Electroconvulsive therapy, more commonly known as ECT, was first introduced in 1938 to help treat psychiatric illnesses, in particular, severe depression. This controversial treatment declined in the 1960s because of the stigma attached to this “violent” and “inhumane” treatment. Yet in the 1970s, ECT became more popular and, currently, is the most effective treatment for medication-resistant depression. It is endorsed by the American Psychiatric Association and approximately 100,000 patients in the United States undergo ECT on an annual basis.
When ECT was first administered in the early 1900s, it was administered without any aesthesia or muscle relaxants, which resulted in severe injuries to the musculoskeletal system, including joint dislocations and bone fractures. During this time, there were also no regulations about dose parameters for electric stimulation and, therefore, the negative cognitive effects from ECT outweighed the benefits. Luckily, today this therapy is much safer and entails strict rules and regulations.
Although the specific mechanism is unknown, ECT delivers electricity to the brain to induce a generalized seizure in patients. This electrical stimulation affects multiple hormones and almost every single neurotransmitter in the brain, altering the brain’s chemistry. An electroencephalogram (EEG) is used to monitor seizure activity and duration in patients while receiving ECT. Today, patients receive generalized anesthesia and muscle relaxants while electricity is being delivered to their brain via electrodes that are strategically placed on the patient’s head. The anesthesia and muscle relaxants prevent muscle injury, including fractures and dislocations, while the patient is having an induced seizure.
ECT is controversial in the pediatric population, but it is deemed safe and effective in pregnancy and in the geriatric population for treatment-resistant depression. In the United States, ECT is generally performed three times per week for a total of six to12 treatments. The total number of treatments depends on the severity of symptoms and how well the patient responds.
ECT efficacy and safety
Although many patients experience an 80 percent improvement rate in depression when ECT is used, negative side effects still persist with this technique. The most well-known and common side effects from ECT are adverse cognitive effects, which include disorientation, and impaired memory and cognition. Although the effects reverse over time, these might deter patients from undergoing ECT for their severe treatment-resistant depression.
Fortunately, new research explores the placement of electrodes on the scalp and has shown to decrease the rate of cognitive decline in patients. Traditional electrode placement is known as bitemporal (BT) placement where electrodes are placed on the temples. Two other placements known as bifrontal (BF) electrode placement and right unilateral (RUL) electrode placement have resulted in decreased cognitive decline. BF electrode placement is where each electrode is placed directly over the eyebrow and RUL electrode placement is when both electrodes are placed on one side of the head instead of opposite sides of the head. BF electrode placement is the preferred placement in today’s practice because it is the most effective and has shown to have the least amount of cognitive decline.
According to the study, “While the immediate effects on memory may be unpleasant with all electrode placements, those associated with BT are greater than those with BF and RUL. The long-term effects on memory are modest for most patients, even when BT is given at energies that are higher than necessary. Increasing energies in RUL increase efficacy but do not spare cognitive effects. Due to its efficacy and memory-sparing qualities, BF electrode placement is the leading alternative to BT electrode placement in clinical practice today.”
The Sovereign Health Group is a leading behavioral health provider with locations across the United States that help treat people with addictions, mental health disorders including depression, eating disorders and co-occurring conditions. For more information, please call our 24/7 helpline.
About the author
Kristen Fuller, M.D., is a senior staff writer at the Sovereign Health Group and enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.