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What is Electroconvulsive Therapy?

By Arushi Neravetla


The controversy surrounding the effectiveness and side effects of electroconvulsive therapy has been debated by scientists and experts by observing the demographic changes seen within patient cases. Electroconvulsive therapy (ECT) is one of the oldest medical treatments and was first performed in 1938 in Italy. The process involves the communication of brain cells and initiating synapses, which are the communication of neurons within the brain. Specifically in severely depressed and schizophrenic patients, ECT stimulates responses within the neurotransmitters, releasing chemicals such as dopamine and serotonin. It has been shown that over 100,000 patients each year get treated using ECT [1].


In psychiatric hospitals, patients with acute mania, schizophrenia, bipolar, and depression are treated with ECT because of their limited mental stability and inability to wait for antidepressant medicine to take effect [1]. To elaborate, patients diagnosed with these symptoms often go through antidepressant medication and psychotherapy. The medication is effective; however, it takes a prolonged period of time to work. This kind of time delay can result in dangerous situations and complications with patients who experience delusions or suicidal thoughts. However, the ECT procedure allows an electrical stimulation to be delivered into the brain and causes a small seizure to relieve the symptoms while the patient is under anethstesia. Scientists are still studying the effects of those seizures and how the usage of electricity affects the brain in a prolonged period of time. In theory, ECT works much more rapidly than antidepressants and can be a great treatment for those who are accompanied by psychosis or a detachment from reality. In fact, ECT is usually prescribed if antidepressant medications do not work on patients at all.


In general, studies have shown that the procedure is often used for older patients who cannot handle antidepressant medication along with pregnant women, who are in a delicate condition and cannot have their fetuses harmed in the process [3]. The steps of the ECT procedure are as follows: patients are required to not drink from midnight the night before their treatment. The patient receives an anesthetic agent to become relaxed for around 5-10 minutes. Additionally, a muscle relaxant is also used to stop the patient’s muscles from moving during the seizure. Once the muscles are not moving, cardiac monitoring pads are placed on the patient’s chest to check the blood pressure and the heart status. Four electrodes are placed on the patient; two monitor the brain waves and the other two are used to generate a controlled set of electrical waves within the body. The electrical pulses that are generated in the system provide a general seizure to enhance the effect. Because of the anesthesia, the patient does not feel anything during that state. After 5-10 minutes, the patient becomes awake and goes to the recovery room until their blood pressure, pulse, and breathing status goes back to normal, taking 20-25 minutes to occur. Typically, ECT treatment is given around two to three times a week for a total of 6-12 sessions depending on the diagnosis the patient has [2]. These sessions overall improve 70 to 90% of patients, making the response rate higher than the antidepressant drugs [1].


The treatment has been effective, but the benefits in correlation tend to be short-lived. For instance, patients who undergo the treatment may experience recurring symptoms and may be advised to go back to using antidepressant medication. Side effects include headaches, nausea, muscle aches/soreness, and memory issues. However, studies have proven that over 70% of patients with psychiatric disorders have benefitted from losing the ability to make memories to make a full recovery because of their mental trauma they may have suffered [3]. Hence, patients should reconsider the challenges that are faced with electroconvulsive therapy and its side effects. More importantly, patients should carefully be tested with examinations and tests before undergoing the operation. It can be concluded that research is still on the way and that the procedure will one day be refined to maximize the efficiency and minimize the risks.


References:

  1. Mennitto, Donna. Frequently Asked Questions about ECT at The Johns Hopkins Hospital in Baltimore, Maryland, 1 Oct. 2019, www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/ect/faq_ect.html

  2. Electroconvulsive Therapy (ECT).” Mental Health America, www.mhanational.org.

  3. Kim, Hyun-Hee. “Electroconvulsive Therapy: A Historical and Legal Perspective.” American Journal of Psychiatry Residents' Journal, vol. 13, no. 3, 2018, pp. 10–11., doi:10.1176/appi.ajp-rj.2018.130305.

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