Sylvia Plath

Electoshock Therapy

History

Electroconvulsive therapy (ECT) is the application of a mild electric current to the brain to produce an epileptic-like seizure as a means of treating certain psychological disorders, including severe depression, severe mania, and catatonia.

Electroconvulsive therapy, also known as ECT and electroshock therapy, was developed in the 1930s when various observations led physicians to conclude that epileptic seizures might prevent or relieve the symptoms of schizophrenia. After experiments with insulin and other potentially seizure-inducing drugs, Italian physicians pioneered the use of an electric current to create seizures in schizophrenic patients.

ECT was routinely used to treat schizophrenia, depression, and, in some cases, mania. ECT was used indiscriminately and often without anesthesia. It was frequently prescribed for treating disorders on which it had no real effect, such as alcohol dependence, and was used for punitive reasons. Patients typically experienced confusion and loss of memory after treatments, and even if their conditions improved, they usually eventually relapsed. Other side effects of ECT include speech defects, physical injury from the force of the convulsions, and cardiac arrest. This therapy became controversial due to its misuse and negative side effects, and its use declined after 1960 with the introduction of antidepressant and antipsychotic drugs.

Current Use

ECT is still used but with less frequency and with modifications, notably a highly controlled setting with the patient under general anesthesia. This has made the procedure safer and less unpleasant. Muscle relaxants are often administered to prevent bone fractures or other injuries from muscle spasms. Patients in the United States typically receive two or three treatments each week for a period of approximately three to four weeks, but the total number and frequency varies by patient. Each treatment administration takes about 5–10 minutes and can be performed while the patient is in the hospital or on an outpatient basis.

About 100,000 people in the United States receive electroconvulsive therapy annually. ECT is used in several instances, notably as a treatment for severely depressed patients who have not responded to antidepressant medications or whose suicidal impulses make it dangerous to wait until such medications can take effect. ECT is also administered to patients with catatonia and patients who have dementia and exhibit agitation and aggression.

Questions and Contoversy

Researchers are still not sure exactly how electroconvulsive therapy works. One hypothesis is that the induced seizures can affect the functioning of neurotransmitters in the brain, including norepinephrine and serotonin, which are associated with depression. Another hypothesis proposes that ECT changes the regulation of stress hormones in the brain, and that, in turn, affects the patient's sleep patterns, appetite, energy levels, and overall mood. A 2015 study that appeared in the Journal of ECT analyzed the blood and suggested that a gene (transcription factor 7) was increased during modified ECT treatment (mECT). The researchers concluded that the RTCF family may play a role in the functional mechanism of mECT.

Despite careful administration of ECT, patients may experience side effects, particularly memory loss. This may include anterograde memory (the ability to learn new material), which typically returns relatively rapidly following treatment; or retrograde memory (the ability to remember past events), which may be more strongly affected. Patients may experience a marked memory deficit in the week after treatment, but memory gradually improves over the following months. In many cases, however, subtle memory losses persist beyond six or seven months and can be serious and debilitating for some patients.

Because of its possible side effects, as well as the public's level of discomfort with both electrical shock and the idea of inducing seizures, ECT remains a controversial, although in some cases very effective, treatment method.