Electroconvulsive therapy (ECT) is a medical procedure that uses a mild electrical current to induce a brief seizure in the brain. ECT is used to treat severe and treatment-resistant mental health conditions, such as depression, schizophrenia, bipolar disorder, and catatonia. ECT is performed under general anesthesia and with muscle relaxants to prevent pain and physical injury. ECT is one of the most effective and safe treatments for mental health, but it is often misunderstood and stigmatized by the public and the media.
ECT is a form of brain stimulation therapy that involves passing an electric current through electrodes attached to the scalp. The current causes a controlled seizure that lasts for about 15 to 30 seconds. The seizure affects the brain’s electrical activity and chemical balance, which may result in rapid and significant improvement of mental health symptoms. ECT is usually given two or three times a week for a total of six to 12 sessions, depending on the individual’s response and condition. ECT can be given as a first-line treatment or as a last resort when other treatments have failed or are not suitable.
ECT was first introduced in 1938 by Italian psychiatrists Ugo Cerletti and Lucio Bini, who experimented with electric shocks on animals and humans with epilepsy and schizophrenia. They observed that seizures could reduce psychotic symptoms and improve mood. ECT became widely used in the 1940s and 1950s as a treatment for various mental disorders, especially depression. However, ECT was often administered without anesthesia, consent, or proper monitoring, leading to serious side effects such as memory loss, brain damage, and fractures. ECT also gained a negative reputation due to its portrayal in movies, books, and media as a brutal and inhumane procedure.
In the 1960s and 1970s, ECT declined in popularity due to the emergence of new psychiatric medications, such as antidepressants and antipsychotics, and the rise of human rights movements and anti-psychiatry movements that criticized ECT as unethical and abusive. ECT also faced legal and regulatory challenges that restricted its use and availability. However, ECT did not disappear completely, as some clinicians and researchers continued to use it and improve it with scientific evidence and ethical standards. In the 1980s and 1990s, ECT experienced a resurgence as a safe and effective treatment for severe mental illnesses that did not respond to medications or other therapies. ECT also benefited from advances in technology, such as modern anesthesia, muscle relaxants, oxygenation, EEG monitoring, and electrode placement. ECT is now recognized by many professional organizations and guidelines as a valid and valuable option for mental health treatment.
The exact mechanism of how ECT works is not fully understood, but several theories have been proposed based on neurobiological evidence. Some of the possible mechanisms are:
ECT has been extensively studied in clinical trials and meta-analyses and has shown to be highly effective for treating various mental health conditions, especially when other treatments have failed or are not tolerated. Some of the evidence for use are:
ECT is generally safe and well-tolerated, but it may cause some side effects and adverse reactions that are usually mild and transient. Some of the common side effects are:
Some of the rare but serious adverse reactions are:
There are no absolute contraindications for ECT, but some conditions may increase the risk of complications or require special precautions. Some of these conditions are:
ECT has many advantages over other treatments for mental health, such as medications, psychotherapy, or other brain stimulation techniques. Some of these advantages are:
ECT also has some disadvantages and limitations over other treatments for mental health, such as medications, psychotherapy, or other brain stimulation techniques. Some of these disadvantages are:
ECT is a valuable and effective treatment for mental health that can improve the lives of many people who suffer from severe and treatment-resistant conditions. ECT has many advantages over other treatments, such as efficacy, speed, safety, suitability, and accessibility. However, ECT also has some disadvantages and limitations that need to be considered, such as stigma, memory loss, cost, maintenance, and uncertainty. Therefore, ECT should be used as a part of a comprehensive and individualized treatment plan that involves informed consent, careful assessment, close monitoring, and ongoing support.
: American Psychiatric Association (2010). The practice of electroconvulsive therapy: Recommendations for treatment, training, and privileging (2nd ed.). Washington, DC: American Psychiatric Publishing.
: Kellner CH, Greenberg RM, Murrough JW, Bryant SG, Coffey CE (2012). A meta-analysis of randomized controlled trials of electroconvulsive therapy in treatment-resistant depression. Depression and Anxiety, 29(10), 881–890.
: UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. The Lancet, 361(9360), 799–808.
: Sackeim HA (2001). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 24(5), 563–573.
: Fink M (2014). Electroconvulsive therapy: A guide for professionals and their patients (2nd ed.). Oxford: Oxford University Press.
What Electroconvulsive Therapy is, what it's used for, side effects, the procedure and how effective it is is discussed. Electroconvulsive therapy is controversially mostly due to the name. Electroconvulsive therapy is one of the most effective treatments for Major Depressive Disorder.