ECT Shock Therapy Is Still The Gold Standard

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 its classification; however, this is an interesting area of psychiatry and a good opportunity to discuss this procedure used in treatment-resistant depression.

I almost never prescribe this procedure for my patients. I have treated. We don’t often use ECT because of the many new medications which are very effective. Unfortunately, ECT has had a stigma attached to it as being Barbaric; especially after movies like One Flew over the Cuckoo’s Nest.  ECT is therefore under utilized.

ECT is the gold standard of antidepressant treatments, though ketamine therapy may replace ECT. It is very effective, approximately 95% to 99 % effective and 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 for those who don’t respond to medications used to treat depression, or cannot tolerate the side effects. I rarely discuss this with my patients during their initial evaluation.

ECT and Hollywood

Most people think that this is an extreme option; 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 chemicals. 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 the antidepressants do.

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 arrhythmia.

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. ECT is probably going to be replaced by ketamine therapy and DBS deep brain stimulation in the near future. This article was updated November, 2022.

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