Electroconvulsive Shock Therapy for Mental Disorders
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...