ECT Shock Therapy Is Still The Gold Standard
A new article has just come out regarding the FDA re-classifying what is often called: ECT shock therapy, or electroshock therapy (ECT) from a high risk to a medium risk medical device. The clinical term is Electro-Convulsive Therapy hence (ECT). Since This article, they reviewed the proposal and decided to maintain it’s classification; however, this is an interesting area of psychiatry and a good opportunity to discuss this procedure used to treat major depression.
In my experience at the state agency level, in working with the severely mentally ill and working in private practice; I have only prescribed this procedure to 5 patients out of almost 5,000 that I have treated. We don’t often use ECT because of the many new medications which are very effective. Unfortunately, ECT shock therapy has had a stigma attached to it as being Barbaric; especially after movies like One Flew over the Cuckoo’s Nest. ECT is therefore underutilized.
Actually ECT is the gold standard of antidepressant treatments. It is very effective, approximately 95% to 99 % effective and usually painless. Some people do experience a mild headache that resolves within a few hours. It is one of the few therapies reserved for treating severe depression or those who don’t respond to drugs used to treat depression, or cannot tolerate the side effects. I tell people about this generally at their first evaluation appointment so that if they are diagnosed with severe Major Depressive Disorder, they look at me with trepidation when I tell them about this option. Unfortunately, it still carries a stigma to its usage. Also, the cost can be prohibitive.
Most people think that this is an extreme option, most likely; however, we don’t perform ECT shock therapy in the way that it was done in these movies. An anesthesiologist anesthetizes the patient in a surgical suite and the patient is asleep through-out the entire procedure. After the patient is asleep, he or she is given a muscle relaxant. The muscles don’t contract, as portrayed in the movies either.
Why Does ECT Shock Therapy Work
How ECT shock treatment works isn’t known. The most widely accepted theory is that ECT causes the release of large amounts of serotonin, norepinephrine, and dopamine in the brain and improves the depressive symptoms. We know that depression is caused by a deficiency in these neurotransmitters. We also think that the seizure activity causes this to happen. So it stands to reason that with increasing these levels, the depressive symptoms resolve, just like what the antidepressants do in increasing their levels in the brain.
ECT shock therapy is performed under general anesthesia. The procedure lasts only 40 seconds and involves the delivery of a small amount of electric current to the head unilaterally or bilaterally, which causes a lowering of the seizure threshold and induction of seizure activity in the brain. Stimulation of one side of the brain with the electrodes is called unilateral electrode placement; and when electrodes are placed on both sides of the brain, it is called bilateral electrode placement. The different placement is for different illnesses and severity of illness. A psychiatrist who has received specialized training in doing this procedure will induce the seizure activity. The amount of electricity used has decreased since ECT shock therapy was introduced in the 1930’s which has helped reduce the side effects. At the same time, the patient will have electrodes placed for the ECG machine, so that, his or her heart function is observed at all times. This is to monitor for any rare events of the ECT inducing heart arrthymias.
The U.S. National Institutes of Health (NIH) acknowledges that ECT shock therapy or treatment can be helpful for treating severe depression patients who don’t respond to drugs used to treat depression or whose depression is accompanied by delusions or other psychotic symptoms. Severely depressed patients who are suicidal or pregnant also may be candidates for electroshock therapy. According to the NIH, usually six to 12 treatments are needed. These treatments are performed every other day for about two to three weeks. Alternating days help to reduce the amount of memory loss that people may have.