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Electroconvulsive Therapy: Experience of Patients

Electroconvulsive therapy is one of the most widely used therapies for people suffering from severe depression and other mental disorders. Studies have revealed that eighty percent of patients with severe depression significantly improved with ECT.

ECT is done by applying electrical shocks to the brain by using electrodes that are planted on the head. In order to attain the most comprehensive positive reactions to depression, it is imperative to undergo repeated treatments.

However, even if ECT is the best depression treatment; many people are still afraid to use it as remedy. The negative thoughts about ECT are brought about by the perceived possible side effects. Experts are now researching on how to maintain the benefits of ECT treatment over time in order to prevent relapse when the treatment is discontinued.

Electroconvulsive Therapy Saved Celine

Electroshock therapy for bipolar disorder worked satisfactorily for Celine. Celine is single, in her late 30′s and used to work as a bank teller. She has a pretty normal life, not until one day when she suffered from an anaphylactic reaction to an x-ray dye. She was supposed to undergo an x-ray to check what was causing pain in her stomach; unfortunately, the dangerous reaction to the liquid dye almost killed her.

After that incident, she became weak, had difficulty in breathing, became very forgetful and moody. After three attempted suicides, she was finally diagnosed to be afflicted with bipolar disorder. Due to the severity of her manic attacks, her doctor combined electroconvulsive therapy with her medication. After the first ECT, she experienced a slight numbness that lasted for about twenty five minutes. The second ECT proved better and so were the consequent therapies. Today, she seldom experiences manic attacks and has integrated herself into society again. She works at a shop in her local community where her talent in sales and marketing have proven very useful.

Depression Shock Therapy for Cathy

Cathy, a mother of two boys suffered from recurring bouts of severe depression after undergoing a painful divorce from her husband. After her diagnosis, her doctor recommended ECT. At first, she was hesitant because of the many side effects of electroconvulsive therapy that she had been hearing about from people around her.

However, her psychiatrist explained to her what ECT was really about and the benefits she can get from it. Eventually, she consented and had the therapy for four months. Two months after her last ECT session, her moods have stabilized and even while she has stopped medication, she was able to return to her job. She is also doing wonderfully well raising her two sons.

The ECT experiences of these two women represent the ease and safety of the procedure as it is done today.

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Electroconvulsive Therapy Modes And Procedures

In the 1850’s, a French physician by the name of Duchenne, using tiny electrical discharges emitted by a Leyden jar, managed by chance, to induce muscular activity and blood circulation improvement into the paralyzed hand of a locksmith. This was the first important step in a journey that still continues to this day. During the 1930’s, an Italian psychiatrist, Ugo Cerletti noticed that patients with schizophrenia do not suffer epilepsy and vice versa. He supposed that the seizures and the convulsions characteristic to epilepsy would cure schizophrenia and tried to find a procedure to replicate the convulsions. Electroshocks proved to be the easiest manner, and this is the way electroconvulsive therapy treatment was born.

Electroconvulsive therapy definition

Electroconvulsive therapy (ECT) is the process of using small quantities of electrical current administered to the patient’s brain, producing seizures that would ameliorate mental disorders. ECT is mainly used with depression, bipolar disorder and schizophrenia – known together as affective disorders.

The method was, in the beginning, rather cruel and fraught with many dangers. This was due to the violent and uncontrolled convulsions. Many patients who underwent the primitive method of ECT suffered fractures in limbs, ruptures in the muscles and problems in the spine. For a time in the 1950′s, there was a public campaign started against the use of electroconvulsive therapy. In time, along with the better understanding of the process and technological advancements, the therapy was refined to what it is today. Muscle relaxants began to be dispensed to control the convulsions. The dangers that accompanied the process of old no longer exist in electroshock therapy today.

What are ECT treatments?

In lieu of using medical drugs to treat mental disorders, electro shock therapy is another approach. That is because there are patients who manifest allergies to some drugs; other patients display side effects to anti-psychotic drugs; many patients on account of their conditions cannot medicate themselves, while still others need quick improvements because they are refusing food and water. Major depressions have their best cure with ECT.

Technically, the ECT procedure is rather simple, and international medical standards have made it safe. There is required the presence of a whole specialist team attending to the patient: their physician, the anesthesiologist, psychiatrist, respiratory therapist, and a cardiologist, each with a precise role in the process.

In preparation for the procedure, patients have to go detailed medical diagnostic examinations. The physician-in-charge will check the results of the physical examination, complete lab and blood tests, EKG, radiography of the chest and spine, and computer tomography of the brain. This is done to check for abnormalities that may present risks to the patient for heart attacks, strokes, or brain lesions during the procedure. If the standards are not met, the patient is disqualified for the electroconvulsive therapy treatment.

Also prior to the ECT itself, the patient is given an intravenous injection containing two elements. One of these drugs induces paralysis in the muscles to prevent convulsions and the other puts the patient in a sedative state. The effect of the doses is calculated to last for some 30 minutes, which is the average duration of a session. A tourniquet is applied, a rubber mouthpiece placed into the patient’s mouth and a respiratory apparatus attached to the patient, all safety precautionary measures.

The patient is then wired to the EKG and EEG. The electrocardiograph’s sensors placed on the chest track the heart rate, while the electroencephalograph’s electrodes placed on the forehead track brain activity.

There are two modalities to connect the subject to the electrotherapy unit: either on the temples or other symmetrical parts of the cranium (bilateral ECT), or over one single lobe (unilateral ECT). Positioning is important because of one single factor. The left hemisphere of the brain is responsible for cognitive activities, while the right hemisphere deals with emotions. The symmetrical placement of electrodes causes electroshocks to flow through both hemispheres. This way, the cognitive side is also affected. This is why more and more of the psychiatrists do unilateral therapy, applying electroshocks only to the affected lobe of the brain.

The electrical shocks are intentionally weak and applied in quick bursts. The range of current used is 70 – 150 volts. Rarely, it can climb up to 400 Volts. The intensity ranges from 0.1 to 0.6 amps and rarely up to 1.5 Amps. The discharges take 5 to 15 seconds, rarely more.

One of the best advantages of electroconvulsive therapy is its high recorded effectiveness rates. ECT experts estimate that 90% of the patients exhibit positive responses, compared to antidepressant medication success rates at only 50%. Another advantage is that while antidepressants can cause addiction which is another problem altogether, ECT does not. ECT is also a supervised procedure and the doctor is able to monitor its conduct while a patient’s medication outside of the hospital or clinic cannot be checked for the patient’s compliance to the dose and frequency.

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Electroconvulsive Therapy Side Effects: Are They Worth It?

During the 1930’s and for the next few decades, electroconvulsive therapy was rather brutal and dangerous. This was so because of the violent and uncontrollable convulsions provoked by the empirical use of electrical shocks. Many of the patients who were subjected to ECT suffered limb fractures, muscular ruptures or even spine problems. Cognitive damages were also reported.

That is why a long-term media campaign was directed against electroconvulsive therapy in the 1950’s. The anti-ECT movement was stirred by a series of movies, to mention only the multi-Oscar winner One Flew over the Cuckoo’s Nest, released in 1975. The main character, played by Jack Nicholson, became a mental zombie after electric shock treatments. The production aroused worldwide tidal waves of emotion against ECT. Nevertheless, overwhelming proof was never shown to demonstrate definitive damages brought to the patients’ minds.

Since the 1980’s, the procedure was refined: muscular relaxants were introduced before the therapy to stop the violent convulsions, more oxygen is brought to the brain, and the general health state of the patient is closely observed during the entire procedure. Today, ECT is no longer physically dangerous.

Studies show that ECT effectiveness has been raised to 90% of the cases, with long remission periods.

Electroconvulsive therapy is mainly used in the treatment of affective disorders such as severe depression and bipolar disorder. ECT is also of great help with mild depression. As for schizophrenia, opinions are split: some scientists say electroconvulsive therapy is very good, others say it has no effect whatsoever.

Despite the procedural improvements, side effects of ECT treatment still persist: cognitive performances are modified, at least for periods of several days, sometimes weeks or even months. The mildest side effects of ECT are those from the use of anesthesia which fade in a matter of hours.

Passing the electrical current through both hemispheres of the brain (bilateral ECT) does help with affective disorders, but can damage the other lobe, the one which is responsible for both verbal and mathematic (non-emotional, intellectual, similar to a computer) functions. A new technique was introduced, unilateral ECT, in order to address the electrical discharges only on the emotional hemisphere.

In spite of their positions, either adversarial or supportive, both sides have come to a common conclusion. That is, that ECT and memory loss are irrefutable cause and effect.

For patients under observation after electroconvulsive therapy, memory loss was reported in two types. The first one refers to short-term memory loss, the incapacity to remember new information like what one did or talked about one hour before. This incapacity disappears within weeks. The second – the most disturbing – refers to long-term memory loss, i.e. the incapacity to recollect entire episodes of past life experience. These memory gaps can refer to events covering episodes or longer periods including not recognizing people on photos, not remembering their own marriage ceremony or honeymoon, etc. This incapacity also usually disappears within weeks. However, there have been reported cases when the long-term memory has been permanently affected, and memories never come back. Both ECT and drugs have this memory-loss effect. Truth is, there is no proof that this is an ECT effect, an antidepressant effect or even an effect from the illness itself.

In the diametric opposite direction, some precisely directed studies showed ECT to result in improved intelligence, attention and learning ability!

Other minor side effects of ECT are temporary confusion, distress, disorientation, and muscle ache.

Electroconvulsive therapy contraindications firstly refer to cerebral lesions; the “for” reports differ 180° from the “anti”. While the first mention no noticeable brain damages, the second report major damage. Casuistry inclines to favor of the first, because, as studied on animals, only massive quantities of electrical current could be able to harm the brain. Reference is made to people that have been struck by lightning. These survivors took shocks from millions of volts and millions of amps!

The reason for which the patient is given such a thorough investigation before therapy is that risks are indeed present.

The use of an EKG and radiography in preparation and during the electroconvulsive therapy is justified by any heart abnormal condition (myocardial infarction, congestive heart failure, severe valvular cardiac disease, vascular #aneurysm, unstable angina etc.). Violent convulsions resulting in heart failures are the main cause of the 1/10,000 (0.1%) patients that have been damaged by ECT. In opposition, the pro-ECT physicians quote scientific researches that blame as much as 5% deaths in antidepressant medication users.

On the other hand, the CT scans can reveal brain damages prior to the electrical shock procedure: intra-cerebral lesions, meningiomas, intracranial pressure, recent cerebral infarction, and so on.

Some risk levels can be diminished by medication, reducing the body’s physiological response to the induced seizure.

Electroconvulsive therapy cost is lower than any surgical procedure. Plus, if support medication is not prescribed, ECT patients could spend less money, with more effectiveness, over a longer period or time.