Is this barbaric treatment still carried out?!
Electroconvulsive therapy (ECT) is a controversial treatment but the stigma relates to early treatments where high dose electricity was given to patients without anaesthetic.
What is it?
A general anaesthetic and muscle relaxant is used to ensure the patient remains as still as possible. Electrodes are used to pass a small electrical current through the brain causing a brief (20-50 second) seizure. It can be given uni-laterally (to one side of the brain) or bi-laterally (to both sides). Very small movements of the limbs will be seen to signify a seizure has taken place. It re-aligns the brain chemistry altered by certain mental illnesses.
Why is is given?
Mental illnesses are treated with medication and psychotherapy but when certain illnesses are severe, life threatening and resistant to these treatments ECT can be used.
Severe symptoms may include:
- Refusal to eat and/or drink
- Risky/life threatening behaviours associated with mania
- Psychosis involving severe loss of touch with reality
ECT is also given if it has been successful in the past and the patient presents with similar symptoms. The decision is usually collaborative, between patients and prescribing psychiatrist, however, the patient may lack insight or have lost touch with reality, then consent is encouraged but not necessary.
Are there side effects?
An electrocardiogram (ECG) and blood tests will be taken to ensure the patient is physically fit enough to undergo the general anaesthetic and receive the treatment. However, side effects may occur.
Short term (minutes-hours):
- Confusion/feeling out of sorts
- Muscle aches
- Memory loss
- Affects of general anaesthetic
Long term (days-years) reported in a minority of cases:
- Memory problems
- Personality changes
- Loss of skills
Death or serious injury can occur in 1 in 80,000 treatments, about the same as with having a general anaesthetic for dental work.
Side effects can be reduced by given unilateral placement of the electrode on the non-dominant hemisphere rather than bilateral stimulation.
Does it work?
ECT is usually given in blocks of 6 treatments twice per week. Improvement in symptoms is usually reported after 2-3 treatments. If small improvements are seen after 6 sessions, up to 12 treatments are given. Treatment is stopped as soon as adequate improvement is seen.
A study of 1895 courses of treatment showed:
- 1712 reported improvement (‘minimally’, ‘much’ or ‘very much’)
- 113 reported no change
- 28 reported feeling worse.
Bilateral and high electrical current is shown to be more effective at treating symptoms but will increase side effects.
There is little evidence for continued or “maintenance” ECT.
A personal story
Mental illness can strike anyone at any time. I have had long standing mental health issues but a few years ago, I became extremely unwell, lost insight and required sectioning under the mental health act to keep me safe. I was unable to control my suicidal behaviours and although medication was tried, it was not effective in the time scale needed. I could not engage with psychotherapy due to severely distorted thinking.
I had lost hope. ECT was offered as a last resort. Due to my distorted thinking I did not know why people were bothering to keep me alive but consented feeling as though I may as well give it a go. (Although, my consent was not necessary as I was section under the MHA.)
It was quite bizarre to be offered it, I had horrendous images of old movies where you’d see the patient’s brain electrocuted and they’d have a violent fit but I was reassured I would have an anaesthetic and muscle relaxant to reduce jerking. It was still hard to understand I was agreeing to my brain being zapped.
After each treatment I would feel muzzy and a bit dazed for the rest of the day but compared to the severity of the symptoms of my illness, this was manageable. I was initially given bilateral ECT we saw a slight improvement in my mood but I was getting severe headaches so we continued with unilateral ECT for 12 more sessions until my mood improved enough for me to engage in psychotherapy.
Long term, I have lost a few chucks of memory but this happens with severe mental illnesses anyway so who’s so say it’s due to the ECT? Without it, I’m in no doubt my suicidal behaviour would have continued and probably ended my life so it truly was a life saving treatment.
ECT should not be given lightly. It is a serious treatment for a serious illness. There are side effects, just like there are for any treatment but since it is reserved for the most seriously ill who’s lives are at risk already the benefits by far outweigh the risks.
If you or someone you care for is offered ECT you will have gone through numerous other treatments unsuccessfully which can lead to feelings of helplessness and hopelessness. ECT is an unusual treatment that can offer hope.
Royal College of Psychiatrists