Electroconvulsive therapy (ECT): characteristics and uses in psychiatry

Throughout history, the treatment offered by psychiatry for some types of disorders and mental disorders has been strongly criticized. Specifically, electroconvulsive therapy or "electroshock" is one of the worst fame among society.

However, with the passage of time this technique has been perfected and Currently electroconvulsive therapy is carried out safely and effectively . Throughout this article we will discuss its characteristics, results and possible risks.

• Related article: "Transcranial magnetic stimulation: types and uses in therapy"

What is electroconvulsive therapy?

Electroconvulsive therapy (ECT), also known as therapy as electroconvulsive therapy , consists of a psychiatric treatment, whose beginnings go back to the 30s and which was designed with the aim of alleviating the symptoms of certain disorders and mental disorders.

For this, electroconvulsive therapy uses electrical energy transmitting devices that they send a series of electrical impulses from the outside to the patient's brain . This impulse causes a small brain seizure whose duration can range from 30 seconds to two full minutes.

Although electro-shock therapy has traditionally been considered as an inhuman method and involves the torture of the patient, this technique has now advanced considerably. Further, the patient is given general anesthesia , so the patient stays asleep during the session and does not become conscious, nor to feel any pain.

In this type of therapy, there are three essential variables that regulate its application:

• The location or placement of the electrodes .
• The duration of the impulse.
• The electro-physical properties of stimulation.

However, despite the advances, this technique continues to carry some risks to the patient's health , so it is not usually resorted to more than in those cases in which the patient does not respond satisfactorily to therapy with psychotropic drugs.

Currently, it is estimated that approximately one million people in the world population receive electroconvulsive therapy. This is a relatively low figure considering the number of the total population that has some psychiatric diagnosis. Also, the main criticism is that, in addition to the associated risks, The effects of electroconvulsive therapy are quite limited over time , so that after the intervention the patient should continue with the medication.

For what pathologies does it apply?

Electroconvulsive therapy it is applied as a second-line treatment in certain psychological disorders such as depression, mania and other mental illnesses in which drugs are not effective, when the clinical picture is so serious or dangerous that drug therapy is not expected to exert any effect or in pregnant patients with a high risk of harm for the fetus.

It has been shown that this type of intervention is effective in the treatment of the following disorders, causing a rapid and considerable decrease in the most severe symptoms . It is usually used in the following cases.

1. Serious depression

ECT is peculiarly effective in those cases of severe depressive disorder, especially if it is characterized by presenting psychotic symptoms as a disconnection from reality or if suicidal thoughts manifest themselves.

2. Resistant depression

In this case it is used when the symptoms of severe depression are maintained over time regardless of the pharmacological treatments administered.

3. Serious mania

Within bipolar disorder, you can resort to electroconvulsive therapy when the patient is in the state of intense euphoria proper to this alteration. This state is often accompanied by impulsive behavior, drug use and psychosis.

4. Catatonia

Catatonia is distinguished by the loss of movement or the manifestation of accelerated and anomalous movements. Although in many cases it is caused by an organic disease, It is usually related to schizophrenia and other psychiatric disorders of the psychotic type.

• Related article: "Catatonia: causes, symptoms and treatment of this syndrome"

5. Dementia

Electroconvulsive therapy may be common in patients with dementia who present high levels of nervousness and aggressiveness . Which are resistant to treatment and reduce the quality of life of the patient.

• Related article: "Types of dementia: the 8 forms of loss of cognition"

What is the procedure?

Before starting electro-shock therapy, the patient must undergo a thorough evaluation that includes the patient's medical history, a physical examination, psychiatric evaluation and physical tests. there are blood tests, electrocardiogram and a report from the anesthetist .

The purpose of these tests is to ensure that electroconvulsive therapy is safe for the patient, thus ensuring minimal risks or possible side effects.

Once the parameters or variables that are mentioned at the beginning of the article are established, the treatment session is carried out. First of all, we proceed to administer general anesthesia and place the intravenous lines that will provide the patient with fluids and anticonvulsant medications.

Then, pads with electrodes are placed on one or two sides of the head , according to whether the current should be administered unilaterally or bilaterally. The session usually lasts between 5 and 10 minutes without taking into account the time the person needs to prepare, as well as to recover from the treatment.

When it is finished, the patient is transferred to a recovery room where the patient is observed and monitored for any adverse reaction. It is usual to experience confusion or disorientation upon awakening.

Finally, the hospitalization of the patient is not necessary, but in many cases it can be performed on an outpatient basis.

What results does it offer?

Although it is still not known exactly how electroconvulsive therapy causes the brain changes that help in the recovery of the patient, this usually shows a significant improvement from the sixth session of TEC, although an absolute remission can take much longer or even impossible in some cases.

Because the improvement in symptoms is usually temporary, in many cases the patient must continue with the pharmacological treatment or, even, require a continuous electroconvulsive treatment.

What are the risks?

While the side effects or risks of electroconvulsive therapy have greatly diminished since its creation , we can still find some unwanted consequences that can be annoying or distressing for the person.

Among these side effects we find:

• Retrograde amnesia or memory loss of what happened just before treatment or during the weeks of treatment.
• Sensation of temporary confusion.
• Headaches
• Hypotension or hypertension .
• Tachycardia or heart problems.
• Muscle pain.
• Sickness .

ECT (April 2024).