Electroconvulsive Therapy: Gotta’ Knows

The procedure that maimed Randle Patrick McMurphy’s brain in One Flew Over the Cuckoo’s Nest was not ECT.

Electroconvulsive therapy (ECT) is a controversial procedure. Some call it a lifesaver, while others believe it’s mad science. Want an unbiased clinical opinion? Tune in for the weekend series.

What is ECT?

The Greek physician Hippocrates observed that when malaria-induced convulsions struck the mentally ill, many were cured. That occurred in 400 BC, so the notion of brain trauma being effective in the treatment of the emotional and mental health disorders is nothing new.

Some 2300 years later, Italian physicians, Ugo Cerletti and Lucio Bini, first used ECT.

Simply, ECT is a procedure during which a brief seizure is intentionally induced by the passage of electric currents through the brain.

When Is It Recommended?

First and foremost, ECT is not first line treatment. It’s used for severe symptoms of a variety of emotional and mental health situations. Let’s take a look…

  • Severe depression – particularly with psychotic features (e.g. hallucinations, delusions, disorganized thought), refusal to eat, and suicidal ideation/behavior
  • Treatment resistant depression
  • Long-term depression that hasn’t traditionally responded well to drugs and psychotherapy
  • Schizophrenia – particularly with active symptoms, refusal to eat, and suicidal ideation/behavior
  • Severe mania (e.g. days without sleep, high-risk/dangerous behaviors, intense euphoria, psychotic features, and substance abuse
  • Catatonia (e.g. irregular body movements, little speech, no body movements)

As a last resort, ECT may also be used in the treatment of…

  • Obsessive-compulsive disorder (OCD)
  • Movement and seizure disorders (e.g. Parkinson’s disease, epilepsy)
  • Tourette’s disorder

Finally, ECT may be the chosen therapy for depression during pregnancy – in lieu of antidepressants that may harm the fetus. It may also be used in the elderly (who may not be able to tolerate drug side effects) and for those who prefer it over meds.

Are There Risks and Side Effects?

No doubt about it. Here’s a list…

  • Confusion: It may be for a few minutes, perhaps several hours – even days. But having difficulty dialing-in to where you are or why you’re doing what you’re doing is not uncommon.  This is more typical for the elderly.
  • Memory Loss: Couple of angles here. Retrograde amnesia – having trouble remembering events that occurred just before the procedure – may be a factor. Recall of events from years ago may also be a problem, as may memory of events after treatment. Typically, memory issues go away after several months.
  • On the day of the procedure you may experience nausea, vomiting, jaw pain, headache, muscle pain and spasms.
  • If you have a heart situation, there’s a risk for cardiac complications (because anesthesia is used).

Wrap on Part 1

Well, we’re off to a great start, but much much more to come. Be sure to come back tomorrow as we discuss the preparation for the procedure and the procedure itself.