What Is Electric Shock Therapy?
Modern electric shock therapy or electroconvulsive therapy involves inducing seizures in an individual to reset the brain functions associated with some psychiatric disorders. It is considered the treatment of last resort for patients who did not have success with drug therapies. It is also used in individuals who have life-threatening psychiatric conditions and those who are suffering from a catatonic state (lack of movement or excessive movements). It is typically indicated for mood disorders, depression, and bipolar disorder. Many individuals experience good improvement in their symptoms after undergoing electric shock treatment.
What Does Shock Therapy Do?
Nerve cells (neurons) in the brain communicate through electrical signals, which influence brain chemistry, contributing to different moods and behavior. The flood of electrical activity sparked by electric shock therapy sessions alters that chemistry. Meaning that it triggers the release of certain chemicals (neurotransmitter molecules) that help carry signals between the neurons and thereby influence one’s mental health. Electric shock therapy also stimulates the flow of hormones to reduce symptoms of depression. Fascinatingly, the specific details of how the therapy works remain unknown, despite its proven track record of success.
What Is the Purpose of Electric Shock Therapy?
Several mental health conditions show significant and rapid improvement with electroconvulsive therapy. One may use it to treat:
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Severe Cases of Major Depression - Extreme state of depression accompanied by delusions and detachment from reality, where one may express suicidal ideations and refuse to eat.
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Treatment-Resistant Depression - Where the individual does not positively respond to full course medications or other strategies of cure.
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Bipolar Disorder - In patients where all other therapies for bipolar disorder were unsuccessful.
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Management of Severe Mania Associated With Bipolar Disorder - Where the individual is in an uncontrollably agitated state of euphoria, violence, or hyperactivity from psychosis or substance abuse. Tend to indulge in impulsive, risky behavior due to poor judgment and poor decision-making abilities.
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Catatonia (Associated With Schizophrenia or Other Psychiatric Disorders) - The individual shows a complete lack of movement, fast or strange moments, or lack of speech. This may be part of certain medical illnesses as well.
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Dementia - Associated with agitation and aggression, compromising one’s quality of life which may be hard to control and treat.
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Poor Tolerance to Drugs - Those who have had adverse reactions to medications that leave them unable to continue treatment with regular drugs.
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In Pregnancy - Regular drug therapy may harm the fetus.
How Is Electric Shock Therapy Performed?
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One may have to undergo a medical evaluation before the therapy, where the doctor reviews the medical history and conducts a full physical examination. The individual’s psychiatric assessment must be complete and unambiguous, and the diagnosis should indicate electroconvulsive therapy. The doctor may order an electrocardiogram (ECG) test and other blood work to deem the individual fit for the procedure.
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Informed consent is a significant part of the process. Written informed consent should be provided by the patient before the therapy. In cases where the patient is severely ill to decide, the consent will be governed by state law.
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The majority of the electric shock treatments are managed like outpatient procedures, and the patient is given general anesthesia. While the individual is asleep (under general anesthesia), electrodes deliver mild electrical pulses into the brain. This fires up a large group of nerve cells all at once to cause a briefly controlled seizure. The seizure is monitored throughout the procedure by electroencephalography (EEG), and mostly just one seizure is induced at a time. The electric current given to the brain will be low enough not to harm the patient and high enough to trigger a seizure. The treatment team stays close by monitoring the patient throughout the procedure. To avoid large-scale spasms affecting the rest of the body, doctors give a muscle relaxant to the patient. Probably, the only physical indication of the electricity flooding the brain is a twitching foot. The treatment lasts for about a minute. And most patients can resume normal activities about an hour after each session.
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Most patients may be concerned about having a seizure while they are unconscious and also, what could happen during a seizure. But with the anesthetic agent, the seizure activity is hardly perceivable. The only way to know one is having a seizure is through the EEG monitor. The patient is awakened soon after the procedure and monitored for a short while, like any other general anesthesia procedure. Within half an hour, they will be discharged from the healthcare facility. Some individuals may need regular recurring ECT treatments to control their condition effectively. Or just have one session of ECT and then continue the rest of the treatment with medication.
What Are the Benefits of Electric Shock Therapy?
Most patients treated with electroshock therapy have two or three sessions per week for several weeks. Some individuals notice an improvement in their symptoms in just one session. But it may take more than one for others. One may still require occasional follow-up sessions for a while or the rest of their life. Interestingly, maintaining the disorders with electric shock therapy works better when paired with medication. Even those who were resistant to the medication before were found to tolerate them well after the therapy.
What Are the Possible Side Effects of Electric Shock Therapy?
Modern electroconvulsive therapy is much safer than it used to be. Yet, some individuals may experience some side effects, such as:
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Feeling achy, fatigued, or nauseated right after treatment.
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Some have trouble remembering what happened before the session. For example, one may not be able to recollect what they ate last night if asked.
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Rarely do some individuals have trouble remembering matters weeks and months before therapy. For the majority, this memory loss improves over time.
What Are Other Brain Stimulation Treatments?
Transcranial Magnetic Stimulation:
Transcranial magnetic stimulation is used for treating depression that does not respond to other therapies. It is not as effective as ECT in treating severe illness. Rapidly alternating magnetic fields are used to stimulate specific areas of the brain. Side effects are milder and include muscle twitches, headache, and pain at the site of stimulation.
Vagus Nerve Stimulation:
Vagus nerve stimulation is used for treating depression that has not responded to other therapies. It is not considered for acute severe depression as the therapy may take months to develop a response.
Conclusion:
Electric shock therapy carries a deep stigma that is leftover from the way it was conducted in the past. In the olden days, an electric shock was given to a patient who was fully awake and conscious. Also, the amount of current used was not properly regulated. This used to cause large-scale whole-body seizures, and the patent often ended up with additional injuries and bruises. Such a history bears little resemblance to the modern electroconvulsive therapy procedure. The persisting misperceptions about ECT often tamper with the treatment's life-changing potential. Electroconvulsive therapy can make a difference in individuals when every other treatment fails. As researchers come to a better understanding of brain function, doctors may likely be able to make electric shock therapy even more effective in the future.
