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ElectroconvulsiveTherapy

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Electroconvulsive therapy

An example of an ECT machine used during the 1960s.

Image: Nasko/Wikimedia Commons
Definition:

Electroconvulsive therapy (ECT) is a form of psychiatric treatment that involves inducing seizures with the use of electrical stimulation while a patient is under general anesthesia. First known as electroshock therapy, ECT was first introduced by a pair of Italian psychiatrists in 1938. However, the use of induced seizures to treat mental illness dates back as far as the early 1500s.

It became a psychiatric technique during the 1940s and 1950s, particularly in the treatment of severe depression. Stigma attached to the use of ECT led to a decline in its use during the 1960s. The emergence of effective psychiatric medications to treat depression also contributed to its decline. Today, electroconvulsive therapy is still used as a treatment for cases of severe depression, mania, and schizophrenia, although its use remains controversial.

ECT Statistics

  • Approximately 70 percent of ECT patients are women.
  • Remission rates are estimated to be between 60 and 70 percent.
  • In one report, between 29 and 55 percent of patients believed that they had experienced permanent memory loss as a result of ECT.
  • In England, more than 11,000 people receive ECT each year.
  • Between 1975 and 1980, there was a 46 percent decline in ECT use in the United States.
  • ECT use remained steady throughout the 1980s, and even began two rise through the next decade.
  • More than a third of ECT patients are age 65 and older.
  • Use in children and teens remains relatively rare. In a 1993 study, less than 0.20 percent of patients receiving ECT were under the age of 18.

On Effectiveness

While the use of ECT remains controversial, many recent studies and literature reviews suggest that it can be a safe and effective treatment, particularly in the case of severe depression:

  • "By 1941 electroconvulsive therapy (ECT) was already in use in 43 percent of mental institutions in the United States. Of these convulsive treatments only ECT continues to be used with any frequency today. The theoretical justification for convulsive treatments was never convincing, and there is always a distinct possibility of permanent brain damage with such treatments. ECT has been found effective for a sizable number of patients who do not respond to other therapies, including antidepressant drugs. One ways to decrease the possibility of brain damage is to limit the convulsion to one cerebral hemisphere, typically the nondominant side of the brain, and to restrict the number of treatments."
    (David Hothersall, History of Psychology)

  • "The evidence supporting the efficacy of ECT in depression is overwhelming...ECT was found to have superior efficacy to all comparison groups, being 41% more effective than placebo, 32% more effective than sham ECT, 20% more effective than generally adequate doses of tricyclic antidepressants (TCAs), and 45% better than monoamine oxidase inhibitors (MAOIs). Although this sweeping conclusion has been challenged, due to the shortcomings of some studies by today's methodological standards, the extraordinary efficacy of ECT is now well accepted, with now controlled study ever showing any other treatment to have superior efficacy to ECT in the treatment of depression."
    (Matthew V. Rudhorfer, Michael E. Henry, & Harold A. Sackeim, "Electroconvulsive Therapy")

On Side Effects

Side effects can range from mild headaches to mental confusion to memory loss:

  • "Some difficulties with memory are probably present in everyone receiving ECT. Most people find these memories return when the course of ECT has finished and a few weeks have passed. However, some people do complain that their memory has been permanently affected, that their memories never come back. It is not clear how much of this is due to the ECT and how much is due to the depressive illness or other factors."
    ("Information on ECT," Royal College of Psychiatrists)

  • "The potential adverse effects from ECT range from mild complications such as myalgias, to serious events such as fractured bones, to catastrophes such as death. In the era that predated anesthesia for this procedure, serious complications occurred in up to 40% of cases. At present, the risk serious complication is about 1 in 10,000 patients."
    (Matthew V. Rudhorfer, Michael E. Henry, & Harold A. Sackeim, "Electroconvulsive Therapy")

More recently, research by noted electroconvulsive therapy researcher Harold Sackheim suggests that ECT can result in permanent dysfunction and brain damage:

  • "Thus, adverse cognitive effects were detected six months following the acute treatment course...This study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings."
    (Harold Sackheim et al., "The Cognitive Effects of Electroconvulsive Therapy in Community Settings," 2007)

More About ECT

For a real account of a patient's experience with electroconvulsive therapy, be sure to check out Anna's ECT Diary. One reader shares her experience with the ECT procedure, including why she chose to undergo the procedure, the aftereffects of the treatment, and her feelings at the completion of the treatment.

black-rose-bielefeld.de's Guide to Depression, Nancy Schimelpfening, also has more information on what happens before, during, and after ECT.

Also Known As:
  • Electric shock therapy
  • Shock treatment
  • Electroshock therapy
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Kendra Cherry

Kendra Cherry
Psychology Guide

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