Electroconvulsive Therapy (ECT): Brutal or Stigmatized Treatment?
- Jiwoo Lee
- Mar 18, 2024
- 4 min read
Updated: Jun 6
What comes to your mind when visualizing electric shock therapy to cure mental illness? If it reminds you of an image of a barbaric psychiatrist stimulating a fully awakened patient with the fatal current of electricity, you might have a stigmatized perception of Electroconvulsive Therapy (ECT). Despite its notorious reputation, ECT is one of the safest and most effective treatments especially for patients who are resistant to conventional pharmacies.
As a “reset button for the brain,” ECT has been a life-saving procedure for patients suffering from depressive symptoms such as severe treatment-resistant depression, schizophrenia, bipolar disorder, and catatonia; Still, ECT is an underrated, misunderstood, and underused treatment regardless the rapid mitigation of symptom after receiving it. In this article, the unknown truth behind ECT will be unfolded.
What is Electroconvulsive Therapy (ECT)?
Electroconvulsive Therapy (ECT) is a therapeutic procedure for patients having serious mental illness in which weak electric currents from electrodes pads travel through the brain, purposely stimulating a small seizure. After injecting a muscle relaxant and an anesthetic, the electric currents start to trigger a slight seizure, which normally lasts less than 1 minute. Patients in the acute series are generally given ECT two to three times a week in one way among three different electrode placement: right unilateral, bi-frontal or bi-lateral.
Most patients begin their journey of recovery with a right unilateral placement when receiving ECT; however, when their symptoms are not mitigating, they can replace the type of stimulus into bi-frontal or bi-lateral placement, taking higher risk of memory loss and other downside effects. Recently, a newer stimulus named right unilateral ultrabrief pulse ECT was developed, and it allows patients to receive treatments on a daily basis without burden.
Three Theories behind the Mystery of ECT’s Mechanism
Even though it has been 86 years since ECT was introduced by Italian psychiatrists Ugo Cerletti and Lucio Bini, the mechanism of ECT still remains inscrutable despite its proven effectiveness and records. Nevertheless, researchers have come up with three major potential theories of how ECT neuroscientifically works: the generalized seizure theory, the neuroendocrine-diencephalic theory, and the combined anatomical-ictal theory.
The Generalized Seizure Theory
Renowned Swedish psychiatrist Jan-Otto Ottosson (1925-2023) theorized that the evocation of generalized seizures is the main factor to the efficacy of ECT. He argued that the greater the seizure generalization measured from ictal EEG amplitude, the stronger the brain stem is activated. Supporting this idea, Ottosson observed that bilateral electrode placement facilitates more distinct seizure generalization and has a better therapeutic ability than other electrode placements. This connection led him to conclude that the key factor of ECT’s mechanism is generalized seizure when electric current flows into the patient’s brain system.
The Neuroendocrine-Diencephalic Theory
This theory suggests that ECT works by repairing neuroendocrine abnormalities related to melancholic depression. Due to the excess secretion of cortisol, which has psychotropic effects, a dysfunction of the HPA Axis provokes states of mania or depression. Then, ECT causes wide release of endocrines and following responses on the HPA Axis, activating the axis and regulating severe depression as a result.
The Combined Anatomical-Ictal Theory
Another theory insists that neurotrophic effects, indispensable for the ECT efficacy, are released from seizure activity in the limbic system, the part of the brain related to emotional and behavioral responses. Based on the brain MRI of depressed patients, researchers observed that the volumes of both sides of hippocampi decreased, suggesting the correlation between the intensity of depression and volumes of hippocampi. The new brain MRI taken one week after ECT showed increases to both hippocampal volume, which supports the effect of ECT on depression.
Benefits and Side Effects of ECT
The ultimate purpose of ECT is to rescue patients from severe symptoms and provide them with a quick, but complete recovery. Even when a perfect recovery is unachievable, more than 80 percent of the patients report at least 50 percent of improvement in symptoms after receiving multiple treatments.
Nevertheless, although it is one of the safest therapeutic treatments given under anesthesia, ECT is not free from side effects. The most commonly reported side effects of ECT are jaw pain, nausea, headache, and memory loss, or retrograde amnesia. In regards to memory loss, especially, numerous patients can barely remember many of the events that happened a few months or weeks before receiving ECT, but fortunately, those lost memories are returned within 6 months. As mentioned earlier, certain electrode placements like bi-lateral and bi-frontal electrode placement induce higher risk of memory loss but provide a much noticeable improvement compared to what the stimulus from right unilateral electrode placement does to patients.
Conclusion
Regardless of its frightening, barbaric portrayal in the media, ECT is a worthwhile treatment to consider as an option after all conventional methods of treatment have failed on patients. Starting from a right unilateral placement, the wave of electric current may revive the pulse of patients’ life, supporting their way to achieve complete recovery. When attempting to escape from the swamp of psychological distress, this quick electric shock may press the “reset button” for your brain.
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