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By Boris M | 02 February, 2020 Published in Guides
2

Electroconvulsive therapy has a controversial history. People associate electroconvulsive therapy with abusive institutions in the past.

However, the procedure is painless today.

ECT is undoubtedly a useful treatment. ECT was never quack medicine; it has always been an effective treatment for mental health problems.

Electroconvulsive therapy involves giving a patient a seizure by sending electricity into their brain. These seizures undoubtedly benefit many patients. Depression, mania, and psychosis often disappear for a long time afterward.

ECT has not become obsolete because of newer and better treatments. Many cases of severe depression and schizophrenia are challenging to treat.

Drugs and talk therapy do not always work. If a patient is resistant to other treatments, doctors may recommend ECT.

While modern ECT is painless, it is not necessarily safe. Even today, repeatedly undergoing electroconvulsive therapy can damage a person’s long term memory.

For this reason, some doctors are against ECT. The medical establishment remains in favour of it because of how effective it is.

Doctors only consider ECT if the problem is severe and is resistant to other treatments. In those cases, doctors believe the benefits outweigh the risks.

Patients must know about the dangers before they consent to ECT.

What conditions is ECT used to treat today?

More than anything else, doctors use ECT to treat severe depression. Severe depression is a debilitating disease and is not merely sadness or lack of energy.

ECT can save lives, as it can help a suicidal patient recover. If the patient’s life is in danger, the risks of ECT are justifiable as long as the treatment is effective.

Depression can do physical as well as mental harm to its victims. A severely depressed patient may refuse to eat.

The health risks of ECT are sometimes less than the health risks of withholding treatment.

A patient who has received ECT before is often firmly in favour of ECT treatment. The families of those who undergo ECT are usually in favour of it as well.

As well as treating depression, ECT can treat mania. Mania is a dangerous mental state related to bipolar disorder.

Sometimes, those with bipolar disorder are very depressed and lethargic, too miserable to function normally.

However, those with bipolar can also be manic. When in a manic state, they are very energetic but prone to risk-taking and dangerous behaviour.

During a manic episode, a person may lose the ability to separate fantasy from reality.

They may use drugs and make terrible decisions that can negatively affect their lives. A lengthy episode of mania is dangerous enough that doctors recommend ECT.

Doctors also use ECT to treat catatonia, dementia, and other mental issues. ECT is most useful for depression.

In about 80% of cases, the treatment can help a severely depressed individual [1].

Unfortunately, ECT is only a treatment and not a cure for these disorders.

A patient needs to undergo ECT repeatedly because the symptoms return after treatment.

Both the American Psychological Association and similar organizations in other countries accept ECT [2].

A doctor never gives ECT to a patient who does not want ECT. It is not an involuntary treatment given to patients in institutions.

Because of general anesthesia, the procedure is painless.

How does ECT work?

Like newer brain stimulation treatments, ECT involves using technology to stimulate the brain. A doctor applies an electric current to a patient’s brain, which causes a seizure.

Why the seizure alleviates mental problems is not well understood. There is plenty of evidence that ECT works, but little understanding of why.

ECT does not do any damage to the brain, as the electric current is too weak to do any harm.

A patient is not conscious during the procedure and, therefore, does not remember the seizure.

There is no surgery involved in ECT, as the electricity passes through the skull.

There are many theories on why ECT works, but none are proven to be true. ECT might cause new neurons to grow.

ECT might also work by releasing chemicals into the brain. Some argue that the treatment works by making neurotransmitters more sensitive [3].

When a person is having a seizure, the body activates certain systems to bring the seizure to an end.

The activation of these systems might have a positive effect on depression and other diseases.

Who can benefit from ECT?

ECT is beneficial as long as the benefits are strong enough to justify the risks. If the situation is not very serious, the treatment is too harsh to justify.

A person does not have to be suicidal or refusing to eat for their case to be considered critical enough.

A person who is not suicidal but has a debilitating case of depression may receive ECT.

If a person cannot take antidepressants for health reasons, a doctor may consider ECT.

A doctor may also recommend ECT if a person does not benefit from antidepressants.

ECT is fully justified if a patient is in a catatonic state. During a catatonic state, a person may be mute and may not react to events.

They might remain in an unusual posture for hours without moving, and without responding to others.

They might also move around a lot but be unresponsive and unwilling to speak. A catatonic state is dangerous and justifies the use of ECT.

Doctors also use ECT to treat schizophrenia. It is not always useful, as it can worsen the patient’s mood in some cases.

ECT can treat psychotic symptoms. Patients always receive drugs first before doctors consider ECT.

ECT can help those who are unresponsive to schizophrenia drugs such as Clozapine.

ECT is unfortunately not a cure, and symptoms are likely to return in the future.

The advantages of ECT

Simply put, ECT is more effective than drugs. ECT benefits many patients that other treatments fail to help. Electroconvulsive therapy works rapidly – pills often take a while to work, talk therapy takes even longer.

Many psychologists say that they would seek out ECT themselves if they had severe clinical depression.

A person undergoing a typical ECT treatment may go through eight or twelve shock treatments.

These repeated treatments do not take as long as you might assume.

Each treatment takes only a few minutes. ECT is not painful, not time-consuming, and not very invasive.

The bad reputation of the therapy comes from doctors using it unethically in the past. The treatment is much gentler now.

A trip to the dentist can feel more dramatic than modern ECT.

Psychologists know how debilitating depression can be. A profoundly depressed person may resemble a stroke victim.

They may not talk or move and might fall into a catatonic state. They may believe that they are dying, that their body is shutting down.

A depressed person looks physically sick and is fed intravenously at the hospital in extreme cases.

Severely depressed people are also at risk of suicide. Sometimes, drugs are enough to treat the suicidal feelings.

However, it can take weeks for medications to help someone overcome a state of profound depression.

Sometimes, no pills are effective. ECT is much faster and much more reliable. It can get a patient out of a painful and life-threatening state.

Possibly, new drugs and other therapies could make ECT obsolete in the future. For now, it remains in use because it is stronger than other treatments.

ECT still has risks and side effects today

Even today, ECT has serious risks. While modern ECT is painless, it can still be dangerous.

If ECT were safe, doctors would recommend ECT to clinically depressed patients in general.

However, it is still risky and, therefore, only used for severe and treatment-resistant psychological issues.

The most worrying side effect of ECT is memory loss. Events around the time of the treatment can vanish from the patient’s mind.

In the worst cases, ECT can lead to long term memory problems. The procedure is still risky, although less so than in the past.

In the past, some people injured themselves during ECT seizures.

Muscle relaxants today minimise the odds of this happening, but damaged bones and teeth are still possible.

Some people also experience odd moods between treatments. ECT does not always have a positive psychological effect.

People can be confused or restless between treatments. Sometimes, ECT does not benefit a patient.

Longer-term side effects can be severe, including difficulty learning new information.

A person’s ambition, energy, and creativity may slowly decline if they repeatedly undergo ECT.

While ECT is usually harmless, it is not a safe treatment with no risk of severe side effects.

Doctors consider ECT to be worth the risks in some cases, but it can be dangerous.

Why is ECT so controversial?

ECT has a history of misuse. It brings up a mental picture of a doctor in the past painfully “shocking” an unwilling patient.

The film “one flew over the cuckoos nest” paints a very negative portrait of ECT. The public mostly sees ECT as an abusive practice.

Sometimes, a patient is surprised that ECT still exists when a doctor suggests it to them.

Doctors do not know precisely why ECT works, only that it is effective. The lack of understanding makes ECT seem unscientific and allows the stigma to remain.

Few patients ever undergo ECT. According to a 2011 study, only 0.16% of people treated for depression ever received ECT [4].

The historical stigma and the real risks involved prevent ECT from being commonly used.

Supporting those undergoing ECT

People who care for persons undergoing ECT want to be with them at the hospital when they receive treatment.

Caregivers are not usually allowed into the room where ECT takes place.

However, they can be with them before and after. Caregivers are often initially worried about the risks of ECT.

Caregivers often become in favour of it after it has a very beneficial effect on the patient.

Patient consent for ECT

Usually, a doctor cannot give a patient ECT without their consent, not even in a hospital.

A very mentally disturbed person may refuse ECT and has the right to refuse it. An exception is if the patient’s life is in danger.

If there is a real threat of death, sometimes medical treatment, including ECT, can be given non-consensually.

Does ECT work for bipolar disorder?

A person with bipolar disorder will swing back and forth between manic phases and depressive phases.

During a depressive period, they are depressed, do very little, and think very little of themselves.

During a manic phase, they are very energetic and happier but capable of dangerous, self-destructive behaviour. ECT often works to treat either phase.

However, these phases are not always long and hazardous enough to justify ECT.

Only if the person’s manic or depressive phases are unusually severe do doctors recommend ECT.

How to know whether local ECT treatments are safe and effective

In Britain, there is an independent regulatory body called the ECT Accreditation service.

The ECT Accreditation Service examines ECT units all over the country and rates their quality.

An ECT unit should tell you whether or not the Accreditation service approves of their ECT unit.

Outside of the U.K., there is not necessarily as much information about the quality of local ECT services.

Other brain stimulation therapies

Electroconvulsive therapy is not the only medical treatment that involves sending electrical signals into the brain.

Doctors can use electrodes to stimulate the brain without inducing seizures.

One can also use magnetic fields to change electric activity in the brain for medical purposes.

While drugs and talk therapy are preferred, doctors recommend brain stimulation treatments if other treatments fail.

1. Transcranial Magnetic Stimulation (TMS)

One can use magnets rather than electrodes to change electrical activity in the brain. TMS is much gentler than electroconvulsive therapy.

TMS is used to treat depression, anxiety, and psychotic episodes.

Only a small part of the brain is affected, smaller than for electroconvulsive treatment.

TMS has been around since the 1980s but was not approved by the FDA until 2008.

Since FDA approval, it has been part of mainstream modern medicine. Doctors consider TMS if at least one antidepressant fails to treat major depression.

Studies on patients in 2010 proved that the treatment works better than the placebo effect.

During the procedure, a doctor holds a magnetic coil close to the patient’s forehead. The device stimulates a part of the brain that regulates mood.

By sending electricity through the coil, magnetic pulses appear and pass through the patient’s skull. The treatment activates nerve cells in the patient’s brain.

The magnetic pulses do not pass all the way through the brain; they only go about two inches deep.

Therefore, the treatment only stimulates the part of the brain that deals with mood control.

How TMS works is not well understood. Brain stimulation treatments are scientifically proven to work without being scientifically understood.

Doctors do not even know precisely where to place or position the magnet.

Brain stimulation treatments are useful, but they are rather primitive and not yet based on deep scientific understanding.

2. Deep Brain Stimulation

Doctors first used deep brain stimulation to treat Parkinson’s disease. The treatment is invasive as it involves surgery and implants.

Doctors place small electrodes inside the brain and continuously stimulate it.

It can alleviate many of the symptoms of the disease, including difficulty walking.

Doctors are experimenting with deep brain stimulation as an alternative treatment for mental disorders.

It is most likely to be used as a treatment for obsessive-compulsive disorder.

The FDA does not yet accept it as a treatment for depression.

Deep brain stimulation as a treatment for depression is still in the experimental stage.

Deep brain stimulation requires brain surgery. It is a rather dramatic treatment, much more so than transcranial magnetic stimulation, which does not even require anesthesia.

Deep brain stimulation slows down activity in parts of the brain that are hyperactive in patients with Parkinson’s disease, depression, or OCD.

The treatment may have serious side effects, including the possibility of a stroke in the worst cases.

3. Vagus Nerve Stimulation

The vagus nerve stretches from the brain down through the neck and the side of the chest.

The nerve helps send signals back and forth between the brain and other organs.

Sometimes, electrodes implanted under the skin can stimulate the vagus nerve to treat medical conditions.

After vagus nerve stimulation initially worked as a treatment for epilepsy, doctors quickly noticed that vagus nerve stimulation could treat depression.

Since 2005, the food and drug administration has approved of vagus nerve stimulation for depression.

The FDA approves of vagus nerve stimulation only after a few other treatments have failed.

The depression must have lasted for years before vagus nerve stimulation may be used to treat depression.

Brain stimulation treatments may be the future of treatment for mental illness. Even the poorly understood treatments of today work well.

The procedures of the future might be much better and safer.

Perhaps, brain stimulation could replace drugs as the primary treatment for mental health problems.

At the current point in time, brain stimulation treatments are riskier than drugs.

Therefore, they remain a secondary treatment used when other treatments have failed.

References

[1] – https://www.psychiatry.org/patients-families/ect

[2] – https://www.psychiatry.org/patients-families/ect

[3] – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565084/

[4] – https://www.sciencedirect.com/science/article/abs/pii/S016503271000604X

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