Is electroconvulsive therapy dangerous?

Since in 1938, the Italian neurologist Ugo Cerletti introduced electroconvulsive therapy as a treatment for various mental disorders, this technique has been the subject of powerful criticism, sometimes based on information incorrect.

At present, and after more than 80 years of use, this therapeutic method continues to raise doubts regarding its efficacy and safety. But why this controversy? Is electroconvulsive therapy dangerous? First of all, let's see what this type of intervention consists of.

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What is electroconvulsive therapy?

Electroconvulsive therapy (ECT) is a procedure carried out under general anesthesia that consists of introduce small electrical currents through the brain in order to intentionally trigger a brief seizure.

This technique consists of placing several electrodes on the patient's forehead and a rubber band around the patient's forehead. where the cables are connected, which in turn are connected to the machine that controls and executes the mechanism electric.

During the procedure, electrical current passes from the electrodes to the brain in just a few seconds. This is what causes the seizure, which usually lasts less than 1 minute. Because the patient is under anesthesia and his muscles are relaxed, there is little or no sign that he is convulsing and his body is usually completely immobile.

The ultimate goal of this therapeutic technique is cause changes in brain neurochemistry so that some of the symptoms can be quickly reversed of the serious mental disorders and illnesses that it tries to alleviate.

For what type of disorders is the therapy indicated?

The main indication for electroconvulsive therapy (ECT) is severe major depression that threatens life or significantly impairs the individual's functioning. Due to its speed of action and efficacy, it may be the treatment of choice. in severe psychiatric disorders such as catatonia, depression, bipolar disorder and psychoses.

This technique is considered the most effective and fastest acute treatment to treat major depression. According to randomized trials conducted, remission occurs in 70-90% of patients receiving the therapy.

Another of the specific indications for ECT is psychotic unipolar depression, people with suicidal tendencies and malnutrition secondary to refusal to eat, severe catatonia, as well as people with recurrent episodes of depression and treated with this therapy after numerous drug failures.

It is considered that there are no absolute contraindications for ECT, regardless of the type of population and their clinical situation, except for populations at risk who must be treated with closer supervision.

Main side effects

Like any therapeutic procedure, electroconvulsive therapy is not without potential side effects. These are the most common:

• Memory loss or amnesia
• muscle aches
• Nausea
• Headache
• Confusion

Headaches, nausea, and muscle aches are usually mild and can be prevented or alleviated with medication. The most unpleasant side effect is usually memory loss, although it is true that it reverses and disappears after a few weeks.

It must be clarified, however, that this type of side effect depends on the patient's previous conditions, such as your age, your susceptibility to this type of treatment, the technique used or the frequency of administration.

Is electroconvulsive therapy really dangerous?

There is evidence that electroconvulsive therapy It is one of the psychiatric treatments with the highest efficacy and safety rates for the approach of some serious mental disorders.

The investigations carried out conclude that the most frequent side effect is memory loss or amnesia. However, this therapy appears to have fewer side effects than some antidepressant and antipsychotic drugs in frail elderly patients.

The effects that this technique may have on the developing brain are still unknown.. In pregnant and lactating women where there are concerns about possible teratogenic sequelae (birth defects during pregnancy of the fetus) and other side effects of the medication, can also be effective, and can be safely treated with this therapy.

A review of 300 cases of ECT during pregnancy found five cases of congenital anomalies (hypertelorism, equine foot (clubfoot), optic atrophy, anencephaly, and lung cysts). The review concluded that these malformations were not the result of therapy, and that there was no evidence of postnatal developmental effects.

Clinical research also supports the efficacy and safety of electroconvulsive therapy. as a therapeutic tool for the prevention of relapses in major depressive disorder, even in adolescents.

It therefore seems that, in view of the studies and investigations carried out, to the question of whether the electroconvulsive therapy we must answer with an unequivocal no, at least until proven otherwise. contrary.

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Efficacy in the intervention on disorders

The investigations carried out indicate that electroconvulsive therapy (ECT) is effective in the short term for the treatment of depression, and it is probably more effective than drug therapy, with bilateral ECT (with electrodes on both sides of the head) being moderately more effective than unilateral.

Studies further conclude that high doses of ECT appear to be more effective than low doses in the treatment of serious mental illnesses such as depression and bipolar disorder. In addition, ECT is also effective in severe bipolar depression.

ECT would also be indicated in children and adolescents with severe and persistent major depression, with life-threatening symptoms or that do not respond to other treatments. However, in this type of younger population, ECT should be used exceptionally and always carried out by a qualified professional.

However, ECT is a therapy reserved solely and mainly for patients with severe symptoms and persistent, especially when they have not responded to other types of treatment or when there is a real serious threat for his life.

Bibliographic references:

• Gallegos J.; Vaidya P.; D'Agati D.; et al. (2012). Decreasing adverse outcomes of unmodified electroconvulsive therapy: suggestions and possibilities. The Journal of Electroconvulsive Therapy. 28 (2): 77 - 81.
• Fitzgerald, P.B. (2013). Non-pharmacological biological treatment approaches to difficult-to-treat depression. The Medical Journal of Australia. 199(6): 48 - 51.