Electroconvulsive Therapy: Part I. A Perspective on the Evolution and Current Practice of ECT

Abstract

The concept of inducing convulsions, mainly through chemical means, to promote mental wellness has existed since the 16th century. In 1938, Italian scientists first applied electrically induced therapeutic seizures. Although electroconvulsive therapy (ECT) is employed in the treatment of several psychiatric disorders, it is most frequently used today to treat severe depressive episodes and remains the most effective treatment available for those disorders. Despite this, ECT continues to be the most stigmatized treatment available in psychiatry, resulting in restrictions on and reduced accessibility to a helpful and potentially life-saving treatment. The psychiatric and psychosocial ramifications of this stigmatization may include the exacerbation of the increasingly serious, global health problem of major depressive disorders as well as serious consequences for individual patients who may not be offered, or may refuse, a potentially beneficial treatment. The goal of this first article in this two-part series is to provide an overview of ECT's historical development and discuss the current state of knowledge about ECT, including technical aspects of delivery, patient selection, its side-effect profile, and factors that may contribute to underuse of ECT.

Randomised controlled trial of ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT study)

“…5 ECT involves inducing a therapeutic generalised seizure by passing an electric current across the brain and predates the first antidepressant drugs by nearly two decades. 6 In modern practice ECT is given under a brief general anaesthetic with a muscle relaxant to minimise the physical seizure and potential harm from this. It is given two or three times a week for a typical course of about eight treatments over 3-4 weeks.…”

Patients’ Physical Response to Thiopental and Alternative Anesthetic Agents in the Setting of Electroconvulsive Therapy

“…In this study, the most common indication for ECT was severe depression, consistent with previous reports. 9 The participants in this study typically continued their psychiatric medications throughout ECT treatment, but the psychiatric medications differed for each group (Table 1). Clear guidelines are not available for concurrent use of antidepressants or antipsychotics in the setting of ECT, and continued use is generally recommended.…”

Deep Brain Stimulation in Schizophrenia

“…According to recent data the electro-convulsive therapy (ECT) has been demonstrated to be of the most successful non-pharmacological treatments in schizophrenia (Payne & Prudic, 2009). Yet, only few conclusions can be drawn from ECT, as it apparently acts on a plethora of biological mechanisms.…”