ECT involves passing an electrical current through the brain for a short period of time over several sessions. It sends the patient into convulsions and muscle relaxants are often administered prior to treatment.
Originally developed as a treatment for schizophrenia in 1938, ECT was found to be ineffective in reducing psychotic symptoms. It is now used exclusively as a treatment for severe depression for which it has been found to be effective, and is usually only administered when drug treatment has failed.
The exact mode of action of ECT is uncertain. However, the most plausible account of ECT's effectiveness is that it produces various biochemical changes in the brain, which are greater than those produced by anti-depressant drugs. Since many physiological changes occur when ECT is administered it is difficult to establish which of these are significant. It is likely that the neurotransmitters noradrenaline and adrenaline are affected as research indicates these are strongly implicated in the disorder.
Issues surrounding the use of ECT
As the film One Flew Over the Cuckoo's Nest suggested, ECT has a history of abuse, being used as a means of punishing or controlling people in mental hospitals, with some people having received hundreds of ECT treatments.
Applying an electrical current to the brain is an admittedly frightening and forceful form of intervention and even with the newer techniques there are still side effects, especially with repeated use. Modern practice now requires that a consent form agreeing to treatment must be signed by the patient or the patient's guardian.
And ECT techniques are continually being improved. Late 20th century procedures cause no detectable changes in brain structure and side effects are fewer than previous methods. A significant 1994 study (Devanand et al.,1994) found no evidence of long-term memory loss or any other longer-term cognitive changes.
Further clinical studies suggest that ECT may be the optimal treatment for depression (Klerman, 1988). Between 60 and 70% of patients improve with ECT, although a large proportion of these become depressed again the following year. ECT is a quick treatment, in contrast to drugs or psychological therapies. And with acute mania, ECT has been found to be effective in around 80% of people who had not responded to medication (Mukherjee et al., 1994).
Nevertheless, effective antidepressant drugs now provide a more attractive alternative, and although techniques are improving the use of ECT continues to decline. ECT is usually only administered if antidepressant drugs have no effect and if there is a risk that the person will commit suicide. ECT has been found to be beneficial to those who have not responded to antidepressant drugs although the relapse rate is high if it is followed by the same ineffective antidepressant drugs.