ECT: The Method of Last Resort
|Copyright (c) 2008 by Kevin Thompson.
What is Electroconvulsive Therapy?
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.
When is ECT Used?
ECT is typically used in these circumstances:
- 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).
- When medications have proven ineffective, and symptoms
- 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
- 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.
What are the Drawbacks?
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
- 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.
Conclusion: The Picture is Mixed
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.
The 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
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