More on Electroconvulsive Therapy (ECT)

In our last article on this topic, we looked at the reasons why ECT is used rather than conventional antidepressant medications only. Principally utilized as a last port of call when other medication and modalities have repeatedly failed, ECT is still mired in controversy.

While it is and has been a definite lifesaver for many sufferers of deep depression, the technique does not enjoy a high popularity rating. One of the principal reasons for this is that, despite the length of time the method has been in use, coupled with numerous refinelments in techniques, there are several serious side effects.

Another reason is that scientists do not yet fully understand what happens during the process of ECT, only that the brain seizures that result from the treatment do seem to have short-term benefits. Sometimes these benefits are enough to save a life, and therefore ECT will always have a place in the arsenal of mental health treatment until such time as a superior emergency treatment is made available.

Unfortunately, up to 50 % of patients who receive the treatment do not receive any benefit, and of those who do, 60% will relapse. That is why it is important to keep receiving ongoing mediation and counseling in conjunction with ECT.

Neuropsychiatrists readily admit that they do not understand why ECT appears to work on some occasions, and not others. Thus a particular severely depressed patient may dramatically improve after a course of therapy which commonly lasts 6 to 10 shock treatments over a period of 1-2 weeks. The next patient may not. The reasons are unknown. What is known is that the brain seizures that result from the electric shock to the brain induce massive functional and even structural changes to the brain, both of which appear to be therapeutic, at least in the short term.

Because of the controversial nature of the treatment, its popularity had dropped by the 1980s and 1990s but its use still persists today. Permanent memory loss is one serious side effect of the treatment and the most common reason for treatment refusal. It is certainly the case that some patients who have undergone repeated rounds of ECT displayed marked short and long term memory loss, and find it difficult to function efficiently in everyday life.

As with any operation involving a general anesthetic, there are risks involved in addition to the problems that accompany the act of voluntarily inducing seizures to the brain. One of these is the rare phenomena that plagues general anesthesia in general – that the anesthetic fails to work properly and the patient is awake throughout the procedure and yet is paralyzed and unable to alert staff to the problem. As with similar instances in physical surgery, where the patient remains awake and feels the pain of the incision and other procedures, this is an added risk factor to the process of ECT.

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