Electroconvulsive therapy (ECT): characteristics and uses in psychiatry

Electroconvulsive therapy (ECT): characteristics and uses in psychiatry

Throughout history, there has been strong criticism of the treatment offered by psychiatry for some types of mental disorders and alterations. Specifically, electroconvulsive therapy, or “electroshock” therapy, is one of the most notorious in society.

However, over time this technique has been perfected and electroconvulsive therapy is now carried out safely and effectively . Throughout this article we will discuss its characteristics, results and possible risks.

What is electroconvulsive therapy?

Electroconvulsive therapy (ECT), also known as electroconvulsive therapy , is a psychiatric treatment, which began in the 1930s and was designed to alleviate the symptoms of certain mental disorders and disorders.

For this purpose, electroconvulsive therapy uses electrical energy transmitting devices that send a series of electrical impulses from the outside to the patient’s brain . This impulse causes a small brain seizure that can last from 30 seconds to two full minutes.

Although electroshock therapy has traditionally been regarded as an inhumane method involving the torture of the patient, this technique has now made considerable progress. In addition, the patient is given a general anaesthetic , so that the patient remains asleep during the session and does not become conscious or feel any pain.

In this type of therapy, there are three essential variables that regulate its application:

  • The location or placement of the electrodes .
  • The duration of the impulse.
  • The electro-physical properties of stimulation.

However, despite the advances, this technique continues to carry some risks for the health of the patient , so it is not usually used except in those cases in which the patient does not respond satisfactorily to therapy with psychotropic drugs.

Currently, it is estimated that approximately one million people in the world are receiving electroconvulsive therapy. This is a relatively low figure considering the number of total population with some psychiatric diagnosis. Likewise, the main criticism is that, in addition to the associated risks, the effects of ECT are quite limited in time , so after the intervention the patient must continue with the medication.

For which pathologies is it applied?

Electroconvulsive therapy is applied as a second-line treatment for certain psychological disorders such as depression, mania and other mental illnesses in which medication is not effective, when the clinical picture is so severe or dangerous that drug therapy is not expected to have any effect or in pregnant patients with a high risk of harming the fetus.

This type of intervention has been shown to be effective in the treatment of the following disorders, causing a rapid and considerable decrease in the most severe symptoms . It is usually used in the following cases.

1. Major depression

ECT is particularly effective in cases of major depressive disorder , especially if the disorder is characterised by psychotic symptoms such as disconnection from reality or suicidal thoughts.

2. Depression resistant

In this case it is used when the symptoms of severe depression are maintained over time independently of the drug treatments administered.

3. Severe mania

In bipolar disorder, electroconvulsive therapy may be used when the patient is in the state of intense euphoria that is typical of this disorder. This state is often accompanied by impulsive behaviour, drug use and psychosis.

4. Catatonia

Catatonia is distinguished by the loss of movement or the manifestation of accelerated and abnormal movements. Although on many occasions it is caused by an organic disease, it is usually related to schizophrenia and other psychiatric disorders of a psychotic nature.

5. Dementia

Electroconvulsive therapy may be common in patients with dementia who have high levels of nervousness and aggression . These are resistant to treatment and diminish the patient’s quality of life.

What is the procedure to follow?

Before starting electroshock therapy, the patient must undergo a thorough evaluation that includes the patient’s medical history, a physical examination, psychiatric evaluation and physical tests including blood tests, electrocardiogram and an anesthesiologist’s report .

The purpose of these tests is to make sure that the electroconvulsive therapy is safe for the patient, thus ensuring the minimum possible risks or side effects.

Once the parameters or variables cited at the beginning of the article have been established, the processing session is carried out. First of all, general anesthesia is administered and intravenous lines are placed to provide the patient with fluids and anticonvulsant medications.

Then pads with the electrodes are placed on one or both sides of the head , depending on whether the current is to be administered unilaterally or bilaterally. The session usually lasts between 5 and 10 minutes, regardless of the time needed to prepare and recover from the treatment.

When this is completed, the patient is transferred to a recovery room where the patient is observed and monitored for any adverse reactions. It is common to experience a feeling of confusion or disorientation upon awakening.

Finally, it is not necessary to admit the patient, but in many cases it can be done on an outpatient basis.

What results does it offer?

Although it is not yet known exactly how ECT causes the brain changes that help in the patient’s recovery, the patient usually shows significant improvement from the sixth ECT session, although an absolute remission may take much longer or even be impossible in some cases.

Since the improvement of symptoms is usually temporary, on many occasions the patient must continue with the pharmacological treatment or even require continuous electroconvulsive treatment.

What are the risks?

Although the side effects or risks of electroconvulsive therapy have decreased a lot since its creation , we can still find some unwanted consequences that can be annoying or distressing for the person.

Among these side effects are:

  • Retrograde amnesia or loss of memory of what happened moments before treatment or during the weeks of treatment.
  • A feeling of temporary confusion.
  • Headaches.
  • Hypotension or hypertension .
  • Tachycardia or heart problems.
  • Muscle pain.
  • Nausea .

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