ECT ( Electroconvulsive therapy )


ECT ( Electroconvulsive therapy )

What is ECT?  It stands for electroconvulsive therapy, formerly known as electroshock, a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect.

ECT therapy is most often recommended for use as a treatment for severe depression which has not responded to other treatment, and is also used in the treatment of mania and catatonia.

Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus.  These three forms of application have significant differences in both adverse side effects and positive outcomes.  After treatment, drug therapy is usually continued, and some patients receive continuation/maintenance ECT.

Immediately following treatment the most common adverse effects are confusion and memory loss.  The state of confusion usually disappears after a few hours.  Some patients experience muscle soreness after ECT.  This is due to the muscle relaxants given during the procedure and rarely due to muscle activity.

It is the purported effects of ECT on long-term memory that give rise to much of the concern surrounding its use.  The acute effects of ECT can include amnesia, both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment).  However, the vast majority of these effects are short lived.  Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents.  The vast majority of modern treatment uses brief pulse currents.

Italian Professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his colleague Lucio Bini developed the idea of using electricity as a substitute for metrazol (a high dose medication used to cause convulsions) in convulsive therapy and, in 1937, experimented for the first time on a person.  Sherwin B. Nuland, having discussed the matter with a first-hand observer in the 1970s, gave the following description of the results of the first use of ECT on a person:

“They thought, ‘Well, we’ll try 55 volts, two-tenths of a second. That’s not going to do anything terrible to him.’ So they did that. […] This fellow — remember, he wasn’t even put to sleep — after this major grand mal convulsion, sat right up, looked at these three fellows and said, ‘What the fuck are you assholes trying to do?’ Well, they were happy as could be, because he hadn’t said a rational word in the weeks of observation.”

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