Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) remains one of the most controversial forms of psychiatric treatment. It is a serious procedure with consequences that can include memory loss but it is also a procedure that can relieve symptoms for patients with severe depression that do not respond to medication.

The procedure as administered today bears little resemblance to the painful electro-shock treatment of decades past.

What Is ECT?

Electroconvulsive therapy, also known as electroshock therapy, is a treatment for mental illness that has been used since the 1930's. It involves passing an electrical current through the brain to induce a controlled seizure. These controlled seizures cause the release of neurotransmitters into the brain and in ways that remain poorly understood; this convulsion-neurotransmitter release effect improves the symptoms of depression and certain other mental illnesses.

ECT Past and Present

In the early 20^th century, doctors of patients with both epilepsy and depression noticed that depressive symptoms were reduced following an epileptic seizure. This observation led the development in the 1930s of machines able to produce electrically stimulated controlled seizures; ECT machines.

In decades past, without the effective medications available today, doctors used ECT to treat a variety of mental health conditions and with far greater frequency than at present. ECT was administered at high doses and without anesthesia, and was by all accounts, a brutal and painful experience.

Today, ECT employs much smaller and more targeted bursts of electricity on sedated patients. ECT is now a far more humane procedure, but remains a very controversial one.

Why Is ECT Used?

Doctors may recommend ECT for the treatment of very severe depression that has not responded to other treatments, such as medication or psychotherapy; particularly the treatment of depression accompanied by extreme weight loss, suicidal or homicidal thoughts or severe insomnia.

ECT is also used for the treatment of very severe mania or schizophrenia, when medications alone do not control symptoms sufficiently.

How Is ECT Administered?

Unlike the brutal administration of electroshocks in the 1950s and 1960s patients receiveing ECT today are placed under anesthesia for the procedure and given a strong muscle relaxant to reduce muscle spasms and injury.

A typical course of ECT will include between 6 and 12 sessions, offered over several weeks. A patient will come in and after a brief physical exam, be placed under anaethesia and given a strong muscle relaxant.

The doctor will administer a small electrical current inducing a short controlled seizure.

The patient will be monitored until she wakes up and then taken to a recovery room to continue recuperation. Once the patient feels well enough to leave, she is free to go.

The whole process takes less than an hour and most patients report feeling an immediate improvement in depressive symptoms following an ECT session.

ECT Side Effects and Risks

Short term side effects include:

• Headache
• Fogginess
• Confusion
• Emotionality
• Memory problems

Immediately following an ECT session and for that same day, patients may feel sick or sore, tearful or emotional and sometimes confused. These side effects are generally short lived. Many patients experience retrograde amnesia – they are unable to remember many events that occurred prior to the beginning of ECT. The more frequently and longer the ECT treatment, the more severe the memory effects, but most patients regain memory following the completion of the therapy.

Longer term side effects can include:

• Memory problems
• Personality changes

Some people report permanent memory loss after ECT. Others report a change in personality or a loss of certain skills.

After ECT

ECT patients will typically progress from a course of ECT to continuing treatment with anti depressant medications and psychotherapy.