Electricity has been used in treatment of mental disorders as early as 1849 in the medical field. Due to the absence of the development of drug treatment at that time, its use became fairly common.
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Though electroshock therapy was once one of most popular treatments for both depression and manic depression, as with the star of Gone With the Wind, Vivian Leigh, who underwent many ECT treatments, in time, antidepressants outshadowed this form of treatment. However, ECT is being used with more frequency in recent years, especially with treatment resistant depression.
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In 1938, two Italian physicians, U. Certetti and L. Bini, after visiting a slaughterhouse and seeing animals rendered unconscious by electric shock, tried the simplest method of all - passing an electric current through a patient's head. (Formerly electricity was conducted through the skin). This method became known as electroconvulsive therapy (ECT), and while not the most common approach in treatment of mental health disorders, including depression, is still widely used in cases where clients do not respond to pharmaceutical treatments.
The number of persons worldwide receiving ECT treatment is reported at about two-million annually. (ECT Org, 2006).
Two million persons worldwide receive electronconvulsive therapy (ECT) annually.
Technique for Administering electronconvulsive therapy (ECT)
The technique for administering ECT has changed considerably since 1938, however the principle remains much the same. Constant electrical current is passed through the brain for about 1.5 seconds causing unconsciousness and the client undergoes muscle contractions. In the past, the seizure caused by the electric shock was so violent that the vertebrae could fracture, one of several potential complications of ECT.
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Today, while complications are still possible, anesthetics and muscle relaxant premedications are used to prevent violent contractions, and monitoring during the procedure lowers the risk. The use of ECT varies in different countries: it is rarely used in Italy, Japan, Germany, the Netherlands and Austria. Unmodified ECT (without anesthetic) is still used in India, Greece, Turkey, Japan, China, and some African countries. (ECT Org, 2006).
Unmodified electronconvulsive therapy (without anesthetic) is still used in
India
Greece
Turkey
Japan
China
Other countries in Asian and other continents
Some African countries
Mayo clinic states concerning ECT:
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. This seems to cause changes in brain chemistry that can alleviate symptoms of certain mental illnesses. Yet 70 years after it was first introduced, electroconvulsive therapy remains controversial.
Much of the stigma attached to electroconvulsive therapy is based on early, brutal treatments in which high doses of electricity were administered without anesthesia, leading to memory loss and death.
Also, ECT has potential for abuse when forced unwillingly upon patients, or when used as a form of torture or punishment. China is one country where (2010) the use of ECT has been abused as a form of punishment in mental hospitals.
Modern Use of ECT
ECT is generally used for chronic depression, and is sometimes used in the treatment of bipolar disorder, mania in the elderly, for the elderly in general who may not be able to take antidepressants. Structural damage to the brain, is usually not evident with modern ECT treatment.
Electroconvulsive therapy is quite different today than it was when it was first introduced to general use in the 1950s. Although electroconvulsive therapy (ECT) can still cause side effects and complications, it now uses precisely calculated electrical currents administered in a controlled setting to achieve the most benefit with the fewest possible risks.
(Mayo Clinic. http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129).
After awakening, the patient has amnesia immediately following the therapy, and is usually somewhat confused for the next hour. Treatment usually consists of approximately twelve sessions, though sometimes more are required or initiated. Treatments are usually administered several times during the week. The patient can becomes disoriented through ECT shock therapy. This disorientation usually subsides upon termination of the treatments. However, memory impairment can sometimes remain for months.
ECT is used for treatment for
Chronic depression, unresponsive to antidepressants
Some cases of bipolar disorder (ECT does not seem to be effective for dysthymic disorder).
The elderly who may not be able to take antidepressants
Schizophrenia - although there is not evidence for its effectiveness
Bilateral and Unilateral Electroconvulsive Therapy (ECT)
The most common method of administering ECT had always involved the entire brain, both sides, and bilateral ECT was once the standard.
More recently, limiting the current to only one side of the brain (the right side in most people), referred to as "unilateral ECT" lessens distressing side effects (such as memory loss), without decreasing therapeutic effects, in some cases. (A higher current is used for unilateral ECT than with the bilateral method).
Some studies, however, indicate that the unilateral method might not be as effective as bilateral, and another method has been developed, whereby treatments start with unilateral treatment, and then switch over to bilateral.
ECT is somewhat effective in relieving depression,
but the recurrence rate of depression is relatively high with ECT treatment
ECT's positive effects in relieving depression have generally been acknowledged. However, there is also a high recurrence rate of depression and other symptoms (the positive effects are generally temporary), so that other treatment methods needed to be pursued.
Controversies concerning ECT
The use of ECT is still considered controversial. Lawsuits have been brought against some physicians, especially when consent was not obtained.
ECT is also sometimes used in treatment of bipolar disorder, mania in the elderly, for the elderly in general who may not be able to take antidepressants. Also, memory impairment can remain for some months. Structural damage to the brain, is usually not evident with ECT treatment.
In 1985 NIMH sponsored a Consensus Development conference surrounding the use of ECT.
The mortality rate of electronconvulsive therapy is about 1 in 3,000.
Psychotic depression. Not effective for dysthymic disorder. And is used sometimes in schizophrenia, although its effectiveness is not evident.
Sometimes maintenance ECT treatments are given for intervals up to six months.
Some of the current major controversies concerning ECT are:
1. The administering of ECT against the will of the patient and without consent. In women over 65 in Britain, that rate is said to be 59%. Forced shock treatment is still practiced in the United States.
See:
Forced Shock Treatment ECT Org
2. A disproportionate number of the elderly who are treated with ECT.
3. The administration of ECT by personnel not fully trained or qualified to perform the procedure.
Concerning the administration of ECT against the will of the client, the BBC reports,
"Charity Mind says it is often used against people's will and it wants to see a ban on this, but psychiatrists say that would mean about 20% of patients who now receive the treatment would not get it despite being most in need. They argue that some people are incapable of giving or denying consent."
In New Zealand, the rate of those treated with ECT against their will or without consent is rated at 23%. (New Zealand Ministry of Health, August, 2006).
In some (non-third world) countries, 20% to 23% of those who receive
ECT therapy, receive it without consent or against their will.
Monetary Incentives and Controversy
As in all health/medical treatment, monetary considerations sometimes take precedence over ethical considerations, or are a strong influence. This is true in the field of psychiatry with the overuse of medication, due to the marketing influence of pharmaceutical companies, and it may be true in treatment using ECT as well.
One report states,
"Critics of the ECT industry have pointed out that in North America, the use of ECT is rising because insurance and government health plans pay for ECT. In 2001, a staff psychiatrist at Vancouver's Riverview Hospital went public with his concerns that the use of ECT there had more than doubled after the Canadian health plan increased payments to doctors for ECT treatments.
He contacted the Minister of Health after he said his job was threatened over his attempt to blow the whistle. He was fired from Riverview in December 2001.
Additionally, critics claim that the trend towards managed care in the US has caused psychiatrists' incomes to decline substantially, and ECT can provide a financial incentive to abuse its use." (ECT Org, August, 2006).
Conclusion on Electroconvulsive Therapy (ECT)
ECT can be effective as a temporary measure to relieve severe and chronic depression, and as an aid in some other mental health disorders. The most common schedule for ECT treatment involved 12 individual treatments over a period of about a month.
There is a high recurrence rate with ECT treatment. In some modern countries, 20 to 23 percent of those who receive ECT treatment do so against their will or without consent. The rate in third world countries may be higher.
While ECT treatment is safer than when it was initially utilized, there still is a risk of serious complications, including death, with a rate of one of 3,000.
Electroconvulsive Therapy References
1. Carson, Robert. C., Butcher, James, N., Mineka, Susan, (2000). Abnormal Psychology and Modern Life. 11th Edition. Boston: Allyn & Bacon
2. ECT Org. (August 2006).
http://www.ect.org/cgi-bin/faq/smartfaq.cgi?answer=1014926757&id=1014926466
2. Electroconvulsive Therapy Annual Statistics. (August 2006). New Zealand Ministry of Health. http://www.moh.govt.nz/moh.nsf/indexmh/electroconvulsive-therapy-annual-statistics?Open
3. Electroconvulsive therapy (December 20, 2000). BBC News, World Edition. http://news.bbc.co.uk/2/hi/health/medical_notes/1079436.stm
4. Electroconvulsive therapy, (July 11, 2008). MayoClinic.com. http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129
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