Electroconvulsive therapy (or ECT for short) is a treatment for depression and other psychiatric conditions.
Use of electricity through the brain to alleviate medical conditions has been noted as far back as Roman times when electric eels were applied to the head to treat headaches. However, this application did not induce a fit and is believed to have been successful through suggestion of a cure rather than any medical benefits.
A school of thought much in the vogue during the 19th century was that to give the patient a physical "shock" would assist the recovery from a number of psychiatric conditions. Thus a variety of physical cures were tried including wet and dry wrapping *, whirligig chairs *, showers and baths * and emetics *. However, these "cures" were also applied as punishments being rather unpleasant *.
Continuing in this vein and encouraged by a further school of thought which assumed that epilepsy and schizophrenia could not co-exist the search went of for further and "better" ways to treating mentally ill patients. At the start of the 20th century experiments were conducted on animals to find the best method of inducing fits using insulin, absinthe (!) and strychnine. In 1934 Meduna applied the new therapy to a patient in a catatonic state and was delighted when the patient awoke in a rational frame of mind. This was the start of a wave of shock therapies administered to patients.
At the same time experiments on inducing fits in dogs through the application of electricity to the brain were being carried out in Italy. Initially the dogs died, but the technique evolved to allow electricity to be safely applied to the temples of the dog rather than the exposed brain.
In 1938 the first treatment was given to a human patient with startling results; the confused patient awoke in a rational state of mind. Thus it was demonstrated that fits could be safely (and cheaply) induced using electricity adding to the previous research into the benefits of induced fits is psychiatric patients.
In 1940 the first ECT treatments were carried out in America and from there the practice flourished. In the 1960s it fell out of favour due to the perceived barbarism of the practice and graphic film portrayals of the treatment. However, it has gradually become more popular again and is widely practised in the UK and the US.
In the UK ECT treatment is used under the following conditions:
1) Where drug therapy has been ineffective
2) Where significant fear of harm to the patient or to others exists and it is necessary to bring relief of the condition quickly.
3) For pregnant women or where other medical conditions mean the use of anti-depressants is not advisable.
Before a course of treatment can be given a full battery of medical checks is run to ascertain whether the patient is fit enough to undergo the treatment. The main risks with ECT are actually associated with the anaesthetic rather than the shocks themselves.
There are two ways of administering ECT treatment.
1) Uni-lateral: Uni-lateral ECT consists of the electrodes being attached to one side of the head, the non-dominant side, with one electrode being placed roughly around the temples and the other attached towards the top of the head at least 10cm away on the same side. Thus the electric charge only passes through the one hemisphere although the induced fit is in all the brain..
2) Bi-lateral: This is where the electrodes are attached to either side of the patient's head in roughly the area of the temples. The current thus passes through the whole brain inducing a fit. Bi-lateral ECT is said to produce fewer side effects that uni-lateral ECT and is used either when it is unclear which hemisphere of the brain is dominant or when uni-lateral ECT has failed
ECT treatment is a series of shocks rather than just one treatment, usually between 4 and 10 at the rate of 2-3 a week. A typical single treatment may follow this pattern:
1) The patient is fasted overnight
2) A general anaesthetic is given - this means the patient is unconscious and unaware of what is happening. *
3) An additional muscle relaxant is given - this guards against injury during the fit.* Because of the muscle relaxant the patient is unable to breathe so the anaesthetist "breathes" for the patient using a bag.
4) Electricity is passed through the brain triggering a fit similar to an epileptic fit. Due to the medication given there is no major fitting and only a slight twitching can be observed. The length of fit is observed and recorded.
5) The patient is woken.
Due to the anaesthetic there is no physical pain. A special gel is used between the pads and the head which conducts the electricity while preventing burns. The application of the electricity is only a few seconds - basically until a fit is started - and the whole procedure is minutes long.
Recovery takes longer. There are the usual effects of having had an anaesthetic and the patient may be tired and confused/disorientated. In theory this wears off over the course of about 24 hours. Longer term effects include memory problems and there is fierce debate as to whether there is actual damage done to the brain during the procedure.
How does it work?
It is not known exactly how the treatment works or what the effects will be in any given patient. Experiments have shown that the fit which occurs alters the brain patterns in some way. There is some evidence that it increases the amount of dopamine in the brain helping to elevate mood. Repeated treatments are said to bring the brain patterns back to "normal". Results are varied. Some people find that they feel appreciatively better after just one treatment, for others they may have to have many before an improvement is detected.
ECT is most widely known through its use in the film One Flew Over the Cuckoo's Nest where it was applied forcibly to patients to subdue them. This has given ECT much of its bad press as was the practice of using ECT indiscriminately for almost all psychiatric conditions.
On a personal note: A researcher's view of ECT
I have written this from my own experiences of ECT and from what I have subsequently researched. I wanted to include some of my own thoughts and experiences here but must emphasise that it is not definitive. It seems that the treatment is so unpredictable in its effects on the physiology and psychology of everyone that there is no one way to think about it. I know of people who have suffered relapses and have begged to have ECT again as it worked well for them. I, on the other hand, would fight never to have it again...
Although I was seriously ill at the time and in a psychiatric hospital I can honestly say that the whole experience of ECT was incredibly traumatic. I hated the pads being put on my head (in fact I tried to pull them off while I was going under the anaesthetic) and I hated the awful disorientation after the treatment. It took a long time for my memory to return properly and I still get frustrated being unable to recall events or things learned.
Apparently it helped me but that is the opinion of my psychiatrist. I am not sure what helped pull me round; being in hospital, the medication being changed or just natural changes. I prefer to think that it wasn't ECT.
However, again I want to stress that this was my experience alone and it is very different for others. Don't make a decision on whether to have the treatment or not based on my opinions alone.
ECT.org - A comprehensive, if negative, look at ECT including stories from patients.
Electroconvulsive Therapy Articles
Shocked! 40,000 volts of fun - a sometimes lighthearted look at ECT with serious statistics and information.
Committee for Truth in Psychiatry - information for former and prospective patients.