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Electroconvulsive Therapy (ECT)

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What is electroconvulsive therapy (ECT)? What is the history of ECT? Why is electroconvulsive therapy controversial?

Electroconvulsive therapy (ECT) is a non-medication medical treatment that is used to address severe psychiatric symptoms, after trials of medications and psychotherapy have been unsuccessful or a mental health disorder is determined to be acute enough to warrant this intervention. During the ECT procedure, an electric current is passed through the patient's brain to produce controlled convulsions (seizures) while the person is sedated using general anesthesia. This device is often used in a hospital but can be done on an outpatient basis (the individual receiving the treatment does not stay overnight in the hospital).

Formerly called electroshock therapy, ECT is a form of mental health therapy that was based on a procedure in which seizures were chemically induced in patients using a heart medication. It was first done in 1934 in Hungary to treat schizophrenia. In 1938, it is thought that electrical currents delivered directly to the brain were first used to induce seizures to treat schizophrenia. That was reportedly performed by Italian psychiatrist Ugo Cerletti. By 1940, ECT was being used in psychiatry in the United States. The U.S. military often used ECT during World War II, after which it became widely used in American and European psychiatric hospitals. It was in the late 1940s that doctors started placing electrodes on one side of the brain (unilaterally) rather than both sides (bilaterally), which resulted in less side effects like memory loss or speech problems.

Despite those advances, ECT fell out of favor for at least a generation in psychiatry, starting in the 1960s. Rather than the popularity of psychoanalysis or the rise of medication treatments from pharmaceutical companies, it is thought that a cultural bias against psychiatry in general and against ECT specifically is the reason that this highly effective medical treatment became controversial. Novels like Asylum in 1961 and One Flew Over the Cuckoo's Nest in 1962, as well as the film based on the latter novel, released in 1975, are thought to have fueled some of that backlash. The antipsychiatry stance of groups like the Church of Scientology is also thought to have contributed to the stigma that mental health treatments, particularly ECT, incurred during that period of time.

Appreciation of the effectiveness of ECT started regaining ground in psychiatry during the mid-1980s with the publication of the National Institutes of Health (NIH) Consensus Conference on Electroconvulsive Therapy, published in the Journal of the American Medical Association (JAMA), which documented how well this medical treatment improves symptoms of depression. By the mid-1990s, several guidelines for conducting ECT were published, providing predictability, standardizing, and thus credibility of this medical treatment in providing care for severe mental health disorders.

Medically Reviewed by a Doctor on 3/31/2017


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