Electroconvulsive therapy (ECT) has been used for more than 70 years, yet it remains one of the most controversial treatments used in psychiatry.
Despite most psychiatrists advocating its use, there remains a great deal of public concern about ECT's continued use.
It is the case however that stopping the use of ECT would deprive certain patients of a potentially effective treatment, which in certain circumstances may be life saving.
What does the treatment involve?
- ECT involves placing an electrical pulse to the patient's head, causing a carefully controlled fit or seizure.
- The treatment is performed under full general anaesthetic, so that the patient is unaware of the seizure. A muscle relaxant is also given to reduce the shaking movements and prevent injury.
- The treatment is usually given twice a week.
- A course of ECT usually comprises between 6 and 12 treatments.
- Most people are hospitalised for the duration of treatment though it is possible to receive ECT as an outpatient.
How does it work?
- ECT arose from many different observations, including doctors realising that patients with epilepsy and depression tended to be less depressed after having a fit or seizure.
- Depression is caused by a fall in some brain chemicals and ECT appears to increase these brain chemicals.
- The precise way in which ECT works remains unknown, but it's no less effective for this.
Indications for ECT
- ECT is actively considered as a treatment in severely depressed patients when other forms of medication have either not worked or have caused unbearable side-effects, or will not help the patient quickly enough (for example if the person is not eating and drinking or is severely suicidal).
- ECT has been used as a treatment for schizophrenia and mania in the past. But it's only occasionally used for these conditions today.
- ECT is no more dangerous than minor surgery under general anaesthetic, which has a death rate of approximately 1 in 10,000.
- It's performed under the care of an anaesthetic consultant or specialist, who administers the general anaesthetic and monitors the patient during the procedure.
- Many patients report patchy but persistent memory loss just before and during ECT treatment. There's no good evidence of long-term memory problems following ECT however.
- Many people experience confusion on waking up from the anaesthetic, but this clears within a few hours.
- The ability to learn new information is impaired for several weeks after ECT treatment, but does return to normal over time.
- Some people suffer from headaches and muscle aches straight after treatment and these respond well to common painkillers, such as paracetamol.
Does ECT cause lasting brain damage?
- The amount of electricity applied to the scalp and the lesser amount that reaches the brain is too small to cause lasting brain damage.
- Researchers specifically looking for evidence of brain damage have not found any.
- Furthermore, people who suffer from epilepsy and have fits spontaneously (under much less carefully controlled conditions) do not develop lasting brain damage unless the fits are prolonged.
- A doctor cannot just decide to give a patient ECT.
- Any patient, who is well enough, will have the procedure explained to them and will be asked to give written consent (permission) to treatment.
- This consent can be withdrawn at any time and the treatment will be stopped.
- Patients who are deemed too ill to give consent would still have the procedure explained to them, but a specially appointed independent doctor (who does not work with the doctor who is treating the patient) would be asked to give an opinion. If he considers ECT the most appropriate treatment this second doctor would effectively give consent on the patient's behalf.
- Any person considering ECT should discuss it with their psychiatrist, who can answer their specific questions.
Despite the great deal of adverse publicity about ECT, it's a safe and effective treatment for severe depression and provides a welcome relief from the suffering caused by severe depression for many patients.