Science

Electroconvulsive Therapy: Barbaric or brilliant?

ECT sounds like a medieval practise... but can it's potential be completely ruled out?

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Image Credit: Otis Historical Archives, National Museum of Health and Medicine

Electroconvulsive therapy (ECT) has been around for decades. Its first use was in 1938 in Italy with the aim of treating psychosis in a patient diagnosed with schizophrenia. The procedure of ECT has evolved in its humaneness since then; what started out as a metal headset, electrodes connected to a control panel and subsequent skull fractures has now become a practised methodology. Now electrodes are attached to the scalp in precise positions and the practice is performed under general anaesthetic, as well as a muscle relaxant. ECT works by inducing a seizure in patients in the hopes of reducing symptoms of psychiatric disorders. This has earned a bad reputation in the public eye over its time due to its misuse in Nazi Germany, in LGBTQ+ conversion therapy, and in 1950s psychiatric hospitals to “control” difficult patients. However, much research has shown ECT to be a robust treatment, particularly for depression that cannot be managed using anti-depressants – also known as treatment-resistant depression.

The successful use of ECT in treating depression has been documented since the 1960s with support for this treatment continuing to be published over the years. For example, in 2020, Ma et al. found  positive response rates as high as 100 percent for patients with treatment-resistant depression and rates of 90 percent for patients with medicated depression. Lin et al. (2019) also found that in patients with treatment-resistant depression, rates and lengths of hospitalisation in the following year decreased significantly when they received ECT compared to those who didn’t and instead were medicated with antidepressants.

ECT can be used to treat much more than depression and has been documented in reducing symptoms in schizophrenia, PTSD, bipolar, OCD, borderline personality disorder, and is now being tested as a treatment for eating disorders. Positive response rates in some of these disorders include 77 percent for schizophrenia (Isserles et al., 2020), 82 percent for PTSD (Margoob et al., 2010) and 80.2 percent for bipolar (Popiolek et al., 2019).

A limitation of ECT is the high rates of reported relapse early on after the treatment. Regarding depression, a meta-analysis by Jelovac in 2013 found that in patients continuing antidepressants after ECT, by three months 27.1 percent had relapsed, increasing to 34.0 percent by six months and to 51.1 percent after one year. These relapse rates were much lower than those in patients who received no continuing treatment – raising the question of whether ECT acts as a treatment or as a kickstart to increase the chance of other treatments working.

Another downfall is the potential for negative cognitive side effects. These can include non-memory cognition (processing speed and executive function), anterograde memory (forming new memories) and autobiographical retrograde memory (personal memory of both past experiences and facts). Whilst any non- and anterograde-memory deficits usually resolve themselves within two weeks of receiving ECT, objective studies have found that in those who experience loss of autobiographical retrograde memory, the problem may persist for at least a year (Porter et al., 2020). The same review reported memory problems as a side effect of ECT in as many as 60 percent, with these effects lasting between weeks and years in 40 percent of patients. With the potential of extreme cognitive deficits, it poses the question of whether the use of ECT in treating psychiatric disorders is overall a worthwhile option, particularly with the possibility of causing more symptoms of negative thoughts and feelings as a result of these memory problems.

To sum up, is the use of passing electrical impulses through the brain to treat disorders in patients who do not respond to medications barbaric? Or does the long history of effectiveness – at least short term – in fact make it brilliant? I would argue that whilst much about electroconvulsive therapy is still unknown and that more research needs to be done investigating areas such as comorbid disorders and treatments, we shouldn’t rule out its potential.

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