Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is the application of a mild electric current to the brain to produce an epileptic-like seizure as a means of treating certain psychological disorders, including severe depression, severe mania, and catatonia.

Electroconvulsive therapy, also known as ECT and electroshock therapy, was developed in the 1930s when various observations led physicians to conclude that epileptic seizures might prevent or relieve the symptoms of schizophrenia. After experiments with insulin and other potentially seizure-inducing drugs, Italian physicians pioneered the use of an electric current to create seizures in schizophrenic patients.

ECT was routinely used to treat schizophrenia, depression, and, in some cases, mania. ECT was used indiscriminately and often without anesthesia and was frequently prescribed for treating disorders on which it had no real effect, such as alcohol dependence, and was used for punitive reasons. Patients typically experienced confusion and loss of memory after treatments, and even if their conditions improved, they usually eventually relapsed. Other side effects of ECT include speech defects, physical injury from the force of the convulsions, and cardiac arrest. This therapy became controversial due to its misuse and negative side effects, and its use declined after 1960 with the introduction of antidepressant and antipsychotic drugs.




A patient is prepared to undergo electroconvulsive therapy (ECT) to treat severe depression.





A patient is prepared to undergo electroconvulsive therapy (ECT) to treat severe depression.
(© Ethan Hyman/Raleigh News & Observer/MCT via Getty Images)




A woman prepares to receive electroconvulsive therapy (ECT), a treatment for depression. ECT works by inducing seizures in the brain; the rubber mouthpiece will keep the patient from biting down on her teeth or her tongue during the procedure.





A woman prepares to receive electroconvulsive therapy (ECT), a treatment for depression. ECT works by inducing seizures in the brain; the rubber mouthpiece will keep the patient from biting down on her teeth or her tongue during the procedure.
(© Photo Researchers, Inc.)

Despite careful administration of ECT, patients may experience side effects, particularly memory loss. This may include anterograde memory (the ability to learn new material), which typically returns relatively rapidly following treatment; or retrograde memory (the ability to remember past events), which may be more strongly affected. Patients may experience a marked memory deficit in the week after treatment, but memory gradually improves over the following months. In many cases, however, subtle memory losses persist beyond six or seven months and can be serious and debilitating for some patients.

About 100,000 people in the United States receive electroconvulsive therapy annually. ECT is used in several instances, notably as a treatment for severely depressed patients who have not responded to antidepressant medications or whose suicidal impulses make it dangerous to wait until such medications can take effect. ECT is also administered to patients with catatonia and patients who have dementia and exhibit agitation and aggression.

KEY TERMS

Anterograde memory—
The ability to learn new material.
Neutotransmitter—
A chemical that transfers signals between nerve cells.
Retrograde memory—
The ability to remember past events.
Seizure—
Uncontrolled electrical activity in the brain, which may lead to a convulsion, thought disturbances, or other responses.

Because of its possible side effects, as well as the public's level of discomfort with both electrical shock and the idea of inducing seizures, ECT remains a controversial, although in some cases very effective, treatment method.

Resources

BOOKS

Braddock, Kathleen, ed. Electroconvulsive Therapy: Clinical Uses, Efficacy and Long-Term Health Effects. Hauppauge, NY: Nova Science, 2014.

Ghaziuddin, Neera, and Garry Walter. Electroconvulsive Therapy in Children and Adolescents. New York: Oxford University Press, 2013.

Kellner, Charles H. Brain Stimulation in Psychiatry: ECT, DBS, TMS and Other Modalities. New York: Cambridge University Press, 2012.

WEBSITES

Mayo Clinic. “Electroconvulsive Therapy (ECT).” http://www.mayoclinic.org/tests-procedures/electroconvulsivetherapy/basics/definition/prc-20014161 (accessed July 24, 2015).

MedlinePlus. “Electroconvulsive Therapy.” http://www.nlm.nih.gov/medlineplus/ency/article/007474.htm (accessed July 24, 2015).

Mental Health Association of San Francisco. “Electroconvulsive Therapy (ICT).” http://mentalhealthsf.org/electroconvulsive-therapy-ect/ (accessed July 24, 2015).

National Alliance on Mental Illness. “ECT, TMS and Other Brain Stimulation Therapies.” https://www.nami.org/Learn-More/Treatment/ECT,-TMS-and-Other-BrainStimulation-Therapies (accessed July 24, 2015).

ORGANIZATIONS

International Society for ECT and Neurostimulation (formerly the Association for Convulsive Therapy), 5454 Wisconsin Ave., Ste. 1220, Chevy Chase, MD, 20815, (301) 951-7220, contact@isen-ect.org, www.isen-ect.org .

Mental Health America, 2000 N. Beauregard St., 6th Fl., Alexandria, VA, 22311, (800) 969-6642, (703) 684-7722, http://www.mentalhealthamerica.net .

National Alliance on Mental Illness, 3803 N. Fairfax Dr., Ste. 100, Arlington, VA, 22203, (703) 524-7600, info@ nami.org, https://www.nami.org/ .