ECT is a psychiatric treatment in which a brief electrical stimulus is given to the brain via electrodes placed on the temples. The electrical charge lasts between 1-4 seconds, and causes an epileptic-like seizure.
Before treatment, the patient is anaesthetised and given an injection of muscle relaxant which depresses the breathing, and oxygen is given until the patient is able to breathe naturally again. Most patients get a total of six to twelve ECTs at a rate of one a day, three times a week. ECT can be given without the patient's consent under UK legislation. It is estimated that in the United Kingdom 10,000 people a year receive ECT treatment.
What is ECT used for?
ECT is usually given to people with severe depression which has not responded to other forms of treatment such as anti-depressants. However, it is sometimes used for those with a diagnosis of bi-polar affective disorder (manic depression) or schizophrenia. It is usually only given after the risks have been explained and with the person’s consent, or in the extreme case when the person’s life is at risk.
How does it work?
This is not clear, but there are numerous theories including the following:
Neurotransmitter theory: ECT works like anti-depressant medication, changing the way brain receptors receive important mood-related chemicals.
Anti-convulsant theory: ECT-induced seizures teach the brain to resist seizures. This effort to inhibit seizures dampens abnormally active brain circuits, stabilising mood.
Neuroendocrine theory: The seizure causes the hypothalamus to release chemicals that cause changes throughout the body. The seizure may release a neuropeptide that regulates mood.
Brain damage theory: Shock damages the brain, causing memory loss and disorientation that creates an illusion that problems are gone, and euphoria, which is a frequently observed result of brain injury. Both are temporary.
Psychological theory: Depressed people often feel guilty, and ECT satisfies their need for punishment. Alternatively, the dramatic nature of ECT and the nursing care afterwards makes patients feel they are being taken seriously; i.e. the placebo effect.
Controversy surrounds the safety, ethics and necessity of ECT. In particular, some mental health services users believe that the side-effects can be quite severe and that they have had ECT administered to them either against their will, or without their knowledge (in cases where people are so depressed that they are unaware of what is going on around them). The UK Advocacy Network's survey of people who had received ECT treatment found that 30% of people who had received ECT found it helpful or very helpful, while over 50% found it unhelpful or damaging.
Specific complaints include:
Inspectors appointed by the Royal College of Psychiatrists found that many ECT clinics did not follow safe and humane practices: e.g. many doctors administering ECT gave higher than necessary doses of current, and patients were sometimes given muscle relaxant before anaesthetic, resulting in a terrifying inability to breathe. In 1998 The Chief Medical Officer and President of the Royal College of Psychiatrists wrote to senior mental health practitioners, asking them to take immediate steps to make sure that ECT was properly administered.
Some people say that ECT gives only temporary relief, 'after four weeks I was back to square one again'. Clinical trials do not demonstrate long-lasting benefits of ECT beyond a few weeks. However, doctors argue that it is sometimes life saving to lift a person quickly out of a life-threatening depression, and allow the possibility that other therapies, or the healing effects of time, can begin to work
On the positive side, there are many stories told by psychiatrists, relatives and patients themselves of people recovering after ECT. Some regard it as almost a miracle cure, 'ECT has transformed my life’.
Many people complain ECT has damaged their memory. Most psychiatrists argue that memory loss is only short term. Both claims are hard to prove, but reports of long-term memory loss are too frequent to be ignored. The UK Advocacy Network's survey of people who had received ECT treatment found that 73% of respondents reported memory loss (not all short-term).
Psychological adverse affects
Some people say they find ECT extremely upsetting. A variety of themes emerged, including feelings of fear, shame and humiliation, worthlessness and helplessness, and a sense of having been abused and assaulted.
Some reports claim that there as many as 4.5 deaths per 10,000 ECT patients. Among the elderly, death rates have been reported to be as high as 1 in 200. There is also some anecdotal evidence about patients who killed themselves because of the damaging effects of ECT (including the author, Ernest Hemingway).