Welcome to my post in the health series where I shall be discussing about a less spoken modality for the treatment of psychiatric conditions,"THE ELECTROSHOCK THERAPY."It is a very interesting topic and the various misconceptions related to it need to be busted.So I will be discussing it in detail in two parts.Let's begin our first part with discussion on the topic proper.
WHAT IS ECT?
The "Electroconvulsive therapy(ECT)" ,"Electroshock therapy" or the "shock treatment" is the procedure in which small amount of electric current is passed through the brain to induce seizures in order to treat various psychiatric conditions.It uses two electrodes most commonly placed over the temples one on each side known as the bilateral ECT or less commonly unilateral ECT where both the electrodes are placed on the same side(.All other details regarding ECT will be discussed later.)
Of course,passing current through the brain is not a joke so it is obvious that the ECT must have a long history from its first concept to its present form.So let's talk about that.
EVOLUTION OF ECT FROM THE PAST TO ITS PRESENT FORM
The concept of inducing seizures came into play when Hungarian neuropsychiatrist Von Meduna found an antagonistic relation between epilepsy and schizophrenia.He hypothesized that when epileptic seizures occured in patients of schizophrenia,the symptoms were improved.So in 1934 ,he used 25% camphor in oil intramuscularly to produce convulsions for the first time for therapeutic purposes.Later he used pentylenetetrazol(metrazol)for the same purpose.
In 1937,the first international meeting on convulsive therapy was held in Switzerland by Swiss psychiatrist Muller the proceedings of which were published in the American Journal of Psychiatry.Within three years, Metrazol convulsive therapy was being used worldwide.
A much safer form of convulsive therapy was proposed by Italian professor of neuropsychiatry"Ugo Cerletti"and his colleague"Lucio Bini".Professor Cereletti was a specialist in Epilepsy and he had realised that electric shock to the head produced convulsions during his various experiments with dogs and other animals.The idea of using it in animals came to him when he saw pigs being anaesthesized with electric shocks before being butchered.So he started his experiments with animals until he developed proper parameters for its use in humans.
Then he selected patients with acute onset of schizophrenia who showed marked improvement after 10-20 episodes of ECT in alternate days.The method of treatment was much safer than with Metrozol .An additional unexpected benefit that came with this therapy was retrograde amnesia (patient could not remember events just prior to the therapy so they did not develop any bad feelings towards the therapy).Cerletti and Bini were even nominated for Nobel prize for their wonderful innovation but they did not get it.
Eventually ECT was being used widely in the US and England by 1940s and all over the world by 1950s.
The ECT in 1940s and 1950s was unmodified type i.e. it was used without any prior administration of muscle relaxant that produced full fledged convulsions producing major side effects such as fractures and dislocations of various bones.In 1940s scientists had already started experiments with muscle relaxants such as curare in order to modify the the convulsions and well as anaesthesizing the patients with barbiturates. In 1952 modified ECT was developed with the use of synthetic muscle relaxants such as succinylcholine.And then use of unilateral electrodes to reduce memory loss and brief impulse current rather than sinusoidal current was proposed.
The fear among the general public that was imposed by one very famous hollywood movie released in 1975,"One Flew Over The Cuckoo's Nest"(based on the novel having the same name written by Ken Kesey in 1962) in which Jack Nicholson has been potrayed as a psychopath receiving the shock therapy for his unruly actions had such a devastating effect on the mentalities of people that they completely disagreed to recieve ECT at any cost.Also the discoveries of newer antidepressant drugs added to its downfall.
In 1978 first American Psychiatric Association Task Force report on ECT was published that endorsed the use of ECT for treatment of depression and emphasized on consent and unilateral electrode use.Again in 1990 and 2001 second and third task force reports were published.The latest task force report of 2001 emphasizes on the informed consent of the patient.
With so many ups and downs in its history,ECT is still one of the most important modes of treatment in modern psychiatry.
We will be looking at how ECT works,the procedure of giving ECT,its indications and side effects in the next post.
1.Textbook of Psychiatry by Niraj Ahuja,7th edition