Two academic papers have recently been published about the current use of electroconvulsive therapy (ECT). ECT is a treatment for psychiatric disorders, usually severe depression. It works by inducing seizures, but like many psychiatric treatments, we’re not really sure why it works. It is reserved only for depression that is so severe that the patient has no quality of life and has not responded to other treatment. I have seen videos of ECT in action, and beforehand, patients often have the most severe of symptoms – in most cases, catatonia (stupor and immobility). The change directly after ECT can be quite remarkable. However, the problem is that in many cases, the benefits do not last very long and can really only be considered as a short-term treatment when someone’s illness is at its worst.
With some suggestion that ECT could have effects on memory and cognition, you can imagine that it’s important to only use ECT on the most severe of cases, where depression can either eliminate any quality of life, or be fatal.
A study in the current issue of Biological Psychiatry examined current rates of ECT use in the United States. From 1993 – 2009, patients receiving ECT declined (12.6 to 7.2/100,000), as did the number of hospitals performing the procedure (14.8% to 10.6%). This suggests that ECT is not being used in America as commonly as it used to be. Hopefully, it is hardly ever used as the first line of treatment.
Another study in the most recent issue of Brain and Behavior examined ECT use worldwide. Unfortunately, they were not able to determine if worldwide use had increased or decreased, but they were able to describe how ECT was performed in many countries. I think the most concerning result from this study is that “unmodified” ECT is still practised in many areas of the world, including Asia, Africa, Latin America, Russia, Turkey, and Spain. “Unmodified” means that ECT is performed on the patient without muscle relaxant or any type of anesthesia. I am not entirely sure why they would not provide this, as it is standard in the rest of the world. Perhaps a reader can enlighten me.
Do you have thoughts on ECT? Should it be used at all? Or should more research be done instead on promising, alternative types of treatment for severe depression, such as deep brain stimulation (see Helen Mayberg‘s work)?