Electroconvulsive Therapy (ECT) is an electrical-stimulation technique used to treat severe depression, bipolar disorder, schizophrenia and psychosis, and catatonia. It is a remarkable fact that ECT is an effective treatment for so many apparently unrelated types of mental illness. It is perhaps equally remarkable that so little is known about why it works, beyond the consensus that it is the seizure induced by ECT that leads to the benefits.
During an ECT session, the patient is given a general anesthetic to induce brief unconsciousness, and then a voltage is applied to cause an electric current to flow through one (right lateral) or both (bilateral) sides of the brain, inducing a seizure. For reasons that are not well understood, this electrically-induced seizure can dramatically alleviate depression.
Bilateral treament acts more rapidly than unilateral treatment, but has more severe side effects. Right unilateral treatment produces less severe memory loss, and is preferred for depression. Bilateral treatment is generally restricted to emergency situations involving severe depression with psychosis, severe manic episodes, severe psychotic episodes, and catatonia.
ECT is typically used in these circumstances:
1. When it is essential to provide the fastest-possible relief for depression, mania, or psychosis (for example, in the case of someone who is suicidal).
2. When medications have proven ineffective, and symptoms remain severe.
3. For patients with bipolar disorder who need immediate stabilization of their condition, or who are experiencing severe manic episodes. ECT helps both the manic and depressive aspects of this disorder, something that is not normally true for individual medications.
4. For patients with catatonia, a dangerous condition that is often resistant to medication.
ECT is a proven technique. It does not always work, but it works more often than medication for severe depression, and generally as well as medications for bipolar disorder and schizophrenia. It often is the only treatment that works for catatonia.
There are a number of drawbacks to ECT, including
* Practical Difficulties. Access to ECT may be difficult, as it is not a common treatment. Also, the expense, and the overhead in terms of time and care that the treatment entails, make it burdensome. Finally, when used to treat depression, a course of 10-20 treatments must be followed by maintenance therapy (medication or monthly ECT treatments), or the benefits will not persist.
* Short-term memory loss. ECT typically causes short-term memory loss, and possibly some temporary impairment of ability to think clearly.
* Possible long-term deficits. There are many anecdotal accounts of long-term, even permanent, impairment of memory, ability to think, and ability to experience the normal range of human emotion. These claims have not been confirmed by clinical studies to date. Those who assert the truth of these claims explain this discrepancy by saying that the studies do not measure these types of deficits. As of this writing, no conclusive evidence exists to settle the debate.
It should also be said that some people not only respond well to ECT, but do so without experiencing significant deficits. For these people, most of whom have exhausted the set of available medications, ECT is very much a life saver.
These drawbacks, plus a somewhat sensational and checkered history of past abuse, has led physicians and possible candidates to shy away from ECT. However, ECT should be considered for the circumstances described above.
Kevin Thompson, Ph.D. is the author of "Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication." You can find information about treatments for depression, bipolar disorder, schizophrenia, and sexual problems on his Web site at www.MentalMeds.org.