Randle McMurphy chomps down on a bite block, electrodes are placed on both sides of his head, the juice flows, and the seizure begins. Several weeks later his limp body, forehead scarred, is returned to the ward.

Of great significance, studies have found that ECT can significantly improve suicidal ideation – quickly.

In the film, One Flew Over the Cuckoo’s Nest, Randle’s first procedure was electroconvulsive therapy (ECT) c.1963. The final procedure was a lobotomy.

Lobotomies are no longer performed. ECT is, but it looks a lot different than Randle’s and the 1957 shot in the image above.

Though highly stigmatized, hence, underused, electroconvulsive therapy is an effective and safe intervention for those enduring treatment-resistant emotional and mental conditions.

It’s definitely not your grandparents’ ECT.

Along with some new and important research, let’s talk about it…

What is electroconvulsive therapy?

How ‘bout we start with the brain stimulation interventions ECT isn’t: deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS).

Electroconvulsive therapy is a medical treatment that uses electrical stimulation to induce a controlled and monitored seizure. The recipient is under general anesthesia.

ECT is most often used for cases of treatment-resistant depression, suicidality, bipolar illness, psychosis, catatonia, and geriatric cognitive challenges.

A few quick tidbits…

  • Some one million people worldwide have ECT each year.
  • Approximately 70% of ECT patients are women.
  • In excess of one-third of ECT patients are age 65 and older.
  • Use in children and teens remains relatively rare and is prohibited in some U.S. states.

ECT is a US FDA authorized therapy. Furthermore, in 2018 the FDA issued a final order to regulate ECT devices. ECT regulation is a priority in other countries as well. For instance, the UKs Royal College of Psychiatrists has established the ECT Accreditation Service.

Types of ECT

There are two primary types of ECT in mainstream use…

  • Bilateral: electrodes are placed on both sides of the head. The goal is to affect the entire brain. It’s by far the most common.
  • Unilateral: an electrode is placed on top of the head and another on the temple, usually the right. It limits current to one side of the brain.

Other techniques are also used – for instance, right unilateral ultrabrief pulse.

Electrode placement, treatment frequency, the electrical waveform of the stimulus – all are decided upon with a goal of max results and min side effects.

An initial course of ECT is typically two to three sessions a week for an average of six to 12 total sessions.

What is ECT used for?

We reviewed a handful of conditions ECT is used for, but let’s take a deeper look. As we do, keep in mind that ECT is most often used when other treatments don’t work. And it’s used when quick results are crucial.

The highlights…

  • Aggression and agitation in dementia patients.
  • Catatonia
  • Parkinson’s disease, particularly Parkinson’s related depression and intractable seizure disorders.
  • Postpartum psychosis and severe depression: ECT can reduce the need for potentially dangerous medications.
  • Psychotic disorders and symptoms
  • Depression: unipolar and bipolar.
  • Mania
  • Immediate threat of suicide

A lot of folks would be in a bad way without ECT.

Why does ECT work?

Welcome to the world of emotional and mental disorders. Antidepressants, antipsychotics, transcranial magnetic stimulation, ketamine, psilocybin, ECT – when it comes to the bottom-line, scientists don’t know why they work.

Now, if you’ve lived in this neck of the woods for a decent amount of time, you know that theories are all over the place. I mean, it has to be something, right?

With what scientists know now, why does ECT work? The  general idea is it helps correct imbalances in the brain’s chemical messenger system. Let’s say the induced seizure “resets” the brain.

Hey, I’m not a scientist, but I could have come up with that. You too, right? Stay tuned, later on we’ll review recent research that’ll get us closer to the bottom-line.

The ECT procedure

ECT can be performed during a hospital stay or on an outpatient basis.

Very simply! EEG, ECG, and blood oxygen monitoring leads are applied. A short-acting general anesthetic, as well as a muscle relaxant to guard against bone and soft tissue injury, are administered through an IV line.. Electrode pads are placed on the head.

While asleep, a small amount of electric current is delivered for typically 100 milliseconds to six seconds. The generated seizure lasts for approximately 40 seconds.

Patients awaken in a recovery area several minutes after the procedure and are most often ready to roll within hours. Of course, a ride is required for outpatient procedures.

Take a look…

ECT: Disrupting the Stigma Around An Essential Treatment Option

Side effects of ECT

The side effects of ECT that get the most attention are memory loss and confusion. For most people, they’re temporary, confusion resolving quickly and memory loss within a few months. However, some folks have permanent memory problems.

Other possible side effects…

  • Headache
  • Hypotension or hypertension
  • Cognitive impairment
  • Increased risk of cardiac issues, particularly in those with coronary artery disease
  • Jaw pain
  • Muscle aches
  • Nausea

As you consider reported side effects, keep in mind that ECT is used for a variety of conditions all over the demographic board.

Does ECT work?

What it is, what it’s used for, why it works, side effects – they’re all important. But for most people’s dough, it’s about whether or not ECT works.

Real quick, people turn to ECT because previous interventions haven’t worked. That generates a ton of expectation, which can hinder an objective assessment of efficacy. Regarding results, maintaining perspective is helpful.

For the treatment of depression without melancholia, some studies have shown an ECT efficacy rate of 80%. It drops to 60% with melancholia. Research suggests that ECT works well in 80%-100% of catatonia patients. And it’s known that ECT gives older psychotic depression patients their best shot at reducing the risk of relapse.

Of great significance, studies have found that ECT can significantly improve suicidal ideation – quickly.

New research: Is this why ECT works?

Okay, let’s wrap it up with some very recent and important news regarding why ECT works.

The story was told in two studies conducted by researchers from the University of California San Diego. Their work was published November 16, 2023 in the journal, Translational Psychiatry.

According to study first author Sydney Smith, the research mission went well beyond solving an almost century-old puzzle. The team wanted to demystify one of the most effective, yet highly stigmatized, treatments for severe depression.

From senior author Dr. Bradley Voytek…

…in people for whom medications don’t work, electroconvulsive therapy can be life-saving. Understanding how it works will help us discover ways to increase the benefits while minimizing side effects.

The team have a curious and altruistic mindset. Let’s see what they came up with.

Aperiodic activity

Smith describes aperiodic activity as the brain’s background noise. He notes that scientists traditionally haven’t paid much attention to it, but that’s changing.

The billions of neurons in our brain are constantly going through cycles of excitation and inhibition – turning on and turning off – that correspond with the mental states we’re all too familiar with.

One of the functions of aperiodic activity is to assist in managing the commotion. And it does it by boosting inhibitory activity – effectively slowing things down.

How’d they come up with that?

electroconvulsive therapy and eeg

Electroencephalography (EEG)

The team used electroencephalography (EEG) to analyze the brain activity of the study participants who received ECT for depression, as well as those who received a similar form of treatment known as magnetic seizure therapy (MST). Instead of electrodes, MST uses magnets to induce a seizure. By the way, I’m sure there’s more to come on MST.

When the team reviewed EEGs of those who received ECT and MST, a slowing pattern of brain electrical activity was observed. It’s believed the inhibitory effects of aperiodic activity helps explain it.

Now, the findings may not provide all the answers, but the link between aperiodic activity and ECT benefits is established. And good things can flow from there.

The UC San Diego team stands ready to apply the insights learned from their work to future investigations. For instance, the team are exploring the possibility of using aperiodic activity as a metric of treatment effectiveness in other depression treatments, such as medications.

I don’t know about you, but I’m thankful for research.

All that matters

It’s a given, electroconvulsive therapy has a dicey reputation, which encourages stigma and discourages use.

In so many ways, that’s unfair.

No, electroconvulsive therapy isn’t always a sure thing. Yes, it can have side effects. But it also has a record of effectiveness and safety. And for someone who’s down to very few options, that’s all that matters.

It’s not your grandparents’ ECT (or Randle’s).

Thanks to Verywell Mind for the info assistance: Electroconvulsive Therapy (ECT): Definition, Types, Techniques, Efficacy written by Kendra Cherry, MEd.

Here’s the University of California San Diego news piece. It includes links to the studies: New Studies of Brain Activity Explain Benefits of Electroconvulsive Therapy

Those Chipur emotional and mental health info and inspiration articles: pick one out.

Featured image: Author: University of Liverpool Faculty of Health & Life Sciences from Liverpool, United Kingdom. Minimally cropped. This file is licensed under the Creative Commons Attribution-Share Alike 2.0 Generic license.

Bill White is not a physician and provides this information for educational purposes only. Always contact your physician with questions and for advice and recommendations.

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