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Electroconvulsive therapy

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Electroconvulsive therapy, also known as electroshock or ECT, is a type of psychiatric shock therapy involving inducing an artificial seizure in a patient by passing electricity through the brain. ECT was once a common psychiatric treatment, especially during the 1940s and 1950s, but it is comparatively rare today. It is typically used to treat bipolar disorder and severe depression in cases where talk therapy and drug treatment have proven ineffective. At one time, it was also used for the treatment of schizophrenia, but is now generally regarded as ineffective for that purpose.

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Overview

During ECT, a grand mal seizure is induced in a patient by passing an electrical current through the brain. Current flow is usually from temple to temple, though sometimes electroshock may be applied to only one hemisphere of the brain. The resultant seizure is characterized as being more severe than a naturally occurring epileptic seizure. The patient loses consciousness and experiences powerful and violent uncontrolled muscle movement (unless a muscle relaxant has been administered beforehand.) Afterwards, patients have no memory of the seizure or events immediately preceding it, and remain mentally dull and listless for hours, days, or even weeks afterwards.

Theraputic ECT is usually administered more than once over a period of time. Repeated administration of ECT produces dramatic long term changes in personality and mood, along with increasingly diminished memory function. After the course of ECT ends, memory gradually improves, though whether it ever returns to pre-ECT levels is highly variable. Some patients anecdotally claim their memory is permanently impaired following ECT, while a few even report better memory afterwards.

History

When ECT was first instituted, the patient was fully conscious at the beginning of the procedure. Patients would often break bones, especially vertebrae, and pull muscles from the violent convulsions induced by the seizure. Patients grew to dread the procedure, and it was not uncommonly employed as a means of punishment and sedation for difficult patients in psychiatric wards.

In modern ECT, the patient is placed under general anesthesia and is unconscious when the seizure is triggered. Muscle relaxants are used to prevent the patient's muscles from actually moving during the treatment. The existence of the seizure is confirmed by means of an EEG.

Following the seizure, there is a short period of time during which electrical activity in the brain ceases and an EEG reading is flat. Opponents of the practice claim this is no different than the state of being brain dead, and that brain cell death occurs during this time.

There is current research in using transcranial magnetic stimulation as an alternative to ECT.

Controversy

There is much debate both within the field of psychiatry and among the general public as to the utility of electroconvulsive therapy. Opponents claim that the mechanism through which electroshock creates changes in mental state is nothing more than the destruction of brain cells, and even proponents are not quite sure how it works. Many patients who have undergone ECT claim it caused their subsequent mental state to improve; many others think their ECT treatments did more harm than good, and some actively campaign to have the treatment legally banned.

A great deal of anti-ECT sentiment was generated by its unfavorable depiction in the 1975 movie One Flew Over the Cuckoo's Nest, based on a novel by Ken Kesey, which in turn was based loosely on the author's own experiences with ECT in various mental hospitals during the 1960s.

External Links

Pro-ECT:

Anti-ECT:

Studies in-progress:



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