ECT (electroconvulsive therapy, or electroshock therapy) is the electrical induction of the type of generalized cerebral seizure associated with a tonic-clonic convulsion, with the objective of treating an abnormal mental state or neurological disorder.
It involves the patient being put to sleep with an anaesthetic. A tiny amount of current is then passed across the head. This causes the person to have a fit or seizure. It is believed that the seizure changes the chemicals in the brain and leads to an improvement in the mental state or neurological disorder. Efficacious treatment requires a series of inductions given two or three times a week.
ECT is typically used when other treatments, including medications and psychotherapy, have not worked. ECT is also used for people who require a rapid treatment response because of the severity of their condition, such as being at risk for suicide.
The indications for ECT are:
1) Major depression
- In 2001, the UK ECT Review group found that ECT is more efficacious than drug treatment (standardized effect size 0.80) in the short term treatment of depressive illness. ECT is highly effective for the relief of major depression. In patients with severe major depression, ECT will produce substantial improvement in approximately 80 per cent of patients. However, some patients may not agree to ECT as they may experience adverse effects on their memory following the treatments.
2) Treatment-resistant depressive illness
- There is a 50 per cent chance of remission with ECT after non-response to an antidepressant, even when it has been augmented by lithium carbonate, a mood stabiliser.
3) Bipolar disorder
- ECT may be considered for severe mania associated with life-threatening physical exhaustion or treatment resistance, i.e., mania that has not responded to mood stabilising agents and/or antipsychotics.
4) Schizophrenia
- The treatment of choice for acute schizophrenia is antipsychotic drug treatment. ECT may be considered as a fourth-line treatment, where clozapine has already proven ineffective or intolerable.
5) Catatonia
- Catatonia is a syndrome that may complicate several psychiatric and medical conditions. The person with catatonia can become increasingly agitated and unresponsive; he or she can seriously injure themselves or develop severe dehydration from not eating or drinking. ECT is sometimes used in treating individuals with catatonia. There are psychiatrists who advocate that the treatment of choice in catatonia is a benzodiazepine drug; most experience is with lorazepam. ECT may be indicated when treatment with lorazepam has been ineffective.
6) Neuropsychiatric disorders
- There are reports on ECT being used to treat Parkinson’s disease, neuroleptic malignant syndrome and treatment-resistant status epilepticus.
