Examining the Effectiveness of Electroconvulsive Therapy

A professor walks into class on the first day and holds up a red textbook. He asks the class, “what color is this textbook”. Confused by the oddity of the question, the class look at each other for a few seconds before unanimously answering “red”.

The professor smiles and says, “ I disagree. This textbook is blue”. This further confuses the class, as the textbook in front of them is so obviously red.

One brave student amongst the crowd stands up and says, “with all due respect sir, this textbook is red”. Again, the professor simply smiles and says, “it’s blue”.

Certain that they had signed up for the wrong class, or perhaps for the wrong teacher, the students start to pack their belongings ready to leave. The professor, who was still holding up the textbook, says. “All of you were so bent on believing that this book is red, which is true. But, if you look at it from my perspective, (he flips the textbook so that the students could see the other side, and to their surprise, the cover is blue), it is indeed blue”.

Moral of the story, there are two sides to every situation.

The effectiveness of electroconvulsive therapy, or more commonly referred to as shock therapy, has been the spectacle of debate for many decades. First introduced in 1938 by two Italian physicians, Cerletti and Bini, electroconvulsive therapy (ECT) is usually used to treat schizophrenia - or more specifically, two atypical disorders: Cotard’s syndrome and cycloid psychosis. ECT is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. Because the muscles are relaxed, the visible effects of the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. In 2001, a task force of the American Psychiatric Association suggested that ECT was effective for psychotic schizophrenic exacerbations of short duration. The task force reported that ECT was effective in the treatment of schizophrenia spectrum disorders, such as schizoaffective and schizophreniform disorders, and in atypical psychoses.

As it appears, the effectiveness of the therapy is partially dependent on the positioning of the electrodes in the brain. Modifications of the technique, in an effort to reduce cognitive side effects, include the unilateral placement and the adjustment of stimulus intensity to the seizure threshold of every patient. Furthermore, placing the electrodes over the right hemisphere causes less severe cognitive side effects than bilateral placement. Despite many trials however, the results of either method remain inconclusive. Which is to say that one method may or may not be more effective than the other since trials done for both produce similar results.

According to a study done by The New England Journal of Medicine in 1993, electrical dose affects the efficiency of ECT. The researchers of the study had managed to diminish the cognitive side effects but at the expense of efficacy in the unilateral therapy thus concluding that this method should be abandoned. As mentioned before, this therapy was conducted back in 1993, and since then ECT has been made safer and is practiced more commonly. The alternative to ECT is Transcranial Magnetic Stimulation (TMS), which unlike ECT which uses electrical currents to “shock” its patients, TMS uses magnetic fields to specifically target parts of the brain and pass a much smaller electrical current without causing loss of consciousness or seizure. TMS works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments. Also, unlike ECT, TMS does not require sedation and is administered on an outpatient basis. Compared to ECT, TMS definitely has the advantage of a more safer alternative, however, research shows that its effect is less than that of ECT.

To tie this all up in a bow, electroconvulsive therapy has been used over the years in various ways to treat brain disorders by transmitting electrical currents in regions of the brain in hopes to reverse the chemistry of the brain. Usually ECT is used as last resort - if all other methods and medications fail. The effects however, are long lasting. Some of the drawbacks of using ECT is that it can become painful and can result in cognitive damage due to misuse of instruments, wrong dosage of current, ECT. Because every patient is different, the dosage of electrical current varies to increase efficacy. Placement of the electrodes on the scalp also play a role in how the ECT is administered on the patient. Depending on where the seizure must be induced, the electrode is placed accordingly. As of now, ECT has proven to be effective to patients both in short term and long term.

Sources

Sackeim, Harold A., Joan Prudic, D.p. Devanand, Judith E. Kiersky, Linda Fitzsimons, Bobba J. Moody, Martin C. Mcelhiney, Eliza A. Coleman, and Joy M. Settembrino. "Effects of Stimulus Intensity and Electrode Placement on the Efficacy and Cognitive Effects of Electroconvulsive Therapy." New England Journal of Medicine N Engl J Med 328.12 (1993): 839-46. Web. 27 Dec. 2015. <http://www.nejm.org/doi/pdf/10.1056/NEJM199303253281204>.

MayoClinicStaff. "Electroconvulsive Therapy (ECT)." Mayo Clinic. N.p., 19 Sept. 2015. Web. 27 Dec. 2015. <http://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/basics/definition/prc-20014161>.

WebMD. "Electroconvulsive Therapy (ECT) Benefits & Side Effects." WebMD. N.p., 2015. Web. 27 Dec. 2015. <http://www.webmd.com/depression/guide/electroconvulsive-therapy?page=3>.

Zincke, Miriam Tanja, Amit Kurani, Rafik Istafanous, and Charles Kellner. "The Successful Use of Electroconvulsive Therapy in a Patient With Interferon-Induced Psychotic Depression." The Journal of ECT 23.4 (2007): 291-92. Web.

Montegomery, John H., MD, and Devi Vasu, MD. "The Use of Electroconvulsive Therapy in Atypical Psychotic Presentations A Case Review." Psychiatry (Edgmont) 10 (2007): 30-39. NCBI. Web. 27 Dec. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860524/>.

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