Understanding the Science Behind Electroconvulsive Therapy
For over eight decades, electroconvulsive therapy (ECT) has been used as a treatment for severe mental illnesses such as schizophrenia, mania, and major depression. Despite its somewhat controversial reputation, ECT remains one of the most effective treatments in psychiatry. ECT is a procedure where controlled electric currents are applied to the brain in order to trigger a brief seizure, which can cause dramatic improvements in severe psychiatric symptoms.
The History of ECT
The roots of ECT can be traced back to the early 20th century when it was discovered that inducing seizures could, paradoxically, mitigate symptoms of mental illness. Italian neuropsychiatrists Ugo Cerletti and Lucio Bini were the first people to apply an electric current to the brain to induce such a seizure, marking the advent of ECT in 1938.
How ECT Works
The science behind ECT is complex and still not completely understood. The procedure involves placing electrodes on the patient’s scalp and passing a finely controlled electric current through the brain to stimulate a seizure that lasts about a minute. ECT appears to cause changes in brain chemistry that can rapidly reverse symptoms of certain mental health conditions. It can have a quicker and broader range of symptom reduction in comparison to medications alone.
During the procedure, patients are under general anesthesia and a muscle relaxant to prevent a physical seizure, although the brain experiences a full seizure activity. The seizure can help reset the balance of various neurotransmitters, the chemicals that transmit signals in the brain.
Additionally, ECT probably works by enhancing neuroplasticity, the brain’s ability to adapt and change. This is evidenced by the fact that ECT increases the levels of certain growth factors involved in neuroplasticity. Also, ECT increases the connectivity between different brain areas, allowing them to communicate more effectively.
Treatment and Efficacy
ECT is typically used when other treatments, such as psychotherapy and medication, have not worked or in emergency situations where there is a high risk, such as intense suicidal intent. A typical course of ECT involves multiple sessions, usually given two or three times a week until the depression lifts, which typically occurs after six to 12 treatments.
A review study published in the American Journal of Psychiatry found remission rates of major depressive disorder with ECT to be approximately 50% for people who had not responded to drugs and as high as 80% to 90% for those who could voluntarily opt for ECT. ECT has also been found effective in treating mania and certain types of schizophrenia.
Risks and Misconceptions
Like any medical procedure, ECT does come with risks and side effects. The most common ones include confusion, memory loss, physical side effects such as nausea and muscle aches. However, memory problems are usually short term and resolve within a few weeks following completion of ECT treatment.
Modern ECT is very different from historical practices often incorrectly portrayed in media. Patients are anesthetized and paralyzed with medications to prevent pain and injury during the procedure. The placement of electrodes can also be modified to minimize cognitive side effects.
Conclusion
ECT is a clinically proven procedure used for treating specific mental health conditions when other treatments are ineffective. The science behind it, while not entirely understood, involves reseting the balance of neurotransmitters and enhancing the brain’s neuroplasticity. While it’s associated with some risks, ECT is still a safer treatment option for severe and life-threatening mental health conditions. It’s important to dispel misconceptions around ECT, facilitating an accurate understanding of this beneficial psychiatric treatment method.
Frequently Asked Questions
1. Is ECT a painful procedure?
No, ECT is not a painful procedure. Patients are under general anesthesia during the treatment and do not feel the electric currents.
2. Does ECT cause memory loss?
Some people experience memory problems following ECT, particularly for events around the time of treatment. However, these memory problems usually improve within a few weeks following ECT treatment.
3. Who is a suitable candidate for ECT?
ECT is typically used when other treatments have not worked, or in emergency situations such as intense suicidal intent or refusal to eat. A health professional can make an assessment and provide advice on an individual basis.
4. How many ECT treatments will I require?
A course of ECT typically involves multiple sessions, usually two or three times a week until the depression lifts, which typically occurs after six to 12 treatments.
