Electroconvulsive Therapy Explained - Dr Fiona

ECT was first introduced in 1938 by Italian neurologists Ugo Cerletti and Lucio Bini. Initially, the procedure was quite primitive, often performed without anesthesia or muscle relaxants, leading to severe side effects and stigma. However, over the decades, significant advancements have been made, particularly in the 1950s and 1960s with the introduction of general anesthesia and muscle relaxants, which greatly improved patient safety and comfort.
Mechanism of Action
The exact mechanism through which ECT exerts its therapeutic effects is not fully understood, but several hypotheses exist:
Neurotransmitter Release: ECT is believed to cause a release of neurotransmitters such as serotonin, norepinephrine, and dopamine, which are often imbalanced in individuals with depression and other psychiatric disorders.
Neuroplasticity: ECT may enhance neuroplasticity, promoting the growth and connectivity of neural networks, which can improve mood and cognitive function.
Hormonal Effects: The procedure might also affect the hypothalamic-pituitary-adrenal (HPA) axis, thereby regulating stress hormones that influence mood and behavior.
Indications for ECT
ECT is primarily indicated for severe psychiatric conditions that have not responded to other treatments. Common indications include:
Major Depressive Disorder: Particularly effective in treatment-resistant depression and severe cases with suicidal ideation or psychotic features.
Bipolar Disorder: Useful for acute manic or depressive episodes that are resistant to medication.
Schizophrenia: Beneficial for catatonic schizophrenia and cases unresponsive to antipsychotic medications.
Other Indications: Including severe obsessive-compulsive disorder, Parkinson’s disease with severe psychiatric symptoms, and certain cases of refractory epilepsy.
ECT Procedure
Modern ECT is a highly controlled and safe procedure performed in a hospital setting under the supervision of a multidisciplinary team, including psychiatrists, anesthesiologists, and nurses. The process involves several key steps:
Pre-Treatment Assessment: Comprehensive evaluation including medical history, physical examination, and informed consent.
Preparation: The patient is given a short-acting anesthetic and a muscle relaxant to prevent injury during the induced seizure.
Electrode Placement: Electrodes are placed on the patient’s scalp. There are two main types of electrode placements:
Bilateral: Electrodes are placed on both sides of the head.
Unilateral: Electrodes are placed on one side of the head, typically the non-dominant hemisphere to reduce cognitive side effects.
Electrical Stimulation: A brief electrical pulse is administered, inducing a controlled seizure lasting about 20-60 seconds.
Recovery: The patient is monitored until they fully regain consciousness, usually within 30-60 minutes.
Effectiveness of ECT
ECT is one of the most effective treatments for severe depression, with response rates as high as 80-90%. Its rapid onset of action is particularly beneficial for patients with life-threatening symptoms. Studies have also demonstrated its efficacy in other psychiatric conditions, although the response rates can vary.
Side Effects and Risks
While ECT is generally safe, it does carry some risks and potential side effects:
Cognitive Side Effects: Memory loss is the most common cognitive side effect, particularly affecting recent memories. Most patients experience improvement in memory function within a few weeks post-treatment.
Physical Side Effects: Headaches, muscle soreness, and nausea can occur but are typically mild and transient.
Anesthetic Risks: As with any procedure involving anesthesia, there are risks, albeit small, related to cardiovascular and respiratory complications.
Current Practices and Future Directions
Modern ECT practice emphasizes safety, patient comfort, and minimizing side effects. Advances such as ultra-brief pulse stimulation and improved electrode placement techniques aim to enhance the therapeutic benefits while reducing cognitive impacts. Additionally, ongoing research is exploring alternative methods, such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS), which may offer similar benefits with fewer side effects.

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