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ECT stands for electroconvulsive therapy, an intervention used by psychiatrists to treat depression, schizophrenia, and psychotic disorders. Centuries ago, physicians believed that convulsions (such as in epilepsy) and schizophrenia are mutually exclusive. Modern science refutes this stimulating researchers to apply electric impulses to mentally diseased individuals (Keltner & Boschini, 2009). More than 100,000 Americans undergo ECT sessions annually, indicating its effectiveness and safety. This paper provides a short explanation of ECT technique, its principles and results on the basis of a recent review by Keltner & Boschini (2009) published in the Perspectives in Psychiatric Care.
The client is hospitalized and the procedure is performed under control of the psychiatrist, anesthesiologist, and a nurse. The patient is given a barbiturate to induce sleep, muscle relaxant to prevent associated muscle contractions, beta-blocker to protect from excessive sympathetic tone, and an anticholinergic agent to reduce salivation. Electrical impulse is applied with a given power through head electrode. The electrical burst of 50-70 mA induces seizures lasting 30 sec. A couple of sessions to reach a dozen are usually enough for a complete course. The most common side effect is amnesia, both retrograde and antegrade, and generalized confusion after awakening from anesthesia. ECT does not damage the brain, but lethal consequences have been reported due to arrhythmias, hypertension, and other associated conditions of general anesthesia.
The exact mechanism how ECT works is still unclear, but the following concepts currently prevail: slowing of brain waves (like shutting of computer to reboot the system), rebalancing of neurotransmitters (second messenger systems, serotonergic, GABAergic, dopaminergic and beta-adrenergic receptors), hormone rebalancing and enhancing neuronal sprouting (Keltner & Boschini, 2009). Probably, all these mechanisms work in combination, probably in various proportions depending on the individual’s neuronal pattern.
Individuals who suffer from major and bipolar depression benefit from ECT best. Postpartum psychosis can be effectively abrupted by a session of ECT. Schizophrenia, bipolar mania, and movement disorders are also sensitive to ECT. Individuals with alcohol problems, drug abuse, anxiety or personality disorders, and phobias are insensitive to ECT. Immediate use of ECT is warranted in suicidal or assaultive behavior as well as catatonia. ECT is usually applied more often to female, affluent, older, and Caucasian patients (Keltner & Boschini, 2009).
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According to scientific findings, ECT is the most effective treatment against depression (Keltner & Boschini, 2009). However, in practice, ECT is reserved as the treatmnet of the last resort by doctors and patients. The reasons for such prejudication against ECT are numerous, and one of them comes from the past and social negative depiction best captured by Jack Nicholson in One Flew Over the Cuckoo’s Nest. The method was propagaised to be barbarian. Another precaution to be explained both to the patient and his/her relatives is potential amnesia that may not be cured completely or confusion as discussed above. Not many physicians are familiar to ECT, and a lot of doctors have never practiced this therapy during their residency. The next problem is the nature of the underlying diagnosis. Over 50% of patients may return to their psychiatric disorders within just a few weeks after the course is over. Nevertheless, scholars state that if a patient reports ineffectiveness of antidepressants, ECT is able to lift depression with a 90% probability. In combination with drugs, there are considerable chances for successful combating depression (Keltner & Boschini, 2009).
The American Psychiatric Association recognizes ECT as a potentially life-saving treatment for those affected by severe depression. It is recommended to apply ECT to those who respond to medications poorly, or in acute situations. Relapse prevention is another indication suggested by the American Psychiatric Association.
In conclusion, ECT is an effective and safe method to treat psychiatric disorders such as depression; however, in practice, it is used typically only after numerous medications have failed to help. Until researchers understand the nature of ECT in more detail, the society will probably resist it as the first choice intervention in mental disorders.
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