Electroconvulsive therapy (ECT): characteristics and uses

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

However, over time this technique has been refined and currently electroconvulsive therapy is carried out safely and effectively. Throughout this article we will talk about its characteristics, its results and its possible risks.

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

What is electroconvulsive therapy?

Electroconvulsive therapy (ECT), also known as therapy such as electroconvulsotherapy, consists of a psychiatric treatment, whose beginnings date back to the 30s and that was devised with the aim of alleviating the symptoms of certain disorders and mental disorders.

To do this, electroconvulsive therapy uses electrical energy transmitting devices that send a series of electrical impulses from outside to the patient's brain

. This impulse causes a small brain seizure that can last from 30 seconds to a full two minutes.

Although electroshock therapy has traditionally been considered an inhumane method and involves the torture of the patient, today this technique has advanced considerably. What's more, the patient is given general anesthesia, so the patient remains asleep during the session and does not become conscious or 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 the stimulation.

However, despite the progress, this technique continues to carry some risks to the patient's healthTherefore, it is not usually used except 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. Likewise, the main criticism is that, in addition to the associated risks, the effects of electroconvulsive therapy are quite limited in timeTherefore, after the intervention, the patient must continue with the medication.

For what pathologies is it applied?

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

This type of intervention has been shown to be effective in treating the following disorders, causing a rapid and considerable decrease in the most serious symptoms. It is usually used in the following cases.

1. Severe depression

ECT is particularly effective in cases of severe depressive disorder, especially if it is characterized by psychotic symptoms as disconnection from reality or if suicidal thoughts are manifested.

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. Severe mania

Within bipolar disorder, electroconvulsive therapy can be used when the patient is in the state of intense euphoria characteristic of this alteration. This state is usually accompanied by impulsive behaviors, drug use, and psychosis.

4. Catatonia

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

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

5. Dementia

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

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

What is the procedure?

Before initiating electroshock therapy, the patient must undergo a comprehensive evaluation that includes the patient's medical history, a physical exam, psychiatric evaluation, and physical tests between which there are blood tests, EKG, 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 mentioned at the beginning of the article have been established, the treatment session is carried out. First of all, general anesthesia is administered and intravenous lines are placed that will provide the patient with fluids and anticonvulsant medications.

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

When this is over, the patient is transferred to a recovery room where the patient is observed and monitored for any adverse reaction. It is common to feel confused or disoriented upon waking.

Finally, it is not necessary to hospitalize the patient, but in many cases it can be done on an outpatient basis.

What results does it offer?

Although it is not yet 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 ECT, even if a complete remission can take much longer or even be impossible in some cases.

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

What are the risks?

Yes OK the side effects or risks of electroconvulsive therapy have greatly decreased since its inception, 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 weeks of treatment.
• Feeling of temporary confusion.
• Headaches
• Hypotension or hypertension.
• Tachycardia or heart problems.
• Muscle pain.
• Sickness.