The truth about electroconvulsive therapy (ECT) - Helen M. Farrell
In 1982, a young nurse was suffering
from severe, unrelenting depression.
She couldn’t work, socialize,
or even concentrate well enough
to read the newspaper.
One treatment changed everything.
After two courses of electroconvulsive
therapy, or ECT, her symptoms lifted.
She went back to work, then on to graduate
school, where she earned high grades.
At first, she talked openly about
her life changing treatment.
But as she realized many people had an
extremely negative impression of ECT,
she stopped sharing her experience.
ECT carried a deep stigma,
leftover from a history that bears little
resemblance to the modern procedure.
The therapy was first
used in medicine in 1938.
In its early years, doctors administered a
strong electrical current to the brain,
causing a whole-body seizure
during which
patients might bite their tongues
or even break bones.
Modern ECT is very different.
While a patient is under
general anesthesia,
electrodes deliver a series
of mild electrical pulses to the brain.
This causes huge numbers of neurons
to fire in unison:
a brief, controlled seizure.
A muscle relaxant keeps spasms
from spreading to the rest of his body.
The only physical indication of the
electricity flooding the brain
is a twitching foot.
The treatment lasts for about a minute,
and most patients are able
to resume normal activities about an
hour after each session.
ECT is commonly used to treat severe cases
of major depression or bipolar disorder
in patients who haven’t responded
to other therapies,
or who have had adverse
reactions to medication.
Half or more of those who undergo
treatment experience an improvement
in their symptoms.
Most patients treated with ECT have two or
three sessions per week for several weeks.
Some begin to notice an improvement
in their symptoms after just one session,
while others take longer to respond.
Patients often continue less frequent
treatments for several months to a year,
and some need occasional maintenance
sessions for the rest of their lives.
Modern ECT is much safer than
it used to be,
but patients can still
experience side effects.
They may feel achy, fatigued,
or nauseated right after treatment.
Some have trouble remembering what
happened right before a session—
for example, what they had for
dinner the previous evening.
Rarely, they might have trouble
remembering up to weeks and months before.
For most patients, this memory
loss does improve over time.
What's fascinating is that despite its
proven track record,
we still don't know exactly why ECT works.
Neurons in the brain communicate via
electrical signals,
which influence our brain chemistry,
contributing to mood and behavior.
The flood of electrical activity sparked
by ECT alters that chemistry.
For example, ECT triggers the release
of certain neurotransmitters,
molecules that help carry signals between
neurons and influence mental health.
ECT also stimulates the flow of hormones
that may help reduce symptoms of depression.
Interestingly, ECT maintenance works
better when paired with medication,
even in patients who were
resistant to medication before.
As we come to a better
understanding of the brain,
we’ll likely be able to make
ECT even more effective.
In 1995, more than a decade after
her first course of ECT,
the nurse decided to publish an
account of her experience.
Because of the stigma surrounding
the treatment,
she worried that doing so
might negatively impact
her personal and professional life,
but she knew ECT could make a difference
for patients when all else failed.
Though misperceptions about ECT persist,
accounts like hers have helped make
doctors and patients alike
aware of the treatment’s
life changing potential.
