By Dr Abida Sajjad, Psychiatrist
ECT is a treatment for a small number of severe mental illnesses. The use of electricity to treat mental illness started out as an experiment. In the 1930s psychiatrists noticed some heavily distressed patients would suddenly improve after an epileptic fit. Passing a strong electric current through the brain could trigger a similar seizure and - they hoped - a similar response. By the 1960s it was widely used to treat a variety of conditions, notably severe depression.
The idea developed in the days before effective medication. Perhaps more significantly, new anti-depressant drugs introduced in the 1970-80s gave doctors new ways to treat long-term mental illness. But for a group of the most severely depressed patients, ECT has remained one of the last options on the table when other therapies have failed. Annually in the UK around 4,000 patients, still undergo ECT. According to Professor Reid in Aberdeen University "It's not intuitive that causing seizures can be good for depression but its long been determined that ECT is effective”.
We do know that it can change patterns of blood flow through the brain and change the metabolism of areas of the brain which may be affected by depression. There is evidence that severe depression is caused by problems with certain brain chemicals. It is thought that ECT causes the release of these chemicals and, probably, more importantly, makes the chemicals more likely to work, and so help recovery. Recent research has also suggested that ECT can help the growth of new cells and nerve pathways in certain areas of the brain.
Uses of ECT:
It is very helpful for someone who has severe depression, resistant mania or catatonia. ECT should be considered for the rapid treatment of severe depression that is life-threatening, or when other treatments have failed. According to Sienaert P, et al. (Dec 2014) ECT is generally a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia. NICE recommends it only in life-threatening situations or when other treatments have failed and as a second-line treatment for bipolar mania.
It should not be used routinely in moderate depression, although it can be helpful for someone with moderate depression if they have not responded to several different drug treatments and psychological treatment.
ECT has been shown to be the most effective treatment for severe depression. It would normally be offered if several different medications have been tried, but have not helped, the side-effects of antidepressants are too severe or ECT has been found helpful in the past.
The National Institute for Health and Care Excellence (NICE) recommends that before ECT, doctors should consider the risks of the treatment which include:
Immediate side effects:
Drowsiness (you may sleep for a while), confusion, headache, feeling sick, aching muscles and loss of appetite
Very rarely, people may experience prolonged fits, especially if they are taking drugs or have medical conditions which lower the seizure threshold. The general anaesthetic (as for any procedure where it is used) carries a risk of illness and a very small risk of death, separate from the ECT treatment itself.
This is the most important side effect of ECT, and the one which causes most concern.It is usually a short-term effect, and most people find their memories gradually return as they recover from ECT.
However, for some people, memory loss can mean both losing personal memories, and having difficulty remembering new information. Some people have been so badly affected that they have lost key skills or knowledge, such as expertise needed to continue their professional work or career.
Guidelines say that you should have a standard test of your memory and thinking abilities as part of your assessment before treatment and after each treatment session
People’s experience of ECT varies enormously. Some people find it the most useful treatment they have had, and would ask for it again if they needed treatment for depression. Others feel violated by it, and would do anything to avoid having it again.
Sixty-four-year-old John Wattie says his breakdown in the late 1990s was triggered by the collapse of his marriage and stress at work. John likens the feeling to being in a hole, a hole he could not get out of despite courses of pills and talking therapies.
But now, he says, all of that has changed thanks to what is one of the least understood treatments in psychiatry - electroconvulsive therapy (ECT).
He says “Before ECT I was the walking dead. I had no interest in life; I just wanted to disappear. After ECT
I felt like there was a way out of it. I felt dramatically better." ( Why are we still using electroconvulsive therapy? By Jim Reed, BBC Newsnight)
Cite this article as:
Abida Sajjad (2016). Role of ECT in mental health. The Beautiful Space-A Journal of Mind, Art and Poetry. September 2016: TBSB103
1. NICE Guidance on the use of electroconvulsive therapy. NICE technology appraisals TA59. Published date: April 2003
2. Sienaert P, et al. (Dec 2014). "A clinical review of the treatment of catatonia." Front Psychiatry. 5: 181.doi:10.3389/fpsyt.2014.00181. PMID 25538636.
3. Malhi GS, et al. (Dec 2012). "Mania: diagnosis and treatment recommendations." Curr Psychiatry Rep. 14 (6): 676–86. doi:10.1007/s11920-012-0324-5.PMID 22986995.
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