ECT is a treatment using electrical stimulus to the brain to induce a generalized seizure (convulsion), hence, “electroconvulsive therapy.”
ECT was developed when doctors noticed that patients with symptoms of depression often felt better after having a seizure. Doctors began using medications to help induce the seizures in order to relieve depression. In 1938, electricity was first used to induce seizures as a therapy for depression.
Unipolar major depression (Major Depressive Disorder)
Generally, ECT is used for episodes of Major Depressive Disorder that may be:
ECT is also used for:
In addition:
Most psychiatric medications are safe for use with ECT, including antidepressants, antipsychotics, and lithium, although dosing schedules and dosage changes may be recommended.
Often, morning doses of medication are held, and the patient may take the medication after ECT.
Antiseizure medications like Depakote/Valproic Acid and Lamictal/lamotrigine can interfere with ECT’s mechanism of action and may need to be reduced or discontinued prior to ECT, except in patients with epilepsy.
Benzodiazepines can interfere with ECT and may need to be held prior to ECT or tapered. Sometimes a medication called flumazenil is used to reverse the effects of benzodiazepines immediately prior to the ECT treatment session.
Yes. Both ECT and Ketamine fall under the category of “interventional psychiatry.” Often, a patient with severe depression will pursue an interventional psychiatry treatment such as ketamine, and if the patient achieves only a partial mood improvement, additional treatment with a different type of “interventional psychiatry” may be indicated.
Yes. TMS is a type of brain stimulation, and it was inspired by the brain stimulation provided by ECT. However, TMS is a much more limited type of brain stimulation as compared to ECT. When a patient does not respond to TMS, it may be appropriate to pursue ECT therapy.
TMS uses a magnet to stimulate the brain “transcranially”: that is, the magnet generates a pulse which travels through the skull and connective tissue and stimulates the brain. The individual pulses generated by the TMS machine are relatively mild, and for this reason, the patient requires many pulses per treatment. In fact, a typical TMS treatment for depression includes 3000 pulses in one session, and more than 100,000 pulses over the course of the entire treatment!
ECT, in contrast, can be likened to cardioversion. When a patient receives cardioversion to reset the beat of the heart, the electrical stimulus is large enough to “reset” the heart’s pacemaker. This is a good metaphor for ECT. In ECT, the electrical stimulus is large enough to lead to a generalized seizure, which leads to a number of changes in the brain. These changes, individually and in combination, have a strong tendency to push the brain out of depression. In a sense, ECT is like a “neuroversion” where the brain is “reset” out of a depressive episode and back to normal functioning.
Ketamine is an anesthetic that is known to have multiple effects on the brain, including increase in neuroplasticity, increase in glutamate transmission, and increase in activity in certain regions of the brain. These mechanisms are thought to underlie the antidepressant effect of ketamine. Ketamine is given as a series of IV infusions over a 3–4-week period.
ECT, in contrast, is a treatment based on brain stimulation rather than on medication. The electrical stimulation in ECT leads to a seizure. The electrical stimulation itself, as well as the seizure, appear to be important in the antidepressant effect of ECT. ECT appears to act as a “neuroversion”: a treatment which resets the brain out of the depressed state and back into a “default” mode of more healthy functioning. ECT is done 2-3 x per week, and typically patients receive between 9 and 12 treatments (but may receive more).
Electroconvulsive therapy (ECT) is a medical treatment that uses electrical currents to stimulate the brain to induce seizures, which have been shown to be an effective treatment for severe depression. Despite its history of controversy, ECT is considered a safe and effective treatment for a range of mental health conditions, including depression, and has been found to be more effective than other treatments in certain cases.
In this essay, I will explore the effectiveness of ECT as a treatment for depression, including its history, the mechanics of the therapy, its benefits and side effects, and its comparison with other treatments.
The use of ECT as a treatment for mental illness dates back to the 1930s when it was first developed by Italian neuropsychiatrist Ugo Cerletti and his colleague Lucio Bini. ECT was initially developed as a treatment for schizophrenia but was later found to be effective in treating depression.
ECT has come a long way since its inception, and modern ECT is administered under strict guidelines and with advanced technology, making it much safer than it once was.
ECT involves the administration of a small electric current to the brain, which induces a seizure. The current is delivered through electrodes that are placed on the patient’s scalp, and the seizure typically lasts for a few seconds to a few minutes.
The exact mechanism by which ECT works is not fully understood, but it is thought to affect the levels of neurotransmitters in the brain, particularly serotonin, which is known to play a role in mood regulation. ECT is also thought to increase the levels of brain-derived neurotrophic factor (BDNF), a protein that is involved in the growth and survival of neurons.
ECT is considered to be one of the most effective treatments for severe depression, and it has been found to be particularly effective in cases where other treatments have failed. In fact, according to the American Psychiatric Association (APA), ECT is considered the “gold standard” of treatment for severe depression.
One of the main benefits of ECT is that it works quickly. Unlike antidepressant medications, which can take weeks or even months to take effect, ECT can produce significant improvements in mood within a few days. This rapid onset of action can be particularly beneficial for patients who are severely depressed and at risk of self-harm or suicide.
Another benefit of ECT is that it is effective in treating depression in older adults. Depression is a common problem in older adults, and it is often difficult to treat with medication due to the increased risk of side effects. ECT has been found to be safe and effective in treating depression in older adults, and it may be a particularly useful treatment option for this population.
Like any medical treatment, ECT can have side effects, but the risks are generally low, and the benefits of treatment often outweigh the risks. Some of the common side effects of ECT include headaches, muscle soreness, and nausea. These side effects typically resolve within a few hours to a few days after treatment.
One of the most significant concerns regarding ECT is the risk of cognitive side effects, such as memory loss. However, it is important to note that the risk of cognitive side effects is generally low, and most patients who undergo ECT do not experience any significant cognitive impairment. In cases where cognitive side effects do occur, they are usually temporary and resolve within a few weeks to a few months.
While ECT is considered to be the most effective treatment for severe depression, there are other treatments available, and the choice of treatment will depend on the individual patient’s needs and preferences.
