Electroconvulsive Shock Therapy for Mental Disorders
Uploaded by Jeremy NM on Jun 13, 2006 |
|
|
Electroconvulsive Shock Therapy for Mental Disorders
Since its introduction to the world in the mid 1930’s, electroconvulsive shock therapy, or ECT, has been one of the most effective and least understood treatments in psychiatry. The technique itself has changed in many ways since its conception and is now considered a safe and effective treatment of patients with major depressive disorder, manic episodes, schizophrenia, and other serious mental disturbances. However, the neurobiological changes critical to the therapeutic success of ECT have not yet been fully understood. Such a knowledge gap has led to an inaccurate portrayal of ECT in the media and misconceptions about ECT being held by many patients, lay people, and even health care professionals.
“Convulsive therapy was introduced in 1934 in Europe by Ladislaus von Meduna as a treatment for catatonic schizophrenia. He induced seizures by the injection of camphor in oil but soon replaced camphor with metrazol because of its solubility and rapid onset of action. Also in 1934, Cerletti and Bini pioneered the use of electricity to induce seizures. Electrical-induced convulsions were more safe, reliable, and inexpensive than the camphor-induced convulsion” (Willoughby 12).
According to the Journal of the American Medical Association, “the number of ECT procedures performed in the United States exceeds coronary bypass, appendectomy, or hernia repair” (Nobler 305). While the most common application of ECT is for psychological disorders, the uses of ECT range from major depression and schizophrenia to cancer and Parkinson’s disease (305).
Although it’s mechanism of action is not understood, studies by the American Journal of Psychiatry showed a decrease in the level of glucose metabolism in the cerebral cortex of the brain following ECT. The “decreased neuronal activity” is consistent with potential anticonvulsant and antidepressant effects (305).
In order for a patient to undergo ECT, the patient must give “informed consent” (Irvin 578). The patient and family members are informed of the risks and potential side effects including: anoxia during the seizure, memory loss, death rate of one per 10,000 treatments, and ventricular arrhythmias (578).
During the procedure, ECT electrodes are placed on the head either bilaterally or unilaterally. The patient is given a muscle relaxant and a short-acting general anesthetic for sedation. An electrical current is applied to induce a grand mal seizure. The seizure must last at least 25 seconds to be effective. It is believed that the seizure initiates a series of events that correct abnormalities of the brain (579).
“ECT is the only somatic treatment in psychiatry that is typically discontinued following response, yet patients untreated following ECT have high rates of relapse” (Sackeim 1299). For this reason pharmacological agents are used concurrently to avoid relapses. The problem is that medications are not effective until four to six weeks after initiation (1299).
Some patients receive outpatient ECT as maintenance to avoid relapses. These sessions may continue for six weeks or six months. The patient may receive treatments in a variety of locations including hospitals or ambulatory clinics (Irvin 576).
Martha Manning, a psychotherapist who wrote a book about her own bout with depression, is convince that ECT saved her life. “In severe depression, everything goes to gray and takes and effort…..You’re a nonreactor. You could win the lottery and you think, ‘So!’” Martha underwent several treatments of ECT and will continue to be on medication for the rest or her life (Hubbard 65).
Top researchers in their field have argued about its safety and efficacy. While psychiatrist David Barton of the Royal Melbourne Hospital, Australia states ECT “remains one of the most effective treatments available in psychiatry” (Harrigan 401), Peter Breggin claims, “It’s barbaric—I’ve seen hundreds of patients with brain damage from it” (Hubbard 65). A consumer group in England criticized the Surgeon General’s claims that electroconvulsive therapy “is regarded as a safe and effective treatment…….has advantages over pharmacotherapy” (Ciment 382). The National Mental Health Consumer’s Self-Help Clearinghouse called the Surgeon General’s statement a “blanket endorsement,” citing overlooked evidence of the dangers and effectiveness of ECT (382).
In an interview by the American Journal of Psychiatry when Dr. Robert Butler was asked if he viewed ECT as a last resort therapy, he responded:
“If someone is suicidal, no longer eating, or losing weight quickly and in danger of some medical crisis, ECT would be my treatment of choice, not my treatment of last resort. It might save their life. An antidepressant take 6 to 8 weeks, often longer, to take effect, assuming the first medicine you try works. If someone is suicidal or medically unstable, this may be too late” (Mulsant 561).
The effectiveness of the ECT correlates with the degree of cognitive impairment. The more stimuli given, the more effective the treatment, but also the more ill effects experienced. There is also much controversy about ECT dosing methods. David Barton explains that there are three dosing methods:
The “stimulus method”, each patients seizure threshold sets subsequent doses. Another method is the “fixed dose” method, where every patient is given the same dose set by the clinic. Finally there is the “age” method, in which the clinic’s standard dose is adjusted for age—e.g., a 40-year-old receives 40% of the standard dose” (Harrigan 401).
According to the American Journal of Psychiatry, less than 8% of all U.S. psychiatrists provide this treatment. A study was completed taking data compiled from 1988-1989 to characterize what psychiatrist would perform ECT. The results of this study were as follows:
“Psychiatrists who provided ECT were more likely to be male, to have graduated from a medical school outside the United States, and to have been trained in the 1960s or 1980s rather than the 1970s. They were more likely to provide medications than psychotherapy, to practice at private rather than state and county hospitals, to treat patients with affective and organic disorders, and to practice in a county containing an academic medical school” (Hermann 889).
According to the AORN Journal, “electroconvulsive therapy offers patients…a safe outpatient treatment alternative. With increased outpatient services, decreased health care resources, and the strong influence of third-party payers, outpatient ECT has tremendous financial potential” (Irvin 573).
I personally believe this alternative healing method does have its benefits. My great grandmother was taken to the Mayo Clinic in Rochester, Minnesota in the late 1930’s. She was diagnosed with involutional melancholia (referred to as severe depression today). She had presented symptoms of severe depression with suicidal tendencies, believed to be partially caused by two previous miscarriages. She was treated with electroconvulsive therapy. She dreaded the treatments, but according to her daughter, this woman changed from a withdrawn, extremely nervous and depressed individual into a happier, more relaxed, well-adjusted but less ambitious person.
It is understandable how the public can hold such negative views of this treatment. In the early development of ECT, the abuses were terrifying, but technological advances have transformed this once dangerous practice into a treatment that, although not without risk, may improve some people's quality of life and in some case, even save lives. The risks involved with electroconvulsive therapy, such as memory loss, may be more frightening than risks associated with pharmacological treatments; however, when quick improvement must be made, or when other alternatives have failed, electroconvulsive therapy should be considered. The history of this treatment should not condemn it to the annals of failed medical practices, but the current advances in this treatment should earn electroconvulsive therapy the status of a viable treatment option for certain patients. |
|
|