What is ECT?
ECT is a treatment where a small electric current is passed through your brain to cause a seizure. This is done while you are under anesthesia and given medication to relax your muscles. The whole procedure is usually done in one session and lasts for less than a minute. Afterward, you will be monitored closely during a recovery period.
How do you get access to ECT?
If you're interested in ECT treatment, you need to speak with a mental health professional, like a psychiatrist or psychologist. They’ll refer you for treatment. The process to receive ECT may differ depending on where you live and whether the treatment is available. In some situations, you may need to be admitted to the hospital to receive ECT, particularly if you're struggling with suicidal thoughts or severe incapacitation. In other cases, you may be able to receive ECT as an outpatient.
Before receiving ECT, you will need to undergo a thorough psychiatric evaluation to ensure the treatment is the right choice for you. This may include a physical examination, a review of your medical and psychiatric history, and diagnostic tests. You'll also need to provide informed consent for the procedure, which means you understand the possible risks and benefits of the treatment and agree to undergo it.
ECT is generally considered safe and effective, with an 80% success rate for severe depression. The specific statistic of an 80% success rate for severe depression with ECT comes from a meta-analysis published in the Journal of ECT in 2016 (as well as this study), which analyzed data from multiple studies on the efficacy of ECT in treating depression. It is also faster-acting and more effective than other treatments, such as medication or talk therapy. ECT can be particularly helpful for those who are struggling with suicidal thoughts or severe incapacitation.
Who is a good candidate for ECT?
If you have severe depression, bipolar disorder, or schizophrenia, and other treatments haven't worked, your doctor may suggest Electroconvulsive therapy (ECT) as an option. ECT is typically used for patients who have severe mental illness and have not responded to other treatments. It can also help patients with other conditions such as catatonia, mania, and agitation.
A mental health professional, such as a psychiatrist, makes the decision to use ECT to treat a patient after a thorough evaluation. They may consider different factors to determine if ECT is appropriate, including how severe the condition is, whether the patient is at risk of suicide, how much incapacitation the patient has, and whether the patient is pregnant. ECT can be a helpful treatment option for pregnant patients with severe mental illness, depending on the individual case.
What are the risks?
Some common side effects may include temporary memory loss, confusion, disorientation, or headaches. While there is a small risk of physical complications, such as broken bones, cuts, or bruises, this can usually be avoided with muscle relaxants.
Despite its effectiveness, ECT is not commonly used in psychiatric treatment because of negative public perceptions of the procedure. Some people are worried about the use of general anesthesia and the induction of seizures. In some cases, ECT has been used without the patient's consent or in a coercive manner. However, when used appropriately and with informed consent, ECT can be a safe and effective treatment for severe mental illness.
What scientific evidence is there?
There is a lot of scientific evidence supporting the effectiveness of ECT. This includes studies like randomized controlled trials, meta-analyses, and systematic reviews.
One review published in 2011 found that ECT was more effective than a placebo in treating severe depression. The review also found that ECT was generally well-tolerated by patients and more effective than some antidepressant medications for severe depression. (Source: Journal of the American Medical Association in 2011, "Efficacy of Electroconvulsive Therapy in Depression: A Meta-analytic Review”)
ECT is also used widely in the treatment of schizophrenia, with many studies showing that it can help reduce symptoms such as hallucinations and delusions. (source)
What are the limitations or criticisms of ECT?
Some of the main criticisms include:
Memory loss: One of the most common side effects of ECT is memory loss, which can be temporary or permanent. Some patients have reported significant memory loss, even being unable to remember events that happened during the treatment.
Coercion: In the past, there have been cases where ECT has been used without a patient's consent or in a way that feels coercive. This has led to concerns about the potential for abuse of the treatment.
Public perception: ECT has often been portrayed negatively in the media and popular culture, which has contributed to negative public perceptions of the treatment. Some people worry about the use of general anesthesia and inducing seizures, and there have been instances of incorrect information about the treatment.
How is it different than Transcranial Magnetic Stimulation (TMS)?
If you're considering treatment for depression or other psychiatric conditions, you may have heard of two options: Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). While both treatments can be helpful, they work differently and have different characteristics.
ECT involves inducing a seizure in the brain by passing an electric current through the head. TMS, on the other hand, uses a magnetic field to stimulate specific areas of the brain. ECT is generally considered more effective than TMS for treating severe depression and other conditions like schizophrenia and mania. However, ECT has some potential risks and side effects, like memory loss and confusion. TMS has a low risk of side effects.
ECT is typically administered in a hospital or clinic setting and requires general anesthesia, while TMS can be given on an outpatient basis and does not require anesthesia. ECT is also usually given more frequently than TMS, with sessions multiple times a week for several weeks.
Overall, both ECT and TMS can be helpful treatments, but the choice between them depends on the specific needs and circumstances of the patient, and the recommendations of the professional you’re working with.
Who are the important figures in ECT?
- Ugo Cerletti: Cerletti was an Italian psychiatrist credited with developing the modern form of ECT in the 1930s. He is considered the pioneer of ECT and is often referred to as the "father of electroconvulsive therapy."
- Merton Sandler: Sandler was a British psychiatrist who contributed significantly to the understanding of ECT in the 1950s and 1960s. He played a key role in developing the use of ECT as a treatment for depression, and he also helped establish guidelines for administering the treatment.
- Max Fink: Fink is an American psychiatrist and researcher who has made significant contributions to the field of ECT. He has conducted extensive research on the mechanisms and effectiveness of ECT and has written extensively on the treatment.
- John Read: Read is a British psychiatrist and researcher who has conducted extensive research on the use of ECT in treating depression and other psychiatric conditions. He has also written extensively on the ethical and social implications of ECT.