Electroconvulsant Shock Therapy

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Depression and Psychoanalysis

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Memory Loss

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Left Frontal Lobectomy

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Electroshock Therapy

 In 1935,  during a time when mental illness was not understood as it is today, and at a time when neuroscience and knowledge of the brain was far less superior, there was an invention called the ‘leukotomy’, better known now as ‘the prefrontal lobotomy’.  If this sounds frightening to you… it should.  The prefrontal lobotomy was invented by Dr. Egas Moniz and was the procedure of drilling two holes into the skull severing connections between the prefrontal lobes and the rest of the brain on individuals that suffered emotional disorders, or irrational behavior.  This showed some success, but also showed some failure.  However, Moniz still received a Nobel Peace Prize for his invention. 

Following the works of Moniz was Dr. Walter Freeman’s invention of ‘The Transorbital Lobotomy’ which was the procedure of inserting a long thin metal rod under the eye-lid and inserting it through to the eye socket, tapping on it until it reached the frontal lobes.  The rod was then rotated back and forth until the connections between the prefrontal lobes were severed by the rest of the brain.  And despite a high rate of permanent brain damage as a result, he continued to perform over 3500 lobotomies!  Unfortunately this procedure resulted in patients suffering from lethargy, intellectual impairment and inability to further care for themselves.  Needless to say, due to the unethical nature of this procedure, the lobotomy is no longer performed today as it was in the past!

However, this brings us to more recent controversial procedures in treating mental illness such as Electroshock Therapy, also known as Electroconvulsive Therapy (ECT).  This in its own right is also a procedure that frightens many. 

History

Developed in 1938 by Italian psychiatrist Ugo Cerletti, electroconvulsive therapy was first used on an individual with the initials S.E. who was diagnosed with schizophrenia.  Cerletti, using this gentleman as his first patient, proceeded to administer electric voltage of 80 volts for 0.2 seconds.  S.E. began to sing, and with that another administration of 110 volts was then given for 0.2 seconds.  Electroconvulsive therapy was also known to be used to ‘cure’ homosexuality during the 11960’s.  Of course, this form of ‘treatment’ for what was once considered an ‘illness’…did not work!

ECT is used sparingly to treat severe depression, bipolar disorder and schizophrenia when traditional forms of medication are ineffective.  

How does it Work?

Prior to treatment, the doctor will need a full mental health diagnosis of the patient, as well as the purpose for receiving ECT.  The risks and benefits of either receiving, or not receiving the treatment must be discussed with any alternative treatments that may not have been considered by the patient. 

This psychosurgical procedure; performed by neurosurgeons, consists of the placement of electrodes on either one, or both sides of the skull, then turning on a brief electrical current which then induces a seizure which is surprisingly known to alleviate symptoms of mental illness.  It works by either activating or inhibiting nerve impulses in the brain by electrodes.  These electrodes can be placed as implants within the brain or the aforementioned electrodes placed on the scalp.  This form of therapy reduces the chance of recurring episodes and has a quicker success rate than medicinal intervention.  During the procedure, the patient is given anesthesia and their vitals are monitored.  The voltage triggers a seizure that lasts less than one minute, and when the patient awakes they feel groggy for a short period of time, but are then able to resume with normal activities.  Treatment usually lasts between 6 – 12 weeks with ECT administered 3 times a week until the patient’s depressive symptoms subside.  Electrical activity during the treatment is dependent upon the resistance of the skin, skull and tissue.  The energy level is individualized to the patients’ particulars such as age, gender size, medications, and needs.  The Bilateral ECT has one electrode placed just above the temple, while the Unilateral ECT has one electrode placed in the center of the forehead while another electrode is placed on the side of one temple. 

One theory is that ECT causes a release of neurotransmitters that are needed for recovery and another theory suggests that ECT helps the growth of cells and synapsis. 

ECT is predominantly used for individuals that suffer from debilitating depression or catatonia and are immune to anti-depressant medication.  When medication cannot treat their depression, and if they are severely suicidal, then ECT can be a life-saving treatment.  It has also been effective for treatment of schizophrenia and can be combined with medication to further increase the success rate.  Schizophrenia that has positive symptoms such as delusions, hallucinations and paranoid behavior can be successfully treated with ECT, however, negative symptoms such as undifferentiated behavior, lack of interest and self-care which tend to be long-term symptoms are not treatable.  In other words, to treat schizophrenia with ECT, it needs to be diagnosed relatively early.

Studies have shown ECT to be effective for seniors for both initial treatment of depression and maintenance treat following.  Electroconvulsive therapy is deemed safe for everyone from children to pregnant women and seniors.  In fact, it has been stated that it is actually safer for some who cannot take psychotropic drugs.

Controversies

Many people rejected the idea of electroshock therapy, claiming it was a form of dangerous medical abuse.  However, their fears and assumptions were not scientifically based, and were derived from myths and anecdotes.  ECT showed a high success rate, with over 9000 citations in scientific journals confirming the efficacy and the safety of this procedure. 

Risks

During the beginning years there was a risk of spinal fracture from the seizures

Although ECT has proven to be a successful last resort, it does come with possible side effects:

  • Nausea or vomiting
  • Flu like symptoms
  • Headaches
  • Memory loss – just prior to the procedure, can be permanent, but very rare
  • Confusion
  • Increased heart rate
  • Increased blood pressure

Conclusion

It has been reported that successful treatment of ECT lowers mortality rates from suicide, and ECT has been stated to have a greater success rate in severely depressed individuals than medication.

To date, over 100,000 Americans have been successfully treated with electroconvulsive therapy, yet unfortunately the stigma of this severe form of therapy still exists.  However, just as with ECT, mental illness to this day is also still stigmatized.  Perhaps the stigma of electroconvulsive therapy cannot vanish until mental illness is more understood.

Sources:

  1. http://www.psychiatrictimes.com/major-depressive-disorder/electroconvulsive-therapy-second-most-controversial-medical-procedure
  2. http://www.serenityrecovery.com/is-electroshock-therapy-beneficial-for-addiction-treatment/
  3. https://www.scientificamerican.com/article/electroconvulsive-therapy-a-history-of-controversy-but-also-of-help/
  4. http://www.healthguideinfo.com/treating-depression/p82087/
  5. https://www.nimh.nih.gov/news/science-news/2016/electroconvulsive-therapy-lifts-depression-sustains-remission-in-older-adults.shtml
  6. https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml
  7. http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/electroconvulsivetherapy,ect.aspx
  8. Fink, Max M.D. Electroshock, Healing Mental Illness (1999) Oxford, University Press, NY
  9. Wade, Tavris, Saucier, Elias Second Canadian Edition Psychology, (2007) Pearson Prentice Hall

 

 

 

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