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]
HOME
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):
386-92.
[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
proposed neurophysiological mechanism. Med Hypotheses. 2003 Mar;60(3):424-9.
[5] Russell PS Electro convulsive therapy in a pre-pubertal child with severe depression. J
Postgrad Med. 2002 Oct-Dec;48(4):290-1.
[6] Quiner S et al, Transcranial magnetic stimulation (TMS)--from diagnostic procedure to
therapy. Wien Klin Wochenschr. 2002 Mar 28;114(5-6):181-6.
[7] X et al, Discovery and brief developmental history of electro -- convulsive therapy in
mental diseases Zhonghua Yi Shi Za Zhi. 2001 Oct;31(4):213-6.
[8] Simpson SW et al, Regional cerebral volume measurements in late-life depression:
relationship to clinical correlates, neuropsychological impairment and response to treatment.
Int J Geriatr Psychiatry. 2001 May;16(5):469-76.
[9]Comparison of thiopentone sodium and propofol for electro convulsive therapy (ECT). J
Pak Med Assoc. 2000 Feb;50(2):60-3.
[10] Ikeji OC et al, Naturalistic comparative study of outcome and cognitive effects of
unmodified electroconvulsive therapy in schizophrenia, mania and severe depression in
Nigeria. East Afr Med J. 1999 Nov;76(11):644-50.
[11] Westphal JR et al The Louisiana Medicare Electro-Convulsive Therapy Quality
Improvement Project. J La State Med Soc. 1999 Oct;151(10):511-7.
[12] Nott MR et al, A fractured hip during electroconvulsive therapy. Eur J Anaesthesiol.
1999 Apr;16(4):265-7.
[13] Gomez J et al, Intravenous tranquillization with electroconvulsive therapy. Br J
Psychiatry. 1975 Dec;127:604-8.
[14] Kukopulos A et al, Spontaneous length of depression and response to
electroconvulsive therapy. Psychol Med. 1977 Nov;7(4):625-9.
RESEARCH ARTICLES ABOUT ELECTROCONVULSIVE THERAPY
Kovac AL Comparison of two esmolol bolus doses on the haemodynamic response and
seizure duration during electroconvulsive therapy. Can J Anaesth. 1991 Mar;38(2):204-9.
Izard P Use of propofol in 1350 anesthetized patients for electroconvulsive therapy Ann Fr
Anesth Reanim. 1991;10(1):16-20.
Kzhizhovski Ia Neurophysiological changes in the nervous system after electro-convulsive
therapy Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91(10):121-3.
Gassy JE et al, A survey of Electro-convulsive therapy in a general hospital psychiatry unit.
Aust N Z J Psychiatry. 1990 Sep;24(3):385-90.
Durham J Sources of public prejudice against electroconvulsive therapy Aust N Z J
Psychiatry. 1989 Dec;23(4):453-60
Varma SL et al, Post-dexamethasone plasma cortisol levels in depressive patients receiving
electroconvulsive therapy. Indian J Med Res. 1988 Jan;87:86-91.
Shenkin L Electroconvulsive therapy. N Z Med J. 1987 Jan 28;100(816):23.
Mitchell RG Electroconvulsive therapy: informing patient and nurse. Prof Nurse. 1991 Feb;6
(5):279-82.
Freedman B Why single out electro-convulsive therapy? Ethical arguments and analysis.
Health Law Can. 1987;8(2):35-8, 58.
Post F Psychotherapy, electro-convulsive treatments, and longterm management of elderly
depressives. J Affect Disord. 1985;Suppl 1:S41-5.
Awasthi PK et al, Increased permeability of blood brain barrier after electro-convulsive
shocks (ECS). Pharmacol Res Commun. 1982 Nov;14(10):983-92.
Gordon D Electroconvulsive therapy with minimum hazard. Br J Psychiatry. 1982 Jul;141:12-
8.
Stanford SC Comparison of the effects of repeated electroconvulsive shock on alpha 2- and
beta-adrenoceptors in different regions of rat brain. Neuroscience. 1982 Jul;7(7):1753-7.
Peng KL et al Consent for electro-convulsive therapy in Singapore. Anglo Am Law Rev.
1992 Oct-Dec;21(4):485-97.
Lehrer B et al, The biological basis of electroconvulsive therapy Harefuah. 1981 Nov 1;101
(9):221-3.
Dhar GL et al, Ophthalmic changes in electroconvulsive therapy. Indian J Ophthalmol. 1980
Oct;28(3):121-5.
katre AM et al, Comparative evaluation of propanidid with thiopentone as an anaesthetic
agent for electroconvulsive therapy. J Postgrad Med. 1980 Jul;26(3):171-7.
Crow TJ The scientific status of electroconvulsive therapy. Psychol Med. 1979 Aug;9(3):401-
8. Edwards GA et al, Electro-convulsive therapy: a new era of controversy. Aust N Z J
Psychiatry. 1978 Sep;12(3):161-4.
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
perspective. Int J Law Psychiatry. 1978;1(3):237-53.
Kriss A et al Asymmetries in the flash evoked response following unilateral electro-
convulsive therapy. Electroencephalogr Clin Neurophysiol. 1975 Oct;39(4):430.
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
adenosine 3':5'-cyclic monophosphate. Biochem J. 1972 Nov;130(1):15P.
Foley EI et al A comparison of recovery times between Althesin and methohexitone following
anaesthesia for electro-convulsive therapy. Postgrad Med J. 1972 Jun;48:Suppl 2:112-5.
Barnsley A Electro-convulsive therapy: a suggested form for recording effects of treatment.
Anaesthesia. 1971 Apr;26(2):239-40.
Fieschi C Disorders of memory caused by monolateral and bilateral electro-convulsive
therapy and chemoconvulsive therapy with flurothyl (Indoklon) Riv Sper Freniatr Med Leg
Alien Ment. 1970 Aug 31;94(4):916-26.
Edwards JG Electro-convulsive therapy in the treatment of bizarre psychogenic movements.
Br J Psychiatry. 1969 Sep;115(526):1065-7.
Naftalin AL et al, A comparison of propaniid and thiopentone as induction agents for
electroconvulsive therapy. Br J Anaesth. 1969 Jun;41(6):506-15.
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.
IMJ Ill Med J. 1969 Jan;135(1):37-9.
Davies CK et al, Propanidid anaesthesia for electroconvulsive therapy. Anaesthesia. 1968
Oct;23(4):708.
Valentine M et al, . A comparison of techniques in electro-convulsive therapy. Br J
Psychiatry. 1968 Aug;114(513):989-96.
Kurosawa M et al, Effect of electroconvulsive therapy (ECT) on the cardiovascular system
Iryo. 1967 Sep;21(9):1047-57
Bodley PO et al, The effects of electro-convulsive therapy on patients with essential
hypertension. Br J Psychiatry. 1966 Dec;112(493):1241-9.
Hunt HF Electro-convulsive shock and learning. Trans N Y Acad Sci. 1965 Jun;27(8):923-45.
VALLANCE M THE EXPERIENCE OF ELECTRO-CONVULSIVE THERAPY BY A PRACTISING
PSYCHIATRIST. Br J Psychiatry. 1965 Apr;111:365-7.
DECAROLIS V et al, CATAMNESTIC FINDINGS IN IMIPRAMINE AND ELECTROCONVULSIVE
THERAPY OF DEPRESSIONS.] Sist Nerv. 1964 Jan-Feb;16:43-52
MCKEGNEY FP et al, AN UNUSUAL FATAL OUTCOME OF ELECTRO-CONVULSIVE
THERAPY, Am J Psychiatry. 1963 Oct;120:398-400.
OSBORNE RG et al, ANESTHETIC AGENT IN ELECTRO-CONVULSIVE THERAPY: A
CONTROLLED COMPARISON. J Nerv Ment Dis. 1963 Sep;137:297-300.
FROMMER E et al, Physical treatments in psychiatric nursing. I. Electro-convulsive therapy
(ECT). Nurs Times. 1963 Feb 15;59:190-2 contd.
STANLEY WJ et al, A clinical comparison of phenelzine and electro-convulsive therapy in
the treatment of depressive illness. J Ment Sci. 1962 Sep;108:708-10.
CANNICOTT SM Unilateral electro-convulsive therapy. Postgrad Med J. 1962 Aug;38:451-9.
RUSSELL GF Body weight and balance of water, sodium and potassium in depressed
patients given electro-convulsive therapy. Clin Sci. 1960 May;19:327-36.
EIDUSON S et al, The effect of electro-convulsive therapy on spinal fluid constitutents. J
Ment Sci. 1960 Apr;106:692-8.
TEWFIK GI et al, Low incidence of fractures among Africans following electro-convulsive
therapy. West Afr Med J. 1960 Feb;9:26-8.
SIEGMANN A, Electroconvulsive treatment in manic depressive psychosis: a statistical
evaluation. Can Psychiatr Assoc J. 1959 Oct;4:213-21.
COLLINS GH et al, The effect of electroconvulsive therapy on initiative. J Ment Sci. 1959 Jul;
105:863-8.
O'MORROW G, Effects of music and recreation upon patients receiving electroconvulsive
therapy. Dis Nerv Syst. 1959 Apr;20(4):179-81.
MITIS CZ et al, Metherdine as an adjuvant to electroconvulsive therapy. Dis Nerv Syst. 1959
Apr;20(4):171-5.
BRILL NQ et al, An experimental study of the relative effectiveness of various components of
electro-convulsive therapy. Am J Psychiatry. 1959 Feb;115(8):734-5.
SRINIVASAN NG et al, Glucose tolerance of mental patients undergoing electroconvulsive
therapy (E.C.T.). Indian J Med Res. 1958 Sep;46(5):703-5.
SRINIVASAN NG et al, Urinary amino-acid excretory patterns of patients undergoing electro-
convulsive therapy (E.C.T.). Indian J Med Res. 1958 Sep;46(5):701-3.
MOORE RW, Therapeutic dissociation by electroconvulsive therapy. N Z Med J. 1958 Aug;57
(320):359-64.
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):
221-7.
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-
convulsive treatment; an approach to the problem of regulation of convulsive therapy.
Electroencephalogr Clin Neurophysiol Suppl. 1957 May;9(2):225-37.
ULETT GA Effect of atropine and scopolamine upon electroencephalographic changes
induced by electroconvulsive therapy. Electroencephalogr Clin Neurophysiol Suppl. 1957
May;9(2):217-24.
SARTESCHI P et al Further study of the use of succinylcholine in electro-convulsive
therapy; notes on 305 cases. Riv Patol Nerv Ment. 1957;78(3):1168-71.
WOLFF GE Electroconvulsive treatment; a help for epileptics. Am Pract Dig Treat. 1956 Nov;
7(11):1791-3.
MILLER D et al An improved oral protective device for use in electro-convulsive therapy. J
Nerv Ment Dis. 1956 Mar;123(3):299-300.
AYD FJ Jr Progress in electroconvulsive therapy. Md State Med J. 1956 Mar;5(3):130-5.
LANZKRON J Electro-convulsive therapy in a case of involutional psychosis in a mental
defective patient. Am J Ment Defic. 1955 Oct;60(2):320-2.
BROWNE-MAYERS AN et al Studies in alpha blocking following electro-convulsive therapy.
J Nerv Ment Dis. 1955 Mar;121(3):257-61.
ALEXANDER SP Modified electro-convulsive therapy with unidirectional current. Dis Nerv
Syst. 1955 Mar;16(3):72-6.
BOUREAU J Administration of curare in electro-convulsive therapy; report on 5,000 cases.
Ann Med Psychol (Paris). 1954 Dec;112, 2(5):712-29.
BILLINGS EG Electro-convulsive therapy in psychiatric and psychosomatic disorders. Rocky
Mt Med J. 1954 Dec;51(12):1076-80.
BASSETT M et al The effect of electro-convulsive therapy on the psycho-galvanic response.
J Ment Sci. 1954 Jul;100(420):632-42.
SCANLON JP Electro-convulsive therapy. Bull Georgetown Univ Med Cent. 1954 May;7(5):
182-9.
FLETCHER EF The use of muscle relaxants in electro-convulsive therapy. Med J Aust. 1954
Apr 17;41(1:16):589-91.
KELLY JP Fractures complicating electro-convulsive therapy and chronic epilepsy. J Bone
Joint Surg Br. 1954 Feb;36-B(1):70-9.
ASHBY WR The mode of action of electro-convulsive therapy. J Ment Sci. 1953 Apr;99(415):
202-15.
WEBB RR Curare and electro-convulsive therapy; a simplified technique. Med J Aust. 1951
Dec 22;2(25):851.
STIEPER DR Changes in impersonal and personal memory following electro-convulsive
therapy. J Clin Psychol. 1951 Oct;7(4):361-6.
IMPASTATO DJ Improved electro-convulsive therapy with low amperage unidirectional
currents. Dis Nerv Syst. 1951 Oct;12(10):306-10.
LEEDY JJ et al Use of music with electro-convulsive therapy; preliminary report. Dis Nerv
Syst. 1951 Sep;12(9):281-4.
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)
physiological observations and comparison with electro-convulsive therapy. J Endocrinol.
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
(17):653-5.
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.
Singapore Med J. 1992 Jun;33(3):271-2.
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
Biol. 1993 Oct;31(10):831-3.
HOME
THIS ARTICLE IS FOR YOUR REFERENCE ONLY. IF YOU HAVE ANY QUESTIONS, YOU
SHOULD CONSULT WITH YOUR DOCTOR.
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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