Electroconvulsive therapy for depression is a method that was born before antidepressants but is not widely applied. It was not until recent years that this therapy was proven to be effective and safe. Currently, electric shock is considered the optimal solution for severe and treatment-resistant depression.
About electroshock therapy
Electroconvulsive Therapy (ECT) is the oldest and most controversial method of treating mental illness. ECT is a method that uses a small amount of electricity to be delivered to the brain through electrodes. Once inside the brain, the electrical current causes controlled seizures and is monitored through an electroencephalogram (EEG).
This method was born about 80 years ago. ECT was first performed on a 39-year-old male patient with severe schizophrenia. Initially, electroconvulsive therapy was administered directly without the aid of muscle relaxants and anesthetics, leading to convulsions, fractures, and temporary or permanent memory loss.
In the beginning, electric shock therapy was not really accepted because there were many deaths. Furthermore, the advent of antidepressants (1950) made electroconvulsive therapy less of a concern. Some media even claim that ETC causes memory loss and destroys the human mind.
Although stereotypes about ECT are unfounded, it was not until 2004 that the therapy began to become more widely used. Because there have been many studies done to prove the effectiveness of electroconvulsive therapy for major depression. With the improvement of anesthetic techniques and the use of muscle relaxants, the risk of side effects from ECT is significantly reduced.
What is electroconvulsive therapy for depression?
Today, electroconvulsive therapy (ECT) has become an important treatment for psychiatric disorders including depression. Electroconvulsive therapy for depression is a method of using electrical currents to stimulate the brain through electrodes. This creates controlled vibrations that improve symptoms and disease progression.
At present, the mechanism of action of electroconvulsive therapy is not well understood. However, this approach has been identified to have the following positive effects:
- Stimulates the release of neurotransmitters such as dopamine and serotonin.
- Changes in brain blood flow.
- Rapid changes in the permeability of the blood-brain barrier
- Release of certain hormones
- Stimulates the activity of genes, thereby promoting the development of brain cells
With the above mechanisms, electroconvulsive therapy also significantly improves symptoms of depression. In addition, electric shock changes the structure and functioning of the brain. This is of great help in managing and preventing disease progression.
When to treat depression with electric shock?
Electroconvulsive therapy is not the preferred treatment for depression. The first choice in the treatment of this pathology is the use of antidepressants and some other centrally acting drugs. In general, depression usually responds well to pharmacotherapy and only a few cases require ECT intervention.
Electroconvulsive therapy for depression is usually indicated in the following cases:
- Depression unresponsive to medication
- Depression has suicidal ideation and has committed or planned suicidal behaviors
- Psychotic depression with persistent delusions, agitation, etc.
- Patients with depression who cannot take medication may also be prescribed electroconvulsive shocks
- The patient refused to eat or drink for several days
The mechanism of electroconvulsive therapy is to create vibrations inside the brain, so it affects the heart rate, breathing rate and many other organs. Therefore, this method is contraindicated in the following cases:
- Increased intracranial pressure
- Having an acute infection
- Increased intraocular pressure
- Severe respiratory illness that can lead to coma (chronic obstructive pulmonary disease, acute respiratory failure)
- Severe cardiovascular diseases such as heart failure, high blood pressure, recent myocardial infarction, aortic aneurysm, cerebral arteriosclerosis, etc.
- Liver and kidney disease
- Spinal trauma, spinal tuberculosis, spinal deformities, sinusitis, osteoporosis, etc.
- Women who are menstruating
- Elderly people over 60 years old and people under 16 years old
It can be seen that electric shock therapy has a limited scope of indications and a wide range of contraindications. Therefore, some patients are sometimes unable to perform this therapy. In addition to severe depression, electric shock therapy is also applied in the treatment of many other mental illnesses such as schizophrenia, bipolar disorder, etc.
Is electroconvulsive therapy effective for depression?
Currently, electroconvulsive therapy is more commonly used and accepted as a treatment for mental disorders. However, some countries still ban electric shocks due to concerns about potential risks. Therefore, many people are skeptical about the real effectiveness of electroconvulsive therapy for depression.
Up to the present time, this method has nearly 80 years of history and is applied in the treatment of many mental illnesses. With the mechanism of increasing the production of neurotransmitters, changing the electrical configuration of the brain, changing blood flow, etc., electric shock helps to improve the symptoms of depression and prevent the disease from progressing in a negative direction. .
A study by the Consortium for the Study of ECT (CORE) performed in 2004 on 253 patients with major depression showed that 75% of patients completely relieved their symptoms after only 7 shocks within 21 days. Besides, this therapy also proved to be safer for the elderly and pregnant women. Because these two groups of subjects cannot use antidepressants.
In addition, some studies show that ECT can reduce suicidal thoughts. Specifically, patients with major depression with suicidal ideation and planning were treated with ETC for a period of time. After 1 week, about 38% of patients no longer had suicidal thoughts and after the end of therapy, 81% of cases had completely dismissed the idea of suicide.
In fact, each method will have certain advantages and limitations. Electric shock directly affects the brain, so it will bring significant effects to patients with severe depression. However, the patient has to go to the hospital to perform an electric shock, so it is quite inconvenient and less active than taking medicine. This is also the reason why patients will be given priority to take medication and receive electric shock only in case of treatment-resistant depression, severe depression, suicidal ideation and behavior.
In the context of the increasing suicide rate associated with depression, electroconvulsive therapy is indeed the optimal solution for patients who have not responded to medication or cannot use it. To optimize the effect, the patient will be given electric shock in combination with the use of drugs and psychotherapy.
Currently, a number of new methods with similar mechanisms to ECT have also been developed, such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS). These therapies are effective in treating Parkinson’s disease, schizophrenia, bipolar disorder, depression, and other common psychiatric disorders. However, when comparing efficacy between methods, ECT proved to be more effective in treating depression.
Side effects of electroconvulsive therapy
Similar to pharmacotherapy, electroconvulsive therapy also causes some side effects. However, the side effects of this therapy are not really “creepy” like malicious prejudices. With the development of medicine, or more specifically, the experience of using muscle relaxants and anesthetic techniques has helped minimize the side effects of ECT.
Adverse effects that may be encountered when performing electric shock treatment for depression:
- Consciousness disorder
- Forgetting (temporary amnesia)
- Some people may also experience irregular heartbeat and breathing
Electroconvulsive therapy for depression
Electroconvulsive therapy for depression is usually given once a day or 2-3 times a week depending on the severity of each case. Patients will be treated for about 3-6 weeks to achieve the best results. However, your doctor may also adjust the number and frequency of sessions depending on your health condition and response to each case.
Each shock session will last about 60 minutes, of which 20 minutes are performed and 30 minutes for the patient to rest and monitor. After the electric shock, the patient will lack alertness, so it is necessary to have the support of relatives and avoid letting the patient drive for at least 24 hours from the time of treatment.
- Doctors and medical staff will prepare necessary tools and machines
- Patients and family members will be specifically explained by the doctor about the method to understand before deciding to perform.
- Patients need to fast for at least 3 hours and defecate before going into shock
- Remove metal objects, dentures (if any) to prevent possible accidents.
- Finally, the patient’s temperature, blood pressure and pulse will be checked before the electric shock.
- The patient will be lying on a chair or bed and wearing the electrodes
- The assistant will have the role of holding the patient’s shoulder and adjusting the tongue during shock to avoid the patient’s tongue biting, bone fracture, spinal injury, etc.
- After preparing, the doctor will adjust the parameters and plug in the shock. Normally, electrical stimulation will have pulses from 0.5 to 2.0ms but sometimes less than 0.5ms.
- The process will take place in a closed room with the support of about 2 assistants and 1 doctor
- After the electric shock, the patient will be moved to an airy room to rest for 30-60 minutes. At this time, medical staff will measure blood pressure, count breathing, measure pulse and body temperature to promptly detect abnormal signs.
- Family members will be instructed on how to care for and support the patient in the first 24 hours. Because the patient is not really awake at this time.
Some notes when treating depression with electric shock
Electroconvulsive therapy for depression is a solution for severe cases where the patient has suicidal thoughts and behaviors. However, before applying this method, patients should note the following issues:
- Only perform electric shock when prescribed by a doctor and must be done in large hospitals with well-trained machinery, equipment and medical staff.
- Although highly effective, ECT is not a substitute for pharmacotherapy and psychotherapy. Ideally, it should be combined with other methods to control the disease effectively.
- It is advisable to examine and treat depression early to limit the need to intervene with brain stimulation methods such as ECT, deep brain stimulation or transcranial magnetic resonance. Because these methods must be done in the hospital and can cause side effects.
- Furthermore, ECT is not a substitute for medication, so patients must still take long-term antidepressants. Cases requiring chemotherapy and ECT will experience more side effects than patients undergoing monotherapy. Therefore, early treatment will be more helpful in controlling the disease and limiting adverse effects.
Electroconvulsive therapy for depression has been shown to be effective and safe. In cases prescribed by a doctor, patients should take steps to control the disease and prevent suicidal behaviors. In addition, should be equipped with knowledge about this therapy to feel secure during treatment and have more thorough preparation steps.