ELECTROCONVULSIVE THERAPY (ECT)

Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT)

Introduction

Electroconvulsive therapy (ECT), also known as electroshock therapy or, simply, electroshock, uses short bursts of an electrical current in the brain in order to elicit a brief seizure while the patient is under general anesthesia. Most countries nowadays only allow electroconvulsive therapy to be conducted under anesthesia, in contrast to the direct electroconvulsive therapy of the past. Usually, the patient receives frequent treatment sessions per week for about one month and then the need for repeated sessions is evaluated. ECT may elicit side effects such as disorientation, headache, and short-term memory loss. (Frank and Thase, 1999)

ECT offers a very fast response when compared to psychotherapy and drug therapy, but this response decays if there is no maintenance treatment with either electroconvulsive therapy or wa drug. Due to its fast action, electroconvulsive therapy is considered to be the treatment of choice in emergency situations (e.g., suicidal behavior or in catatonic depression with cessation of oral intake). Antidepressant drugs may be associated from the beginning of ECT so as to allow early discontinuation of it after drug therapy achieves control of the symptoms.

ECT has assumed a bad reputation in popular culture worldwide, but it is still considered a good treatment option if well indicated, that is, where other treatment options have failed, in severely depressed patients (especially those who have a story of previous response to ECT), in patients with significant psychotic symptoms or where antidepressants cannot be used for any reason. It is, therefore, considered to be a therapy of exception.

Background

Electroconvulsive Therapy (ECT) is used frequently to treat severe depression (American Psychiatric Association, 2001). This intervention, known colloquially as “shock therapy,” was introduced in the 1930s by two Italian scientists, Cerletti and Bini. The first patient Cerletti and Bini treated was suffering from “incoherent schizophrenia.” After receiving multiple ECT treatments, the man purportedly was able to work and to live a normal life. The notion that electrically induced convulsions served a therapeutic function gained rapid acceptance in the field. Early treatment with ECT was brutal. Strong seizures frequently resulted in broken bones, and significant retrograde memory losses following treatment were not uncommon. The public's trust in ECT as a viable treatment option was eroded further by its negative portrayal in the popular 1975 movie, One Flew Over the Cuckoo's Nest. Moreover, for many years, ECT was used to treat a broad spectrum of mental illnesses in the absence of scientific evidence demonstrating its utility for these diverse illnesses.

Applications

The application of ECT today bears little resemblance to earlier practices. Current practice is strictly governed by guidelines put forth by the American Psychiatric Association (2001). For example, administration of general anesthesia precludes the patient from experiencing pain during the procedure. Additionally, the routine use of muscle relaxants prevents broken bones. Although the seizure activity elicited by the electrical current is observed on an electroencephalogram (EEG) during the procedure, no outward convulsion occurs. Memory problems are also minimized but not totally avoided—by current ...