Electroconvulsive therapy (ECT)
During ECT, a brief electrical stimulus is given to the brain via electrodes placed on the temples. The electrical charge lasts between one and four seconds, and causes an epileptic-like seizure.
Before treatment, the patient is anaesthetised and given an injection of muscle relaxant that depresses the breathing, and oxygen is given until the patient is able to breathe naturally again. Most patients are given a course of between six and 12 doses of ECT at a rate of one a day, three times a week.
What is ECT used for?
ECT is usually given to people with severe depression which has not responded to other forms of treatment such as anti-depressants. However, it is sometimes used for people with a diagnosis of bi-polar disorder (manic depression) or schizophrenia. It should only be given after the risks have been explained and with the person’s consent. It can only given without consent if the person’s life is at risk.
How does it work?
It is not known how ECT works, but there are numerous theories.
- Neurotransmitter theory. ECT works like anti-depressant medication, changing the way brain receptors receive important mood-related chemicals.
- Anti-convulsant theory. ECT-induced seizures teach the brain to resist seizures. This effort to inhibit seizures dampens abnormally active brain circuits, stabilising mood.
- Neuroendocrine theory. The seizure causes the hypothalamus to release chemicals that cause changes throughout the body. The seizure may release a neuropeptide that regulates mood.
- Brain damage theory. Shock damages the brain, causing memory loss and disorientation that creates an illusion that problems are gone, and euphoria, which is a frequently observed result of brain injury. Both are temporary.
- Psychological theory. Depressed people often feel guilty, and ECT satisfies their need for punishment. Alternatively, the dramatic nature of ECT and the nursing care afterwards makes patients feel they are being taken seriously – the placebo effect.
Controversies about ECT
Controversy surrounds the safety, ethics and necessity of ECT. In particular, some mental health service users report severe side-effects, including severe memory loss, and that they have had ECT administered to them either against their will, or without their knowledge (where people are so depressed that they are unaware of what is going on around them).
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