Electroconvulsive therapy

Electroconvulsive therapy, also known as electroshock or ECT, is a very controversial type of psychiatric shock therapy involving the induction of an artificial seizure in a patient by passing electricity through the brain. Researchers remain uncertain as to exactly how ECT affects the mental state, though patients with a variety of conditions have shown short-term improvement after the procedure. Large segments of the public came to view ECT in a negative light after several unfavorable depictions in popular books and films.

Current usage

Currently ECT is mainly used to treat severe depression, particularly if complicated by psychosis (NIH & NIMH Consensus Conference, 1985; Depression Guideline Panel, 1993; Potter & Rudorfer, 1993). It is also used in cases of severe depression where antidepressant medication (sometimes in multiple courses), psychotherapy, or both have proven ineffective (Potter et al., 1991; Depression Guideline Panel, 1993), when medication cannot be taken, or when other treatments would be too slow (for example, in a person with delusional depression and intense, unremitting suicidality). Specific indications include depression accompanied by a physical illness or pregnancy, which renders the use of the usually preferred antidepressants dangerous to the patient or to a developing fetus. Under such circumstances, carefully weighing risks and benefits, some psychiatrists consider ECT to be the safest treatment option for severe depression. It is also sometimes used to treat the manic phase of bipolar disorder and in the uncommon condition of catatonia.

Related Topics:
Depression - Psychosis - Antidepressant - Psychotherapy - Suicidality - Pregnancy - Fetus - Manic phase - Bipolar disorder - Catatonia

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ECT should be administered under controlled conditions, with appropriate personnel (Rudorfer et al., 1997) and some mental health laws mandate this.

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Recent epidemiological surveys in the United States show that the modern use of ECT is generally limited to evidence-based indications (Hermann et al., 1999). Indeed, concern has been raised that in some settings, particularly in the public sector and outside major metropolitan areas, ECT may be underutilized due to the wide variability in the availability of this treatment across the country (Hermann et al., 1995). Consequently, minority patients tend to be underrepresented among those receiving ECT (Rudorfer et al., 1997).

Related Topics:
Epidemiological - United States

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