Electroconvulsive Therapy (ECT)

“The stigma affects providers and patients.  The treatment is perceived by the public as brutal. Undoubtedly people don’t receive the treatment, because they’re afraid of it.  In some cases it’s quite tragic because they may not live.” – Dr. Harold Sackheim, Chief, Dept. of Biological Psychiatry, New York State Psychiatric Institute.

Electroconvulsive Therapy (ECT), previously known as Electroshock Therapy, is a psychiatric procedure in which a generalized seizure is intentionally created by the brief application of electric currents passing through the brain.  It is not known exactly how or why ECT works, or what the electrically stimulated seizure does to the brain, but it is believed to create abrupt changes in brain chemistry that can quickly diminish the symptoms of particular psychiatric illnesses.  It is most typically used as a last line treatment intervention and can provide quick and considerable improvements in the severe symptoms of a number of significant mental illnesses.  ECT has been shown to be effective in the treatment of severe depression, severe mania, treatment resistant depression, agitation and aggressive behaviors in individuals with dementia, certain schizophrenic syndromes, and in cases of catatonia (a persistent state of immobility and daze).  It has also been shown to be a beneficial treatment option when medications are not well tolerated or other forms of interventions have been unsuccessful.  In some cases ECT may be used: during pregnancy when medication options cannot be used due to heightened risk to fetal development; when ECT has been successfully used in the past; in geriatric patients who cannot tolerate medication side effects; and, in some suicidal patients who may be at significant risk while waiting for antidepressant medication to take effect.

ECT was first administered by to Italian neuropsychiatrists, Lucio Bini and Ugo Cerletti, in 1938, and gained popularity as an effective form of treatment among psychiatrists in the 1940s and 1950s.  Much of the stigma attached to ECT is based on these early treatments in which high doses of electrical currents were administered without anesthesia, leading to fractured bones and other serious side effects, and the media’s depiction of it still being some sort of archaic painful procedure.  The present day reality cannot be further from the truth.  For decades now ECT has been administered under general anesthesia along with the use of potent muscle relaxants.  In fact, ECT is among one of the safest and most effective treatments available for severe medication resistant depression.

Currently, ECT is administered to an estimated 100,000 patients annually, primarily in general and psychiatric hospitals, but more and more in outpatient facilities as well.  Approximately 70 percent of ECT patients are female, most likely due to the fact that women are at twice the risk for depression as men.  A typical course of ECT involves multiple administrations, usually given two-to-three times per week, until the patient’s severe symptoms significantly remit, which typically is between six to twelve treatments. Many patients will begin to notice significant improvement in their symptoms after just two or three treatments, although full benefits of ECT usually take longer.  During an ECT treatment electrodes are placed on the patient’s scalp and while under general anesthesia, along with the use of a potent muscle relaxant, finely tuned and controlled electric current is administered.  It is this current that creates the desired momentary seizure activity in the brain.  After just a few minutes the patient is brought out from under anesthesia, oftentimes awakening in a somewhat confused state which only lasts a short while, and typically without any memory of the experience itself.  Most often the patient is strongly urged to continue on their medication regimen following ECT in order to reduce the likelihood of relapse.

Even though ECT has been in use since the 1940’s it remains likely the most controversial, and probably most misunderstood, psychiatric intervention still in use.  Much of this controversy is likely due to the debate of the benefits from ECT versus the side effects, along with its recent rise in popularity, and the misconception that it is a quick and easy treatment answer instead of the much more lengthy process of psychotherapy, and/or the use of psychiatric medications, or psychiatric hospitalization.  All this, along with unflattering media coverage, have stoked the fires of this controversial, yet quite effective, treatment.

In truth, review of contemporary scientific and medical/psychiatric literature on ECT demonstrate the vast majority finding it to be an extremely safe and effective intervention for patients with the appropriate indications for use.  A report out of Yale in 2008 concluded that “ECT is well established as a safe and effective treatment for several psychiatric disorders.”  Furthermore, an article in the Journal of ECT in 2009 noted that, “Despite the wide consensus over the safety and efficacy of electroconvulsive therapy, it still faces negative publicity and unfavorable attitudes of patients and families.”

Some of the controversy exists over just exactly what the effects of ECT are on brain tissue.  Critics of ECT propose that ECT actually induces a “closed-head injury caused by and overwhelming current of electricity sufficient to cause a grand mal seizure”, and that somehow the clinical improvements seen in these patients are due to the resultant brain damage.  These types of assertions have been rejected by the overwhelming majority of medical and scientific scholars on the subject as being completely and utterly unsubstantiated.  In fact, a report by the U.S. Surgeon General fifteen years ago noted, “The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals.”  Dr. Charles Kellner, a leading researcher on ECT, has stated that “Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness.”

ECT can vary in how it is administered based on the frequency of treatment, placement of the electrodes, and the waveform of the electrical impulse itself.  These varying applications effect both symptom remission and potential side effects.  Although considered very safe, immediately following the administration of ECT the most commonly seen adverse effects are memory loss, and transient confusion usually lasting less than a few hours.  Other side effects may include:  nausea and vomiting; muscle ache; and, complications from anesthesia.

Although ECT is not available locally there are in-hospital and outpatient venues in the greater Los Angeles area that provide this safe and highly effective treatment.

Glenn E. Miller, M.D. is a Board Certified Psychiatrist.  Educated as a pharmacist, physician and psychiatrist Dr. Miller has been in private practice in Santa Barbara for more than twenty-five years.  Dr. Miller is co-author of Ancient Herbs, Modern Medicine: Improving Your Health by Combining Chinese Herbal Medicine and Western Medicine.  Opinions in the column are Dr. Miller’s and not necessarily those of this newspaper.  Send questions or topics you would like covered to glenn@healthymindhealthyfuture.com.