Electroconvulsive Therapy (ECT)

The application of a mild electric current to the brain to produce an epileptic-like seizure as a means of treating certain psychological disorders, primarily severe depression.

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. It eventually became a source of controversy due to misuse and negative side effects. ECT was used indiscriminately and was often 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 those whose condition improved eventually relapsed. Other side effects of ECT include speech defects, physical injury from the force of the convulsions, and cardiac arrest. Use of electroconvulsive therapy declined after 1960 with the introduction of antidepressant and antipsychotic drugs.

ECT is still used today but with less frequency and with modifications that have made the procedure safer and less unpleasant. Anesthetics and muscle relaxants are usually administered to prevent bone fractures or other injuries from muscle spasms. Patients receive approximately 4 to 10 treatments administered over a period of about two weeks. Confusion and memory loss are minimized by the common practice of applying the current only to the non-dominant brain hemisphere, usually the right-brain hemisphere. Nevertheless, some memory loss still occurs; anterograde memory (the ability to learn new material) returns relatively rapidly following treatment, but retrograde memory (the ability to remember past events) is more strongly affected. There is a marked memory deficit one week after treatment which gradually improves over the next six or seven months. In many cases, however, subtle memory losses persist even beyond this point, and can be serious and debilitating for some patients.

About 100,000 people in the United States receive electroconvulsive therapy annually. ECT can only be administered with the informed consent of the patient and is used primarily 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 bipolar disorder. Contrary to the theories of those who first pioneered its use, ECT is not an effective treatment for schizophrenia unless the patient is also suffering from depression. The rate of relapse after administration of ECT can be greatly diminished when it is accompanied by other forms of treatment.

Researchers are still not sure exactly how electro-convulsive therapy works, although it is known that the seizures rather than the electric current itself are the basis for the treatment's effects, and that seizures can affect the functioning of neurotransmitters in the brain, including norepinephrine and serotonin, which are associated with depression. They also increase the release of pituitary hormones. 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 treatment method. In 1982, the city of Berkeley, California, passed a referendum making the administration of ECT a misdemeanor punishable by fines of up to $500 and six months in prison, but the law was later overturned.