You must have heard of resilient people and their triumphant battles, but have you ever heard of a treatment option fighting for its acceptance? It is a consistent walk of thorough determination and sheer confidence that Electroshock Therapy is a journey worth talking about.
Electroconvulsive therapy has been one of the most renowned and revolutionary treatments that medical and psychiatric history has seen so far. Offering undeniable efficacy and minimal chemical intervention, ECT instilled hope for treating psychiatric illnesses that were otherwise deemed exceedingly challenging. Despite being a straightforward option with minimal side effects, its outlandish reception overshadowed the benefits at large.
It is also one of those psychiatric treatments that hold a dense history of controversy. To get a better insight into Electroconvulsive Therapy being a revolution and how it became a magnet to controversy, it is necessary to take a look at its development over the years.
Table of Contents
History and development of ECT
The base concept of Electroconvulsive Therapy is causing one disease to treat the other. Wagner-Jauregg discovered this principle when he used high fever episodes to treat malaria. So, the abstraction that was refined to become ECT was a chemically induced epileptic seizure that made adjustments in the neurochemistry in a way that helped in treating complex psychological illnesses or managing the symptoms in a better way.
Early days of the treatment (chemical induction of the seizure)
Ladislas J. Meduna utilized the practice of chemically induced seizures in patients by injecting camphor intramuscularly, which triggers a grand mal seizure, commonly referred to as a tonic-clonic seizure. Though the impact of these seizures was significantly positive, parallel to that, two serious concerns were also noticed.
Patients’ experiences
Firstly, despite being effective in the first session, the proper treatment may stretch to multiple sessions. Secondly, these seizures involve intense muscular convulsions. As a result, the patients had to go through consuming sessions filled with pain and agony that lasted even after the session, and a number of such sessions had a lasting impact on muscular strength.
Patients frequently started reporting broken bones and related injuries. The absence of muscle relaxants added to the strain, shadowing the progress it helped in making toward the psychological illness being treated.
It was not just limited to physical stress but taxed the patients emotionally too. The daunting wait between the administration of Camphor and the seizure to initiate brought immeasurable psychological pressure to the patient. They had to marinate in fear of the unknown forthcoming for an indefinite time.
Practitioner’s experience
These complications weren’t only a barrier to the acceptance of the treatment by the patients, but the precarious and precautionary nature of each step was an obstacle to the seamless performance of this procedure. Due to the administered chemical’s toxicity, strict control over its quantity was necessary. There was a lingering and tedious wait between every small amount of administration until the seizure was instigated. It was difficult to figure out a one for all dosage as the chemical was toxic, it had certain limitations that had to be followed, and its impact varied from person to person.
The initial days of this treatment have seen a constant build-up of unlikely outcomes around a greater potential. Hence requiring intense research and keen problem-solving, targeting the hindrances individually. Despite having positive capabilities, the chemically induced epileptic seizures could not have the patients’ trust, and many practitioners hesitated about the procedure. The drawbacks were prominent and hence required to keep the research going.
What often happened to patients in the early days of ECT?
An Italian team of physicians led by Ugo Cerletti and Lucio Bini stepped forward with their input, which took the whole idea of this treatment to a completely different level. They established the concept of replacing toxic chemical administration with using electric current as a means to induce seizures. This leap in the research was made to remove the fear associated with the administration of toxic drugs. It also removed the painfully lingering interlude between the chemical administration and the seizure.
First practical experimentation
This extremely promising advancement towards electroshock therapy was implemented on a dog first. One electrode was placed in its anus, and the other one was placed in its mouth. And the current was passed between both electrodes. This put the dog in cardiac arrest. But the leads from this initial experimentation led the scientist to work on a more refined and workable version of this high-potential and effective treatment option and make it more effective and less painful.
First usage for human treatment
This time, the scientists reduced the area exposed to the electric current to just the cranial region. As anticipated, this approach alleviated concerns regarding the risk of inducing cardiac arrest. And so the first human trial of electroshock therapy was conducted in 1938, on a 39-year-old, topsy-turvy, schizophrenic man found strolling on the train station alone in Rome.
It took 110 volts of alternating current for 0.2 seconds to induce a seizure in him. And throughout his hospital stay, he received ten rounds of this treatment. The treatment showed very noticeable results, and his psychosis was reduced so much that he was able to return to his home and wife.
This successful experimentation took the neuro-medical industry by storm. The word for ECT spread throughout Europe and North America, grabbing the attention of needy patients and professionals. This advancement in the treatment also encouraged research scientists and physicians to continue adding to this treatment until it was refined enough to pull people out of the fear of ‘What happens when ECT doesn’t work?’
Developments in electroconvulsive therapy
Following were meaningful developments made in electroshock therapy before it took the final shape that it has today.
- Wladimir T. Liberson, in 1944, experimented with shortening the duration of passing the current. This resulted in a reduction in recuperation time, cognitive dulling and Aphasia after the procedure.
- In 1952, Holmberg and Thesleff significantly advanced by introducing an anesthetized procedure for electroshock therapy. This involved administering anesthesia to the patient before the process, greatly enhancing tolerability. Before this breakthrough, research predominantly centered around post-procedural effects.
What was electroshock therapy used for?
Although today, electroshock therapy stands as one of the most advanced developments in neuromodulation. Still, it has only been considered as a treatment option rather than a first choice. ECT is found to be most effective in the list of illnesses mentioned ahead.
Electroconvulsive therapy for affective disorders
Affective disorders, also known as mood disorders, are the ones where electroconvulsive therapy is the most effective. Out of a considerably long list, a few are mentioned below:
- Seasonal Affective Depression
- Clinical Depression
- Panic Disorder
- Bipolar Disorder
- Generalized Anxiety Disorder
- Dysthymia and Cyclothymia
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
- Phobias
The efficacy of this treatment was closely studied between the years 1960s to 1980s. It was considered more effective than antidepressants or traditional treatment routes. It was also considered the first choice for suicidal patients due to its anti-suicide effects.
Electroconvulsive therapy is also used for patients that show drug resistance. This helps as an effective alternative to prevent relapse and manage the symptoms.
Electroconvulsive therapy for Psychosis and Schizophrenia
Besides affective disorders, ECT has shown promising results in managing symptoms, preventing relapse, and supporting conventional pharmacotherapeutic approaches for catatonia, schizophrenia, psychosis, and postpartum psychosis. Another reason behind considering this as a major option in the treatment and management of these disorders is due to the frequently rising issue of patients showing drug resistance.
Life after ECT treatment
Although research scientists have set safety and comfort as a primary goal when progressing with electroconvulsive therapy. Although they successfully reduced the pain and discomfort experienced by patients during the procedure, eliminating all side effects remains a challenge.
At the beginning of ECT, muscular convulsions and physical injuries were among the most prominent side effects after long-term memory loss.
Later, In the 1950s, as muscle relaxants were brought to the market for safe use, they were made a part of the treatment. This was able to eliminate all the muscle and injury-related side effects.
However, even after thorough experimentation and research on the duration and quantity of the electric current passed through the brain and its surface area exposed to this current, the issues with cognitive functioning persist. Some of the side effects that may appear immediately after the procedure include:
- Anxiety and fear
- Memory Loss
- Disorganization and disorientation
- Headache
- Extreme drowsiness
- Nausea
- Drooling
- Muscle stiffness
- Tremor all over the body
- Loss of appetite
- Hallucinations
- Fatigue
Most of the time, patients return to their routine without any disruption caused by these side effects. But some reported cases show a long-term extension of the cognitive dysfunction caused by electroconvulsive therapy.
Reviews of electroconvulsive therapy
ECT is a highly advanced development in the field of neuromodulation. And it is equally new for the public to comprehend and accept. Print media, digital media and social media and word of mouth being the sources of information for the public to gather awareness, these mediums did not play the role as required or expected. The portrayal of ECT was kept primarily as brutal and parallel to the other barbaric torture methods.
Being displayed as punishment in a few famous movies actively contributed to building an unlikely perception among the public, causing a hindrance in the acceptability and a welcoming response. Namely, the films that contributed to the negative portrayal of ECT are ‘One Flew Over The Cuckoo’s Nest’- 1975, ‘Frances – 1982’, ‘Any Angel At My Table – 1990’, and ‘Shine – 1996’. These films propagated a brutal image of the procedure, leading to its complete rejection by the general public.
Patient reviews for ECT
The patients’ view of ECT is not free from its notoriety either. Despite being a stakeholder in its relief and treatment, patients still hold back due to stereotypes and stigmas.
Statistically collecting patients’ reviews about electroshock therapy, the procedure they underwent, and the results they experienced remains challenging. The anxiety and fear before the procedure and the effects of electric current on memory, cognitive functioning and sense of reality (in some cases) stand as a primary obstacle in recording raw and honest patient reviews.
Over time, it is noticed that the precedent fear and anxiety are majorly due to a lack of awareness and detailed information provided by the practitioners. When doctors or practitioners have provided detailed sessions of pre-requisite information to the patients, they have a more favorable eye for the procedure.
Although this constant complaint about lack of complete information being provided has reduced over time and has shown results that impact the reviews about this procedure, patients have started talking positively about its efficacy and effect over the symptoms. But it was unfortunate how the staff was seen struggling with providing proper and friendly care to the patients throughout their hospital stays, adding a fair share to their already existing concerns. A number of cases also mentioned the absence of patients’ consent as a concern when discussing the procedure.
Life after ECT treatment and its long-term effects
While collecting the data, with life after ect treatment and its long-term effects staying as a primary concern, other mainly discussed factors and issues that left the patients and their support unsatisfied were about the things that are not directly associated with the procedure. It is mainly related to the practitioner, public opinion, or the environment where the procedure is being done.
Talking about the current standing of patient reviews after all the years of development in the procedure, patients have given good reviews of the procedure. The patients have also highlighted the requirement of multiple rounds of the procedure as an inconvenience. One thing that remained present in the discussion about ECT was memory loss. It was one of the most highlighted issues when talking to patients about life after electroconvulsive therapy. Some statistics regarding the association of memory loss with ECT are discussed further.
Memory Loss: Multiple surveys conducted at different times with different groups showed a prominent relation between ECT and memory loss. According to the US government website, some of these surveys are mentioned.
- Out of 30 patients who were interviewed, 80% of them reported memory loss.
- 389 subjects answered the survey and 50% of them reported memory loss.
- Out of 51 patients, 60% mentioned impaired memory
- 45% out of 108 patients showed consistent memory loss
A close consideration of these stats points towards ECT causing memory loss. But the number of people claiming to have a reasonably good memory and even talking about improvement in the memory after a few sessions of the procedure makes this whole survey and memory loss due to electroconvulsive therapy a subject of dispute.
Reviews for ECT from the carer
Talking about the carer’s perspective of this treatment, most state this to be effective but still would propose this treatment to be kept as a last resort. Another primary concern that is being highlighted by the carers is related to consent. The amount of information provided before the treatment is either incomplete or incorrect, leading to unclarity and improper consent in the situation. Apart from that, the issues regarding memory loss (short and long-term) are also reported via family members and caregivers.
Reception of Electroshock Therapy (demographically)
Despite some prominent results and evident stats that strongly support the fact that it shows positive and notable results in treating clinical depression and other psychiatric disorders, the reception of electroconvulsive therapy has been weak. Several surveys were conducted to analyze the demographic factors of electroconvulsive therapy, yielding the following results.
- A study conducted in the Netherlands showed that 40% of psychiatrists did not have the right amount of skill and knowledge regarding the procedure and practice of electroconvulsive therapy.
- The survey conducted in 23 countries and 257 institutions in Asia showed that this treatment technique is considered insignificant and is only thought of as the last option left. No formal skill training is given to the practitioner, and it is only brought forth for the patients of schizophrenia.
- In Norway, the survey showed that the patients receiving treatment had a male-to-female ratio of 1:2.
- 78% of patients in Sweden, 80.2% in Spain, and 70% in Denmark received ECT for severe depression.
- The age of patients receiving it came out to be 18 – 59 years old for depression.
- Moving to Asian countries, it was seen that the stats were somewhat different. It was mostly younger men with schizophrenia. The patients aged between 24 and 44 were not more educated than at the school level.
- Studies conducted in Iraq showed varying stats. Of the patients receiving ECT, 51% had schizophrenia, 31.5% had severe depression, 10.4% had resistant mania, 2.4 % had catatonia, and 4.4% had other problems.
- Another research conducted in Thailand showed that 74% of patients received electroconvulsive therapy for schizophrenia, 8% had mania, and 7% were treated for major depression.
- The study conducted in Germany revealed unfavorable results, highlighting the urgent need for investment in awareness campaigns and advocacy to enhance the perception and understanding of electroconvulsive therapy among the German population.
However, it has existed as a treatment option for 75 years, with a cordial image as it is performed under anesthesia and with muscle relaxants to make the treatment comfortable and painless for the patients. Still, its connotation remains stigmatized among the German population. The treated person rate in Germany is 0.25. For comparison, the highest treated person rate is 5.1, and that is in the USA.
- An independent audit conducted in England collected data successfully from thirty-seven trusts, showing the progressive decline in the number of patients receiving electroconvulsive therapy. With a 47-fold difference between the highest and lowest per capita, the popularity of ect witnessed a reverse slope steepness.
- Most recipients were recorded to be women over the age of 60. However, an official survey needs to be conducted on a state level.
- A study was conducted on the data collected for up to 17 years of ect in three US states, namely, California, Vermont, and Illinois. It represented 62,602 patients in total. The ratio of female to male patients was 1.65: 1. 3% were over the age of 65, which makes up 11.7% of the population. Talking about race, stats show that 83% of the patients receiving electroconvulsive therapy were white. This makes up 48.2% of the total population.
- In a Swiss survey in 2005, the effectiveness of ECT in the public eye was just 1%.
- Another public survey was conducted. 57% of the population considered it to be harmful and showed a view of distrust towards this form of treatment. And only 1.2 % think that the treatment is effective and its administration shall continue.
Guidelines for ECT administration
The administration of electroconvulsive therapy has been uniquely dealt with over the years in different countries. From being a choice to the last option, it still has public and practitioner reception issues. Despite being considered a safe medical practice with extensive research and development reducing its side effects, the administration of electroconvulsive therapy still requires careful handling.
There are review guidelines for the administration of electroconvulsive therapy. These guidelines ensure the administration of it on a level that can eradicate any possible complications that may appear following the session or the whole treatment.
The guidelines structured by the regulatory body in the USA to be followed strictly while administering ECT are:
- Electroconvulsive therapy can be considered a primary treatment option for patients showing signs of syndromes like severe depression, catatonia, acute mania, and mood disorders with psychotic features.
- Proceeding with it as a secondary treatment option, the patient must have a history of absence or poor response to traditional treatment options like therapy or drugs. It can be used for major depression, mania, and severe depression.
- Tests and history of diseases and treatments taken is necessary to stay ahead of any precautions.
- It can be administered regardless of the types of medication already being consumed by the patient, as it has no chemical interactions reported so far.
- This can be administered to elderly people without hesitation. The efficacy of this treatment will not be affected by the advancing age.
- Electroconvulsive therapy is safe to administer during any trimester of pregnancy, postpartum period, and even while nursing. It may offer greater effectiveness and safety than pharmacological treatments with potential adverse effects.
- For children and adolescents, Electroconvulsive therapy must be considered as a last option. It must be administered after confirming the failed efficacy of pharmacotherapy and other treatment options.
Conclusion
Electroconvulsive therapy holds the spot for both, being the most revolutionary and one of the most controversial treatment options in medical history. But staying true to their professions, doctors and research scientists have shown enough resilience and determination to bring it forth as a treatment option that is beneficial for complex psychological illnesses and frees the patients from the worries that come with treatment through the drug intake route.
From the 1930s until today, Electroshock Therapy has taken a steady stride from dangling on the verge of abandonment to having a fixed spot as a primary treatment option for multiple psychological disorders. Despite societal challenges, the effectiveness of this treatment is increasingly recognized, although further progress is necessary. The stats of positive treatment responses and the cases of relief must be given a spotlight to enhance the light of relief over the shadow of stigma.
