How is Electroconvulsive Therapy (ECT) used to treat depression? To answer this question, we must first answer these other questions: What is electroconvulsive therapy? When depression is diagnosed, which patients are suitable for ECT and which for psychotherapy? If not all depressed patients will respond to ECT, how are we to identify those likely to benefit?
Invented by Cerletti and Bini, in 1938, ECT was the first form of therapy that reliably reduced severe depression (Abrams and Essman, 1982). Electroconvulsive therapy is a technique for treating psychiatric patients, in which seizures similar to those of epilepsy are induced by passing a current of electricity through the forehead (Encarta, 1995).
Cerlitti started his experiments on dogs, applying electrodes to the mouth and anus. He did not want to try this experience on humans because half of the dogs being treated had died. Bini discovered that the reason for the dogs’ deaths was that the current was traveling straight through to the heart. It was then that he tried putting the electrodes on the two temples. After this change, no more dogs died and his first human patient was in April of 1938 (Abrams and Essman, 1982).
Side effects included temporary memory loss and intellectual impairment, with a slight risk of fractures and respiratory failure. In recent years such as side effects have been reduced by a modified treatment involving a much lower current and sometimes a reduced number of sessions (Groiler, 1993). Normally the current is administered three times weekly for two to six week’s (Fraser, 1982).
When ECT was first used, patients frequently suffered fractures while having convulsions, but muscle relaxant drugs are now routinely used to prevent such fractures (Encarta, 1995).
For example, in the book Undercurrents, Martha Manning was given a shot of atropine which is used to dry secretions before many hospital procedures. Through an IV, Manning also received succinylcholine, which immobilized her to prevent the breakage of bones and methohexital, which acted as a short-acting anesthetic (Manning, 1994).
Also, as in Undercurrents, another modern practice involved applying the electric current to only the nondominant side of the brain, thus reducing the loss of memory, which is the most troubling side effect of ECT (Manning, 1994; Encarta, 1995). Unilateral ECT, as described above, is less effective than bilateral ECT (Encarta, 1995).
The answer of when to give ECT is about as simple as the question. ECT is considered most effective for depressions not responsive to drug therapy (Fraser, 1982). Although controversial, ECT brings rapid relief from severe depression and can often prevent suicide (Encarta, 1995).
Electroconvulsive therapy should be the treatment of choice for the severely ill depressives who have hallucinations and delusions or who have significant suicidal feelings. Where speed is essential in treatment, oral antidepressants may not be the first choice, since they can take two or more weeks to show an adequate effect; in themselves they can have unpleasant or dangerous side-effects (Fraser, 1982).
ECT is primarily indicated in the treatment of mood disorders (Abrams and Essman, 1982). Depressive states characterized by profound sadness or dysphoria respond best. While the following are also diagnostic criteria:
1. Sad, dysphoric, or anxious moods;
2. Early A.M. waking, diurnal mood swing (worse in the A.M.), greater than five pound weight loss in three weeks, retardation/ agitation, suicidal thoughts/ behavior, feelings of guilt/ self-reproach/ hopelessness/ worthlessness;
3. No coarse brain disease or use of steroids in the past month, no medical illness known to cause depressive symptoms (Abrams and Essman, 1982).
Although shock therapy has been performed for decades, researchers still do not know precisely how it works to combat depression. There are four major theories: the neurotransmitter theory, anti-convulsant theory, neuroendocrine theory, and the brain damage theory (Fraser, 1982).
The neurotransmitter theory suggests that the shock waves, like anti-depressant medication, change the way brain receptors receive important mood-related chemicals, such as serotonin and dopamine and norepinphrine (Fraser, 1982).
The anti-convulsant theory suggests that the shock-induced seizures teach the brain to resist seizures. This effort to inhibit seizure dampens abnormally active brain circuits, stabilizing mood (Fraser, 1982).
The neuroendocrine theory suggests that the seizure may cause the hypothalamus to release chemicals that cause change throughout the body. The seizure may release a neuropeptide that regulates mood (Fraser, 1982).
And finally, the brain damage theory suggests that shock damages the brain, causing memory loss and disorientation that creates a temporary illusion that problems are gone (Fraser, 1982).
I personally agree with the neurotransmitter theory. This theory seems the most logical to me, because I can see how the release of these chemicals would elevate the mood.
Because of the memory loss and unappealing nature of electroconvulsive therapy, it has been among the most controversial treatments in psychiatry, yet it is effective in relieving severe depression and therefore its use has continued (Encarta, 1995). No one knows why exactly ECT seems to work, but evidence clearly demonstrates its effectiveness (Maistro and Morris, 1996).
Writing this paper opened my eyes to the level that psychologist and scientist’s go to help people and the extent they must reach sometimes because the treatment’s just don’t work. I have read thing’s people have written on the Internet about it being cruel and not worth it. The way I feel about it is if you are having hallucination’s, suicidal thought’s and other mental problem’s and you do not react to any other medicine you should try it because one way or the other you are going to die. For the reasons that the procedure often does produce memory loss, and it is certainly capable of damaging the brain, it is often considered a last resort treatment when all other methods have failed (Maistro and Morris, 1996). I believe though, whether it is a first or last resort, if you and your doctor feel it will benefit your situation, you should try it.
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