Electroconvulsive Therapy was first used on humans in 1938. It has been often seen as a brutal, tortuous procedure used on the mentally ill. In many countries, its use is not only trivialized by psychiatrists, but it is sometimes used on unwilling patients. Often, patients are not told of all the possible side effects and risks of ETC.
In many cases, ECT is used as a last resort, as in cases of severe depression that havent improved with medication. In other cases, it seems to be used somewhat randomly. According to the best literature I could find, ECT should only be used in cases of extreme, long term depression. That means it shouldnt be used for other mental disorders. It shouldnt be used for situational depression, such as depression after a loss or trauma. And it should only be used when all other forms of relief have failed.
There are two types of ECT commonly preformed. Bilateral ECT is when the electrodes are placed on each side of the head in the area of the temples. With unilateral ECT, the electrodes are placed with both on one side of the head, often the non-dominant side of the brain. The shock applied is anywhere from 70 to 400 volts and 200 to 1600 mill amperes. This is enough electricity to stop the heart were it not applied just to the head. There are conflicting reports as to which of these procedures are the most effective.
ECT is usually done around 6 to 12 times in a single course of treatment, but its not uncommon for an individual to undergo more than one course of treatment. This can result in a person being shocked dozens of time. In many descriptions of the treatment, the resulting seizure is referred to as a "fit." In addition, patients who have reoccurring depression will often undergo a series of "maintenance ECT," that is repeated when the depression reappears.
Research on the effects of ECT on the brain has seemingly come to a stop, despite vast sums given in government grants in the United States for research that doesnt seem to be answering any of the questions about ECT.
However, there are doctors who dont follow the guidelines. They downplay the potential side effects and treat it like a wonderful cure-all. They exaggerate the success rates of the procedure. And some even do the procedure without sufficient staff and facilities.
The side effects of ECT are the worse news. There has been compelling research since the 1940's that show that ECT causes brain damage in animals and humans, and this damage can visualized in the brain tissue. It can cause small capillaries to bleed into the brain. It can result in memory loss that sometimes is temporary but is often permanent. It also seems to sometimes result in an inability to perform prior skills - how to drive, how to do ones job, how to enjoy former hobbies.
Although I think ECT has to be a personal choice, I would suggest anyone considering it to spend some serious time considering the risks. In addition, according to the research Ive read, the most effective treatment for depression is medication and psychotherapy. In all of the ECT data and discussions Ive read, they compare the effectiveness to medication therapy, but not to the combination of the two therapies. Often, it can take medications two to three months to become fully effective, and its not unusual for a patient to try several medications before something that works is found.
Depression is a very difficult illness. Its not fully understood. But I think I would rather have several months of therapy, with drugs and psychotherapy, than risk possible brain damage. One psychoanalyst summed it up when he stated that it was useless to continue analysis with patients who had ETC - they couldnt remember their problems any more.
Next week Ill have an interview with a woman who had twelve ECT treatments.
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