When Do Doctors Give Electric Shocks?
Electric shock treatment, or electro convulsive therapy, is sometimes used with people suffering from mental illnesses in which severe depression is the main symptom. Electro convulsive therapy (ECT), previously known as electroshock therapy, and often referred to as shock treatment is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect.
It was first used in 1938 by U. Cerletti and L. Bini in Rome, and was recommended for the treatment of manic-depression and schizophrenia (literally, “splitting of the mind”). It gained widespread use as a form of treatment in the 1940s and 1950s; today, an estimated 1 million people worldwide receive electro convulsive therapy every year, usually in a course of 6–12 treatments administered 2 or 3 times a week.
Today, electro convulsive therapy is most often used as a treatment for severe major depression which has not responded to other treatment, and is also used in the treatment of mania (often in bipolar disorder), and catatonia. ECT machines have been placed in the Class III category (high risk) by the United States Food and Drug Administration (FDA) since 1976. A round of ECT is effective for about 50% of people with treatment-resistant major depressive disorder, whether it is unipolar or bipolar.
Follow-up treatment is still poorly studied, but about half of people who respond relapse within 12 months. Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment, the most common adverse effects are confusion and memory loss. ECT is considered one of the least harmful treatment options available for severely depressed pregnant women.
A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient is no longer suffering symptoms. ECT is administered under anesthetic with a muscle relaxant. Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission.
Placement can be bilateral, in which the electric current is passed across the whole brain, or unilateral, in which the current is passed across one hemisphere of the brain. Bilateral placement seems to have greater efficacy than unilateral, but also carries greater risk of memory loss. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT.
ECT appears to work in the short term via an anticonvulsant effect mostly in the frontal lobes, and longer term via neurotrophic effects primarily in the medial temporal lobe. ECT is used with informed consent in treatment-resistant major depressive disorder, treatment-resistant catatonia, or prolonged or severe mania, and in conditions where “there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by stupor, marked psycho-motor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania).”
For major depressive disorder, ECT is generally used only when other treatments have failed, or in emergencies, such as imminent suicide. ECT has also been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson’s disease, Huntington’s chorea, developmental delay, brain arteriovenous malformations and hydrocephalus.