Electroshock: applications of electroconvulsive therapy

Electroshock: applications of electroconvulsive therapy

With the popularization of the use of electricity in the 19th century, a large number of applications of this phenomenon appeared. One of them was the treatment of physical and mental diseases by electroshock; however, electroconvulsive therapy as such did not emerge until the first half of the last century.

Despite its bad reputation, electroconvulsive therapy or electroshock has several applications that have been validated by scientific research. Although it still carries some side effects and risks today, these are much less serious than is usually believed.

What is electroconvulsive therapy?

Electroshock therapy consists of applying low intensity electrical currents to the brain with the aim of provoking a mild seizure. This in turn produces chemical changes in the central nervous system, which may relieve the symptoms of certain psychological disorders.

The exact mechanism of action of ECT is not known, although it is believed to have a short-term anticonvulsant effect on the frontal lobes and a long-term effect on blood supply and metabolism in the temporal lobes . In addition, it seems to increase the volume of the hippocampus.

This type of intervention is performed under the effects of anesthesia and muscle sedatives; in addition, mouth guards are usually used to prevent damage to the tongue and teeth. Small electrodes are placed on one or both sides of the head, through which the shocks will be received.

The convulsions induced by the electroshock equipment normally last less than a minute. Although the person remains unconscious and physically relaxed, electroencephalographic activity is triggered during this period; subsequently the brain recovers its normal function.

Electroconvulsive therapy interventions consist of several sessions, generally between 6 and 12 , which are spread over a period of 3 or 4 weeks, so that at least a couple of days are left between each application of electroshock. The treatment is adapted according to the specific disorder and the severity of the symptoms.

Applications of this treatment

Electroconvulsive therapy is usually used in patients with severe symptoms that do not respond to other treatments , although it does not work in all cases. Research has so far confirmed the effectiveness of electroshock in the following disorders.

1. Major depression

In the case of depression, electroshock is mainly used when there are psychotic symptoms or risk of imminent suicide , especially if other treatments have been applied and no results have been obtained.

This therapy is considered to be useful in the management of psychogenic depression, but also that which appears as a consequence of biological alterations, such as Parkinson’s disease, Huntington’s chorea or multiple sclerosis.

Electroconvulsive therapy has a 50% success rate in this type of case. Depressive episodes in the context of bipolar disorder show a similar response to electroshock.

2. Bipolar disorder

Electroshock is a second-line treatment for bipolar disorder, both for depressive and manic episodes, which are characterized by a prolonged state of excessive euphoria and activation. It is applied particularly in bipolar patients who present long-lasting manic episodes .

3. Catatonia

Catatonia is a state of immobility or motor disorganization that occurs with a decrease in reactivity to environmental stimuli. It usually occurs in the context of schizophrenia , although it can also occur in depression, post-traumatic stress disorder or due to physical affectations, such as substance overdose.

When the catatonia is severe and life-threatening, mainly due to starvation, electroconvulsive therapy is considered the treatment of choice. However, it seems that these effects are of short duration , so it is necessary to combine electroshock with other long-term treatments.

4. Schizophrenia

Electroconvulsive therapy is sometimes applied to schizophrenic patients who do not respond to treatment by antipsychotic drugs . As we have seen, it is especially effective in cases of catatonic schizophrenia, one of the most common subtypes of this disorder.

Side effects and risks of electroshock

In the beginning, electroshock was applied without anaesthesia and the electrical discharges were usually unnecessarily intense . This meant that the primitive treatments caused very serious side effects, the most common and striking of which were memory loss and the fracture of teeth and vertebrae.

Today electroshock is considered a safe treatment . It is true that sometimes confusion and retrograde amnesia occur just after the application of shocks, but orientation recovers after a few days at most, and memory loss is rarely maintained after one or two months after the end of the treatment.

During the weeks of treatment it is common for headaches , muscles and jaws to appear, as well as nausea. These symptoms subside with the use of ordinary medication. In general, the risks and side effects of electroshock are no greater than those of any other procedure involving the use of anesthesia.

One of the most striking aspects of electroconvulsive therapy is that has not been described as having any contraindications ; for example, it is the treatment of choice for treating severe, psychotherapy-resistant depression in pregnant women, as it carries no risk to the fetus, unlike most medications.

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