Electroconvulsive Therapy Makes a Comeback
Since the 1980s, shock therapy (also known as electroconvulsive therapy, or ECT) has been making its way back into mainstream mental health care. According to the National Mental Health Association, nearly 100,000 people undergo ECT annually in the United States. ECT can be used to treat patients who suffer from severe depression, acute mania, and certain schizophrenic syndromes. According to the American Psychiatric Association, ECT can be a safe and effective treatment for depression and other mental illnesses.
ECT portrayed in movies often shows the patient receiving high doses of electricity while conscious. The movie One Flew Over The Cuckoo’s Nest left a lasting impression in the collective consciousness of America in regards to ECT. This method of therapy had a high risk of memory loss or death for the patient. The ECT procedure used today is very different, however. Modern techniques involve the patient receiving calculated electrical currents administered in a setting that is very controlled.
ECT is usually performed in the morning before the patient’s first meal of the day. General anesthesia and a muscle relaxant are administered, then electrodes are applied to the patient’s head and a pre-determined amount of electric current is delivered, causing a short seizure. The patient awakes confused with little or no memory of what occurred shortly before or after the treatment. Typically, treatment is repeated three times a week for one month. In addition to ECT, a patient is usually treated with medication, psychotherapy, family therapy, and behavioral therapy.
Memory loss is the most common side effect experienced by ECT patients. Some people have trouble with short-term memory; for example, a patient may have no recollection of an article read one hour before treatment. Typically, this kind of memory loss lasts only a short time, maybe a few weeks. But long-term memory loss can also occur, with memory gaps from a few weeks to years long in isolated cases. Most ECT patients experience some confusion and find it challenging to concentrate immediately after treatment.
Exactly how ECT works to treat depression has not yet been determined. One theory is that it modifies brain chemicals, including neurotransmitters (e.g., serotonin), endorphins, and adrenaline.
ECT has been in use for over 70 years, and remains one of psychiatry’s most controversial treatments. At the height of its popularity in the 1960s, about 300,000 patients received ECT annually in the United States. One of the most common debates is whether the therapy’s effectiveness is worth the side effects, which can include not only short-term cognitive impairment and memory loss, but also nausea and vomiting, headaches, and muscle and jaw pain. What’s more, ECT causes heart rate and blood pressure to increase during the procedure, and in some people that can lead to severe heart trouble. As with any procedure that uses anesthesia, there is also a small risk of death.
Furthermore, it has been argued that ECT is a quick fix, though this is seen as a misconception by many in the medical and mental health professions. In this era of managed care in the United States, critics of ECT have also accused doctors and hospitals of encouraging patients to undergo the procedure in order to justify hospitalization.
Before undergoing an ECT treatment, the patient should have a complete physical examination, as well as a psychiatric evaluation. The pre-ECT examination should include:
- A complete medical history.
- Basic blood tests.
- An electrocardiogram (ECG) to monitor for certain types of heart disease.
In addition, a patient should consult with the anesthesiologist to discuss the potential side effects of anesthesia.
If you are interested in learning more about ECT, the National Mental Health Association website, www.nmha.org, is a good place to start your research. When conventional therapies fail, ECT may offer improved quality of life to some—if its benefits outweigh its side effects.