Healthy Place, a watchdog group, claims that in New York state, over 40% of ECT treatments are court ordered.
Before the seizure is induced, the patient is given a muscle relaxer and a short acting dose of general anesthetic. He or she is unconscious during the entire procedure. Electrodes are then placed either on one side of the head (unilateral ETC) or both sides of the head (bilateral ETC) and a brief shock is administered. A seizure results from the shock.
The patient awakens ten to fifteen minutes later and may experience headaches, muscle pain, nausea, or confusion. These side effects typically fade within twenty minutes to an hour.
ECT Pros
Probably the biggest pro of ECT is that it works quickly, often within a week or two, making it a lifesaver for people who are experiencing severe symptoms and cannot wait for medications to kick in.
ECT is also a viable alternative for people who can't or won't take medication for depression and mania.
Finally, ECT has a higher success rate when compared to medications or talk therapies. It may work when nothing else is effective in treating mania and depression.
ECT Cons
Electric shock therapy has been associated with memory loss, most commonly retrograde amnesia (memory loss for events that occurred prior to treatment) and amnesia for events that occur during treatment. While most people do eventually retrieve their lost memories, some never regain their recollections, making cognitive impairment a very real risk of electroconvulsive therapy.
Then there is the relapse rate. Twenty to fifty percent of people who are successfully treated with ECT relapse within six months and must undergo further shock treatment; others may be forced to find another maintenance treatment.
Finally, ECT is expensive, and many insurance companies will cover only part of the costs, making it inaccessible to some people.
Electroconvulsive Therapy as a Treatment Method
After a discouraging start, ECT has shown that it does, indeed have a place in the treatment of medication-resistant depression and mania. It is currently nothing like the nightmarish torture depicted in the movies, but it does have side effects, some of them quite troubling, associated with it. Anyone considering ECT should consult a psychiatrist who is familiar with its use and who can help their patient explore all of his or her options.
Sources:
Healthy Place. Shocked! ETC Homepage. Accessed on 6/14/10.
Med Help. All About ECT. Accessed on 6/14/10.
Mayo Clinic. Electroconvulsive Therapy. Accessed 6/14/10.
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