Electroconvulsive Therapy Benefits
and Side-Effects

Electrical stock helps depression.

Does this statement surprise you? The shock treatment or electroconvulsive therapy is
helpful on patients suffered from major depressive disorder, manic episodes and other
serious mental disorders. [4, 7] Electroconvulsive therapy is usually regarded as a last
resort - after all attempts at medications therapy have failed.

Electroconvulsive therapy provokes a convulsion similar to a grand mal epileptic seizure via
an electric shock. No one knows exactly how electro-convulsive therapy makes a depression
lift, but it just works.

Back in 1960s or earlier, electroconvulsive therapy was over-prescribed. Fracture, tooth
loss, muscle contractions happened. Nowadays, patients are minor tranquillizers to minimize
such adverse events.

Immediately prior to the treatment, the patient is injected with a medication that prevents
abnormal heart rhythms, then the patient is given an intravenous barbiturate which is used
as the general anesthetic, and then the blocking agents. A rubber rod is usually placed into
patientÂ’s mouth, to prevent tongue biting. Electrodes are attached to the patient's scalp - a
switch is flipped for a few seconds, the convulsion itself lasts about 30 seconds, and several
minutes later the patient wakes up disoriented and groggy, and often with no recollection of
the events surrounding the treatment.

Electroconvulsive therapy was found to work very well patients suffered from major
depression regardless the age. [11] The effectiveness and side effects of electroconvulsive
therapy in adolescents are actually comparable with those in adults. However, there is a
pervasive reluctance to use electroconvulsive therapy in children and adolescents. [5]

RESEARCH FINDINGS ON ELECTROCONVULSIVE THERAPY BENEFITS

MEDICATIONS USED IN ELECTROCONVULSIVE THERAPY

When electroconvulsive therapy was given without tranquillization, the incidence and
severity of post-operative agitation and of side effects were significantly greater in those
patients with a high level of anxiety before treatment. Both diazepam and haloperidol were
found to be effective in subduing agitation and side effects in anxious, depressed patients,
but with diazepam recovery time was longer. [13]

For safe conduct of electro convulsive therapy, general anaesthesia, such as thiopentone
sodium, is administered to the patients. Zaidi NA et al found that Propofol offered a superior
haemodynamic stability during the procedure and a quick recovery from sleep from their
study. [9]

ELECTROCONVULSIVE THERAPY POSSIBLE MECHANISMS

The actual mechanism for electroconvulsive therapy is not clear. But, scientists have found
some relevant information:

Involvement of NO is critical in the efficiency of Electroconvulsive therapy. [4]

Reductions in right prefrontal cerebral blood flow have been correlated with symptomatic
improvement in depressed individuals receiving electroconvulsive therapy. Non-invasive
near infrared spectroscopy has previously been shown to reliably measure changes in
cerebral hemoglobin concentrations and oxygen saturation. Fabbri F and his co-workers at
Tufts University found that the electrically induced seizure causes a strong cerebral
deoxygenation on the side ipsilateral to the electrical current, during the right unilateral
electroconvulsive therapy. A decrease in the total hemoglobin concentration was also
observed on the brain side ipsilateral to the electrical discharge of electroconvulsive
therapy. [2]

Chistyakov AV et al at The Technion, Israel Institute of Technology found the
antidepressant effect of electroconvulsive therapy associated with an enhancement of left
hemispheric excitability. In a study, they recruited 22 patients with major depression and
assigned them to receive electro-convulsive therapy and right prefrontal transcranial
magnetic stimulation or electro-convulsive therapy with sham transcranial magnetic
stimulation. They applied electro-convulsive therapy twice weekly and transcranial magnetic
stimulation on the remaining 4 days, throughout 3 weeks.

They observed a marked clinical improvement in 19 out of the 22 patients. And, these
patients was associated with a significant increase of the motor evoked potential P/M-wave
area ratio, decrease of the active motor threshold and reduction of the intra-cortical
inhibition in the left hemisphere. [1]

ELECTROCONVULSIVE THERAPY EFFECTIVENESS

Electroconvulsive treatment (ECT) was therapeutically ineffective in 27 (20%) of 136
depressed patients. Failure to respond occurred in long-lasting depressions and in patients
with a history of long-lasting depressions. In these cases the depression lasted at least 6
months. The hypothesis is proposed that electro-convulsive therapy is effective only when
given within 6 months of the spontaneous end of the depression. [14]

ELECTROCONVULSIVE THERAPY FOR DRUG TREATMENT RESISTANT GROUP

Electroconvulsive therapy combined with pharmacotherapy is found to be safe and effective
with non-enduring subjective memory difficulty for the drug treatment resistant group of
psychotic patients. Electroconvulsive therapy facilitated recovery in this potentially drug
treatment resistant psychotic subjects. [10]

ELECTROCONVULSIVE THERAPY SIDE EFFECTS

The most pronounced side effect is short-term memory loss in about two-thirds of the
patients. Some patients can also experience longer-term memory loss.

Complaints of muscle pain (31.4%), post- electroconvulsive therapy confusion (15.7%) and
post-ECT headache (20%) in the first week of treatment, were not evident at follow up. [10]

Transient hypertension (13%) and cardiac dysrhythmia (3.5%), which resolved in the
recovery period were the most frequent complications in a study of white female patients.
[11]

Bone injury while undergoing electroconvulsive therapy is rare. However, a case of hip
fracture during treatment was reported. Patients suffered from osteoporosis should get
doctorÂ’s advise before electro-convulsive therapy. [12]

Side effects, post-operative agitation and retrograde memory impairment were assessed in
each patient after each of several treatments. [13]

ELECTROCONVULSIVE THERAPY TREATMENT RESISTANT GROUP

There was a trend for smaller frontal-temporal volumes in the treatment-resistant patients.
Impaired immediate working memory was linked with reduced frontal and parietal lobe
volume and impaired short-term memory functioning was associated with reduced temporal
lobe volume. Ventricular enlargement was associated with prior administration of
electroconvulsive therapy, poor physical health and later age at onset of first episode of
depression. [8]

MAGNETIC SEIZURE THERAPY

Magnetic seizure therapy is the use of transcranial magnetic stimulation* to induce a
seizure. It is believed that magnetic seizure therapy can induce more targeted seizures. The
method is based on the principle that a time-varying magnetic field induces an electric field
which leads to activation of inhibitory and excitatory neurons in neural tissue. [6] This
magnetic field passes through tissue unimpeded, providing more control over the site and
extent of stimulation than can be achieved with Electroconvulsive Therapy. Preliminary
results suggest that magnetic seizure therapy may have some advantages over
Electroconvulsive Therapy in terms of subjective side effects and acute cognitive
functioning. [3]

                                    
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REFERENCES

[1] Effect of electroconvulsive therapy on cortical excitability in patients with major
depression: a transcranial magnetic stimulation study. Clin Neurophysiol. 2005 Feb;116(2):
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[2] Bilateral near-infrared monitoring of the cerebral concentration and oxygen-saturation of
hemoglobin during right unilateral electro-convulsive therapy. Brain Res. 2003 Dec 5;992(2):
193-204.
[3] Lisanby SH et al New developments in electroconvulsive therapy and magnetic seizure
therapy. CNS Spectr. 2003 Jul;8(7):529-36.
[4] Rosen Y et al The significance of the nitric oxide in electro-convulsive therapy: a
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[5] Russell PS Electro convulsive therapy in a pre-pubertal child with severe depression. J
Postgrad Med. 2002 Oct-Dec;48(4):290-1.
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[7] X et al, Discovery and brief developmental history of electro -- convulsive therapy in
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[8] Simpson SW et al, Regional cerebral volume measurements in late-life depression:
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unmodified electroconvulsive therapy in schizophrenia, mania and severe depression in
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[11] Westphal JR et al The Louisiana Medicare Electro-Convulsive Therapy Quality
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[12] Nott MR et al, A fractured hip during electroconvulsive therapy. Eur J Anaesthesiol.
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RESEARCH ARTICLES ABOUT ELECTROCONVULSIVE THERAPY

Kovac AL Comparison of two esmolol bolus doses on the haemodynamic response and
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Izard P Use of propofol in 1350 anesthetized patients for electroconvulsive therapy Ann Fr
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Mitchell RG Electroconvulsive therapy: informing patient and nurse. Prof Nurse. 1991 Feb;6
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Peng KL et al Consent for electro-convulsive therapy in Singapore. Anglo Am Law Rev.
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8. Edwards GA et al, Electro-convulsive therapy: a new era of controversy. Aust N Z J
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Lee YY A study of the subjective side-effects of electro-convulsive therapy Hu Li Za Zhi.
1978 Apr;25(2):9-15.
Clare AW Therapeutic and ethical aspects of electroconvulsive therapy: a British
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Kriss A et al Asymmetries in the flash evoked response following unilateral electro-
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Cannicott SM Unilateral electro-convulsive therapy. Nurs Times. 1974 Jul 18;70(29):1116-7.
O'Dwyer M Electro-convulsive therapy. Nurs Times. 1973 Mar 15;69(10):352-3.
Hamadah K et al The effect of electro-convulsive therapy on the urinary excretion of
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Edwards JG Electro-convulsive therapy in the treatment of bizarre psychogenic movements.
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Naftalin AL et al, A comparison of propaniid and thiopentone as induction agents for
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Elithorn A et al, Adrenocrotical responsiveness during courses of electro-convulsive
therapy. Br J Psychiatry. 1969 May;115(522):575-80.
Cannicott SM Unilateral electroconvulsive therapy. Curr Psychiatr Ther. 1969;9:155-60.
Frank I et al, Two-year experience with electro-convulsive therapy in a semi-rural hospital.
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Iryo. 1967 Sep;21(9):1047-57
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hypertension. Br J Psychiatry. 1966 Dec;112(493):1241-9.
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VALLANCE M THE EXPERIENCE OF ELECTRO-CONVULSIVE THERAPY BY A PRACTISING
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DECAROLIS V et al, CATAMNESTIC FINDINGS IN IMIPRAMINE AND ELECTROCONVULSIVE
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SIEGMANN A, Electroconvulsive treatment in manic depressive psychosis: a statistical
evaluation. Can Psychiatr Assoc J. 1959 Oct;4:213-21.
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electro-convulsive therapy. Am J Psychiatry. 1959 Feb;115(8):734-5.
SRINIVASAN NG et al, Glucose tolerance of mental patients undergoing electroconvulsive
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SRINIVASAN NG et al, Urinary amino-acid excretory patterns of patients undergoing electro-
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MOORE RW, Therapeutic dissociation by electroconvulsive therapy. N Z Med J. 1958 Aug;57
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EPSTEIN J, A new naso-pharyngeal airway for use with cerebral electro-convulsive therapy.
Am J Psychiatry. 1958 May;114(11):1030-1.
FOGEL EJ et al, Laryngospasm: its incidence and management in electro-convulsive
treatment. Dis Nerv Syst. 1958 Feb;19(2):61-5.
LANCASTER NP et al, Unilateral electro-convulsive therapy. J Ment Sci. 1958 Jan;104(434):
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CARPENTER LG Jr Relation of aggression in the personality to outcome with electro-
convulsive shock therapy. J Gen Psychol. 1957 Jul;57(1):3-22.
TEWFIK GI et al, The use of arfonad for the alleviation of cardio-vascular stress following
electro-convulsive therapy. J Ment Sci. 1957 Jul;103(432):636-44.
ROTH M Prognosis and pentothal induced electroencephalographic changes in electro-
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Electroencephalogr Clin Neurophysiol Suppl. 1957 May;9(2):225-37.
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SARTESCHI P et al Further study of the use of succinylcholine in electro-convulsive
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AYD FJ Jr Progress in electroconvulsive therapy. Md State Med J. 1956 Mar;5(3):130-5.
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ALEXANDER SP Modified electro-convulsive therapy with unidirectional current. Dis Nerv
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BOUREAU J Administration of curare in electro-convulsive therapy; report on 5,000 cases.
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BILLINGS EG Electro-convulsive therapy in psychiatric and psychosomatic disorders. Rocky
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BASSETT M et al The effect of electro-convulsive therapy on the psycho-galvanic response.
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SCANLON JP Electro-convulsive therapy. Bull Georgetown Univ Med Cent. 1954 May;7(5):
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FLETCHER EF The use of muscle relaxants in electro-convulsive therapy. Med J Aust. 1954
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KELLY JP Fractures complicating electro-convulsive therapy and chronic epilepsy. J Bone
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ASHBY WR The mode of action of electro-convulsive therapy. J Ment Sci. 1953 Apr;99(415):
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WEBB RR Curare and electro-convulsive therapy; a simplified technique. Med J Aust. 1951
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STIEPER DR Changes in impersonal and personal memory following electro-convulsive
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IMPASTATO DJ Improved electro-convulsive therapy with low amperage unidirectional
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LEEDY JJ et al Use of music with electro-convulsive therapy; preliminary report. Dis Nerv
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ROTH M Changes in the EEG under barbiturate anaesthesia produced by electro-
convulsive treatment and their significance for the theory of ECT action. Electroencephalogr
Clin Neurophysiol. 1951 Aug;3(3):261-80
EARLY DF et al The use of ACTH in psychiatry: (a) response tests; (b) therapy; (c)
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1951 Jun;7(2):xviii-xix.
STENGEL E Intensive electro-convulsive therapy. J Ment Sci. 1951 Jan;97(406):139-42.
TARNOWER SM and GLADSTONE RW Use of pentothal sodium in the prevention of
musculoskeletal injuries during electro-convulsive therapy. N Engl J Med. 1950 Apr 27;242
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Bernstein HG et al Electro-convulsive therapy, nitric oxide and HPA axis: a closer look at
human hypothalamus. Med Hypotheses. 2004;62(1):158-9.
Han Kho K et al Predictors for the efficacy of electroconvulsive therapy: chart review of a
naturalistic study. J Clin Psychiatry. 2005 Jul;66(7):894-9.
Prudic J et al, Electro-convulsive therapy practices in the community. Psychol Med. 2001 Jul;
31(5):929-34.
Berle JO Severe postpartum depression and psychosis--when is electroconvulsive therapy
the treatment of choice? Tidsskr Nor Laegeforen. 1999 Aug 30;119(20):3000-3.
Gass JP The knowledge and attitudes of mental health nurses to electro-convulsive therapy.
J Adv Nurs. 1998 Jan;27(1):83-90.
Bennedsen BE Prolonged pseudodementia after treatment with tricyclic antidepressive
agents and electroconvulsive therapy Ugeskr Laeger. 1996 Apr 8;158(15):2134-5.
Engelhardt W et al, Intra-individual open comparison of burst-suppression-isoflurane-
anaesthesia versus electroconvulsive therapy in the treatment of severe depression. Eur J
Anaesthesiol. 1993 Mar;10(2):113-8.
Zyss T Will electroconvulsive therapy induce seizures: magnetic brain stimulation as
hypothesis of a new psychiatric therapy Psychiatr Pol. 1992 Nov-Dec;26(6):531-41
Chee KT Medico-legal implications of electro-convulsive therapy--a Singapore viewpoint.
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Ladds B Involuntary electro-convulsive therapy to restore competency to stand trial: a five
year study in New York State. J Forensic Sci. 1995 Mar;40(2):183-7.
Krishnamurthy M et al, Effects of ECT-dothiepin combination on learning in rats. Indian J Exp
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THIS ARTICLE IS FOR YOUR REFERENCE ONLY. IF YOU HAVE ANY QUESTIONS, YOU
SHOULD CONSULT WITH YOUR DOCTOR.