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What is Electroconvulsive (ECT) Therapy?
Electroconvulsive therapy (ECT) or shock therapy is a treatment for severe mental conditions . This treatment uses electric current to stimulate the brain to induce a seizure. ECT is used primarily as a last resort when medication does not work. The rate on the amount of sessions vary among patients and matainence sessions may be required.
There are two types of ECT: bilateral and unilateral. In bilateral ECT one electrode is secured above the temple and in unilateral ECT an electrode is placed in the center of the forehead and another on the temple of the non dominant side of the brain. This causes a small electric current to pass through the brain to produce the seizure.
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FDA Classification of Electoconvulsive Therapy
There is some controversy currently as to the proper classification of the device used to administer the shock treatment by the Federal Drug Administration. In 1979, The Federal Drug Administration (FDA) classifies this medical device as a Class III device meaning that it is categorized as high risk and poses possible risk of injury after reviewing and listening to patient testimony. The classification now allows the device to go through a process showing that it is safe.
Currently some professionals in the mental health field are requesting for the classification to be changed from a class III to a class II meaning the device would be considered low risk. Others believe there has not been enough information from the manufacters of the device to prove the benefits outweighs the risk. Anyone who might undergo this procedure should discuss the pros and cons of electroconvulsive therapy before treatment to ensure they understand the risks and benefits.
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Who can Benefit?
- Severely depressed
- Acute mania
- Suicidal (not able to wait 3 weeks for medication to work)
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In a study published in the Journal of the Royal Society of Medicine in April of 1981 seventy-two patients that received ECT for severe mental disorders were asked how they felt after receiving ECT. 83% stated they have improved by having ECT and 81% said they would have the treatment again. Some patients (54%) felt the dentist was more unpleasant.
Electroconvulsive therapy has saved the lives of many when medication did not help. Patients who have been deemed severely depressed literally felt as if they were living in their own hell and having no future with death as their only prospect now have their hopes and dreams restored.
The acute manic patient who has had no relief from drug therapy now has another option other than being placed at a hospital for inpatient treatment during a manic episode. When nothing else has worked and their lives feel as if they are spinning out of control and becoming suicidal, ECT has been effective in making the acute manic episodes decrease or stop.
ECT maybe used with medication for those with schizophrenia who have become depressed or withdrawn and resistant to drug therapy. The effects are still being studied and suggest that the benefit may be short lasting for the management of schizophrenia.
In speaking with a patient who had ECT treatment she said , "When I went in for ECT I was not eating or moving and was in a very dark place. I was in the psych ward for a few weeks before they considered the ECT. I have been on all types of anti depressants for over 12 years and nothing was working.
I had 8 treatments and at first had slight memory loss, but it all came back to me within weeks. I am all for ECT it helped me and it helps so many people. These days it is a lot different from the olden days, the methods have all changed and I do not think it harms any one in anyway. I am glad I had it done. After treatment I felt I had a kick start. I was rebooted and my life since is a lot better. I have had no admissions since and I had ECT 4 years ago. I still have dark days but have learned to deal with it a lot better through things like therapy."
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- Headache and muscle stiffness
- Confusion upon awakening (usually decreasing after 20 to 60 minutes).
- Memory loss both long and short term. Memory usually will return within a few weeks to seven months.
- Relapse may occur within 6 months and maintenance treatment my be required.
- There has also been controversy has to whether ECT causes brain damage to temporal lobes.
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What should be Discussed Prior to ECT?
The decision is ultimately the patient's and a referral from a psychiatrist is needed. There must be informed consent given in order to receive treatment. The patient must fully understand the risk associated with electroconvulsive therapy and make an informed decision as to wheter the treatment is right for them.
- The patient's mental health diagnosis
- The nature and purpose of receiving ECT
- The risks and benefits of receiving ECT
- Alternative treatments even if they are not covered by insurance
- The risks and benefits of the alternative treatment
- The risks and benefits of not receiving ECT
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Keck, P. E. Jr (2003) The management of acute mania. BMJ, 327, 1002 -1003
Jennifer Hughes, BM Barraclough, W Reeve (1981) Are patients shocked by ECT? Journal of the Royal Society of Medicine Volumer 74 April 1981 283
Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD000076. DOI: 10.1002/14651858.CD000076.pub2.
John M. Friedberg, M.D. American Journal of Psychiatry 134:9, September 1977. pp: 1010-1013. Shock Treatment, Brain Damage, and Memory Loss: A Neurological Perspective