Current use of electroconvulsive therapy (ECT)

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.

Illustration of the world map

ECT practices do not appear to be standard around the world.
Photo: © Pokerman | Stock Free Images

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)?

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One thought on “Current use of electroconvulsive therapy (ECT)

  1. Here is what I say to those who are considering ECT:
    ECT causes brain damage. It is not a cure. Same as being hit over the head with a mallet. The euphoria lasts for 4 weeks – the same time it takes to recover from a brain injury then you are back where you started with depression but also with the problem of permanent memory loss and difficulty learning anything new. Unilateral ECT on the right side of the brain also targets your insight so you will be less likely to notice your deficits.
    Psychiatrists do not tell you the negatives. Find someone who will get you off the prescription drugs slowly and safely – they are probably doing the harm. Also drugs increase the likelihood of having the ECT electricity turned up for a seizure – more electricity equals more brain damage. The bigger the headache the more damage has been done. You wouldn’t run an electric current across your computer hard drive in the hope of getting rid of a virus would you? Your brain is more sensitive. Treat it kindly. Also even though your muscles don’t contract, the electricity still runs through your body stronger than a ‘normal’ epileptic fit, What is so good about an epileptic fit anyway? Neurologists try all they can to STOP people having epileptic fits! ECT can cause spontaneous epileptic fits in a few people. Do you want that?
    Click on the ECT tab at http://www.breggin.com/

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