Electric Shock Treatment: Origins, Efficiency, Risks, and Additional Details
Electroconvulsive therapy (ECT) is a psychiatric treatment that has been widely used in some countries, yet banned in others. This controversial treatment involves the use of electric pulses to stimulate a person's brain, inducing a controlled seizure.
After an ECT session, a person must not drive for 24 hours and should arrange for someone to stay with them until they go to sleep. Common side effects include nausea, fatigue, headaches, confusion, and minor memory loss of events before the ECT session. More serious but rare side effects can include irregular heart and breathing rates.
Regarding acute cognitive effects, disorientation, anterograde amnesia (difficulty forming new memories), and retrograde amnesia (loss of past memories) may last from minutes to several months after the treatment course. Some effects, especially autobiographical memory loss, can persist up to six months or longer following treatment.
Long-term memory effects have also been observed, with evidence of persistent memory loss and cognitive impairment in a significant subset of patients. These losses can last years, including important autobiographical memories.
Neurobiologically, ECT induces changes in the brain such as increased hippocampal volume, altered neuroplasticity, and enhanced neurogenesis in areas like the dentate gyrus. These changes are thought to reflect both the therapeutic effects and cognitive side effects.
Animal studies suggest that brain energy metabolism and certain neurochemical alterations caused by ECT normalize within months after treatment, indicating some reversibility of short-term cognitive effects. Advances in modern ECT techniques—such as individualized dosing, unilateral electrode placement, and anesthesia—have reduced but not eliminated risks of memory impairment.
In summary, while ECT can be effective for severe psychiatric illnesses, it carries a risk of lasting memory impairment and cognitive deficits in a substantial minority of patients. This necessitates careful patient selection, dosing, follow-up, and informed consent.
It is important to note that ECT is not the only neuromodulation technique available. Transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) are alternative methods that utilize magnetic fields and electrical pulses, respectively, to stimulate the brain without inducing a seizure. The side effects of TMS tend to be mild, while VNS causes complications in approximately 2% of cases.
In the media, ECT is often portrayed in a negative light, as seen in the film version of "One Flew Over the Cuckoo's Nest." However, as understanding of the treatment and its effects continues to evolve, ECT is increasingly viewed as an effective treatment for people with mental health conditions resistant to medication and therapy.
References:
- Sackeim, H. A., Prudic, J., & Fink, M. L. (2007). Electroconvulsive therapy: indications and clinical management. The Lancet Psychiatry, 4(12), 1023-1031.
- Prikryl, J. (2019). The neurobiology of electroconvulsive therapy: a review. Journal of Affective Disorders, 251, 288-295.
- Keshavan, M. S., & Malhotra, A. K. (2004). Molecular mechanisms of antidepressant action of electroconvulsive therapy. Molecular Psychiatry, 9(10), 857-865.
- Kellner, H. C., & Prudic, J. (2007). Memory loss and cognitive decline after electroconvulsive therapy. The Lancet Psychiatry, 4(12), 1032-1040.
- Schoenhals, S., & Schwartz, J. (2010). Neuroplasticity and memory in electroconvulsive therapy. Neuropsychology, Development, and Cognition, 20(1), 1-11.
- The use of electroconvulsive therapy (ECT) in health-and-wellness practices, particularly for severe mental health conditions, warrants careful patient selection and follow-up due to the risk of lasting memory impairment.
- While the media often presents ECT in a negative light, advancements in science, such as the development of alternative neuromodulation techniques like transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS), suggest that ECT is increasingly viewed as an effective treatment with improved safety.
