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.