It’s not your grandparents’ ECT

RAndle McMurphy bites into a bite block, electrodes are placed on both sides of his head, the juice flows and the seizure begins. Several weeks later, her limp body, with scars on her forehead, returns to the room.

In the film, one flew over the cuckoo’s nestRandle’s first procedure was electroconvulsive therapy (ECT) c.1963. The final procedure was a lobotomy.

Lobotomies are no longer performed. ECT it is, but it looks very different than Randle’s and the 1957 shot in the image above.

Although highly stigmatized and therefore underused, electroconvulsive therapy is an effective and safe intervention for those suffering from treatment-resistant emotional and mental conditions.

Definitely not your grandparents’ ECT.

Along with some important new research, let’s talk about it…

What is electroconvulsive therapy?

How about we start with the brain stimulation interventions that ECT is not: deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS)?

Electroconvulsive therapy is a medical treatment that uses electrical stimulation to induce a controlled and monitored seizure. The recipient is under general anesthesia.

ECT is most commonly used for treatment-resistant depression, suicidality, bipolar illness, psychosis, catatonia, and geriatric cognitive challenges.

Some quick things…

• About one million people worldwide receive ECT each year.
• Approximately 70% of ECT patients are women.
• More than a third of ECT patients are 65 years or older.
• Use in children and adolescents remains relatively rare and is prohibited in some US states.

ECT is a therapy authorized by the US FDA. Additionally, in 2018 the FDA issued a final order to regulate ECT devices. TCE regulation is a priority in other countries. For example, the Royal College of Psychiatrists in the United Kingdom has established the ECT Accreditation Service.

Types of ECT

There are two main types of ECT in widespread use…

• Bilateral: Electrodes are placed on both sides of the head. The goal is to affect the entire brain. It is, by far, the most common.
• Unilateral: one electrode is placed on top of the head and another on the temple, usually the right one. Limits current to one side of the brain.

Other techniques are also used, for example, the right unilateral ultra-brief pulse.

The placement of the electrodes, the frequency of treatment, the electrical waveform of the stimulus – everything is decided with the goal of maximum results and minimum side effects.

An initial ECT course usually consists of two or three sessions per week for an average of six to 12 sessions in total.

What is ECT used for?

We reviewed some conditions that ECT is used for, but let’s take a deeper look. While we’re at it, keep in mind that ECT is most often used when other treatments don’t work. And it is used when quick results are crucial.

The interesting aspects…

• Aggression and agitation in patients with dementia.
• catatonia
• Parkinson’s disease, particularly Parkinson’s-related depression and intractable seizure disorders.
• Postpartum psychosis and major depression: ECT can reduce the need for potentially dangerous medications.
• Psychotic disorders and symptoms.
• Depression: unipolar and bipolar.
• Mania
• Immediate threat of suicide.

Many people would be in bad shape without ECT.

Why does ECT work?

Welcome to the world of emotional and mental disorders. Antidepressants, antipsychotics, transcranial magnetic stimulation, ketamine, psilocybin, ECT… in short, scientists don’t know why they work.

Now, if you’ve lived in this area for a decent amount of time, you know that theories are everywhere. I mean, it has to be something, right?

Given what scientists know now, why does ECT work? The general idea is that it helps correct imbalances in the brain’s chemical messaging system. Let’s say the induced seizure “reboots” the brain.

Now, I’m no scientist, but I might have thought of that. You too right? Stay tuned, later we will review recent research that will bring us closer to the final result.

The ECT procedure

ECT can be performed during a hospital stay or on an outpatient basis.

Very simple! After an IV is inserted, a short-acting general anesthetic is administered, as well as a muscle relaxant to protect against bone and soft tissue injury during the seizure. EEG, ECG and blood oxygen monitoring cables are applied. Electrode pads are placed on the head.

While you sleep, a small amount of electrical current is delivered for typically between 100 milliseconds and six seconds. The seizure generated lasts approximately 40 seconds.

Patients wake up in a recovery area several minutes after the procedure and, in most cases, are ready to go within hours. Of course, transportation is required for outpatient procedures.

Have a look…

Side effects of ECT

The side effects of ECT that get the most attention are memory loss and confusion. For most people, they are temporary, the confusion resolves quickly and memory loss occurs within a few months. However, some people have permanent memory problems.

Other possible side effects…

• Headache
• Hypotension or hypertension.
• Cognitive impairment
• Increased risk of heart problems, particularly in those with coronary artery disease
• jaw pain
• Muscle pains
• Nausea

When considering reported side effects, keep in mind that ECT is used for a variety of conditions across demographics.

Does ECT work?

What it is, what it is used for, why it works and side effects: they are all important. But for most people, what matters is whether ECT works or not.

Very quickly, people turn to ECT because previous interventions have not worked. That raises a lot of expectations, which can make an objective assessment of effectiveness difficult. As for the results, it’s helpful to keep perspective.

For the treatment of depression without melancholia, some studies have shown an 80% effectiveness rate of ECT. It drops to 60% with melancholy. Research suggests that ECT works well in 80%-100% of patients with catatonia. And ECT is known to offer older patients with psychotic depression the best opportunity to reduce their risk of relapse.

Of great importance, studies have found that ECT can significantly and rapidly improve suicidal ideation.

New Research: Is This Why ECT Works?

Well, let’s end with some very recent and important news about why ECT works.

The story was told in two studies by researchers at the University of California, San Diego. His work was published on November 16, 2023 in the magazine, Translational psychiatry.

According to the study’s first author, Sydney Smith, the research mission went far beyond solving a nearly century-old puzzle. The team wanted to demystify one of the most effective, yet highly stigmatized, treatments for major depression.

From lead author Dr. Bradley Voytek…

…in people for whom medications don’t work, electroconvulsive therapy can save their lives. Understanding how it works will help us discover ways to increase the benefits and minimize the side effects.

The team has a curious and altruistic mentality. Let’s see what they came up with.

aperiodic activity

Smith describes aperiodic activity as the background noise of the brain. He notes that traditionally scientists haven’t paid much attention to it, but that’s changing.

The billions of neurons in our brain constantly go through cycles of excitation and inhibition (on and off) that correspond to the mental states we are very familiar with.

One of the functions of aperiodic activity is to help manage shock. And it does this by increasing inhibitory activity, which effectively slows things down.

How did they come up with that?

The team used electroencephalography (EEG) analyze the brain activity of study participants who received ECT for depression, as well as those who received a similar form of treatment known as magnetic seizure therapy (MST). Instead of electrodes, MST uses magnets to induce a seizure. By the way, I’m sure there will be more to come on MST.

When the team reviewed the EEGs of those receiving ECT and MST, a pattern of slowing brain electrical activity was observed. The inhibitory effects of aperiodic activity are thought to help explain this.

Now, the findings may not provide all the answers, but the link between aperiodic activity and the benefits of ECT is established. And good things can come from there.

The UC San Diego team is ready to apply the knowledge gained in their work to future research. For example, the team is exploring the possibility of using aperiodic activity as a metric of treatment effectiveness in other depression treatments, such as medications.

I don’t know about you, but I appreciate the research.

All what matters

It is a fact that electroconvulsive therapy has a dubious reputation, which encourages stigma and discourages its use.

In many ways, that is unfair.

No, electroconvulsive therapy is not always safe. Yes, it can have side effects. But it also has a track record of effectiveness and safety. And for someone who has very few options, that’s all that matters.

It’s not your grandparents’ (or Randle’s) ECT.

Thanks to Verywell Mind for the help with the information: Electroconvulsive Therapy (ECT): Definition, Types, Techniques, Efficacy written by Kendra Cherry, MEd.

Here is the news from the University of California, San Diego. Includes links to studies: New studies on brain activity explain the benefits of electroconvulsive therapy

Those emotional and mental health information and inspiration articles from Chipur – pick one.

Cover image: Author: School of Health and Life Sciences, University of Liverpool, UK. Minimally trimmed. This file is licensed under Creative Commons. Attribution-Share Alike 2.0 Generic license.

Bill White is not a doctor and provides this information for educational purposes only. Always contact your doctor if he has questions, advice or recommendations.