A. Thesis Statement
Electroconvulsive therapy (ECT) is a treatment for severe mental illness in which the brain is stimulated with a strong electrical current which induces a seizure. The seizure rearranges the brain's neurochemistry and results in an elevation of mood. This essay asks: Is ECT any safer and more effective in treating mood disorders than drug therapies? This treatment has a controversial history ever since it was first introduced in 1938. I intend to argue that electroconvulsive therapy is indeed a safe treatment of mental disorders when other treatments have failed. Due to the development of safer and less traumatic ways of administering ECT, the treatment has made a comeback, is greatly used, and proves to be
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C. Central Issue
Since its beginning, the issue of the safety and efficacy of ECT has existed, and thus its use has been always remained controversial (Weiner & Krystal, 1994). Even with the modern development of ECT, some of the same issues are still prevalent. There are two sides here: the advocates that support the use of the treatment, and those who do not. This is explored next.
The first argument for the use of ECT is the fact that majority of studies and modern literature show that this treatment is very successful in treating many psychological disorders. Evidence seems strongest for the efficacy in severely depressed patients, as well as manic patients (Reisner, 2003). When looking at those with major depression, the likelihood of substantial improvement ranges from 80-90% (Weiner & Krystal, 1994). In manic patients, Gabbard concludes that 80% of patients show “marked improvement” (2001, p.1272).
The second argument for the use of ECT is that successful treatments induce remission in episodes of illness (Gabbard, 2001). The evidence supporting this conclusion is compelling and includes a sizable number of well-controlled “sham-ECT” studies. In these studies, patients were randomized to receive real ECT or sham-ECT (which involves anaesthesia but no electrical stimulation), thus providing for precise double-blind tests of efficacy (Gabbard, 2001). One misconception is that it provides a “cure”. This is not the case - it does not produce a “cure” any
Electroshock therapy is the process of electroshocking the brain of a human, this a process that takes multiple sessions (CBS News). ECT caused critical seizures. Doctors used this method to cure of reduce schizophrenia. Electroshock therapy was performed daily, it was known referred to as “The shock of the day” (D’Antonio). Doctors saw ECT as a easy and fast way to cure a patient.
Still today it is not known why ECT works but it seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It is also said that the shock literally shocks the person out of their illness as it is regarded as a punishment for the inappropriate behaviour. Another explanation is that the associated memory loss following shock allows the person to start afresh. They literally ‘forget’ they were suffering from a mental illness. Created in +1934 by Hungarian neuropsychiatrist Ladislas Meduna, [11]. However, ECT was not introduced in England until 1939 when Lothar Kalinowsky, observed the treatment administered in Italy and decided to use it in England due to its promising results. During this time high doses of electricity were administered without anaesthesia and muscle relaxations. This lead to memory loss, fractured bones and other serious side effects, which lead to, much of the stigma attached to ECT, because of these early treatments [12]. ECT is a treatment that is still used today, however much less brutally than in the 1930s.
However, there still remains controversy. There remains controversy because some experience more negative effects than they do positive effects. Negative results include side effects, relapse, and possible death. On the other hand, the positive result is an immediate anti-depressant effect despite the possible side effects and relapse. Some argue however, "There is no controversy about the indications for ECT and its efficacy in alleviating severe mood disorders, not about the safety of the procedure when properly done" (2). There are those who argue that ECT is brain-damaging or brain-disabling, but research has not been able to find tangible evidence on long-term brain changes when properly administered.
According to the Mental Health America website (2012), ECT is making a comeback. They assert with “the increase in the elderly population and Medicare, and the push by insurance companies to provide fast, “medical” treatment rather than talk therapy” (para. 6) has created yet another potentially dangerous field to navigate. Is it appropriate to treat these elderly patients with ECT when they have pre-existing medical conditions, specifically cardiac conditions where an electric shock could be fatal? Who is the advocate for the elderly widow without family to speak for her should she become so incapacitated by mental illness this becomes a viable option? This patient is vulnerable
Although more SZ patient improved with real ECT, which compared to placebo, when comparing to antipsychotics medication, the drugs are more beneficial. There was some limited evidence to suggest that ECT combined with medication resulted in greater improvement in mental state. The conclusion was that a combination of drugs and ECT could be useful if a rapid reduction of symptoms is required or when patients don’t respond well to drugs alone. (Tharyan and adams 2005)
ECT has become much safer than the dangerous past shown in One Flew Over the Cuckoo’s Nest. Electroconvulsive therapy has little resemblance to that depiction. ECT brings about fast results compared to some other medications and treatments. After the shock, there is immediate relief to the symptoms of many mental illnesses. The electric current only lasts for a few seconds and the seizure lasts for about a minute. Many medications take weeks to become effective and ECT is an ideal option for those people that need the relief right away. ECT has often worked when many other treatments have
(Nordenberg, 4-6). People with milder forms of depression may respond favorably to psychotherapy; however, it is common for people with moderate to sever depression to benefit from both the use of anti-depressants and psychotherapy. Lastly, electroconvulsive therapy (ECT) is used by people who suffer from severe depression or by people whose depression is life threatening or for those who cannot take anti-depressant medications. ECT is most effective where anti-depressants can't provide sufficient relief of symptoms. In order for ECT to be effective, several sessions are necessary, usually three sessions per week. (5). ("Depression: An Overview" 5-7).
Along medication, certain types of therapies are also used for treating Mental Health patients. One such therapy is Electroconvulsive therapy (ECT). It is a type of treatment which is effective in severe depression. The treatment involves procedure
I learned that often times, ECT is used along with a general anesthesia and a brief electrical current initiated to trigger a brief seizure. Likewise, I realized that ECT is the preferred treatment when other options are not as well tolerated. After becoming more familiar with the procedure, it seems as though ECT may be a more desirable option than pharmacological interventions as drug interventions may require more time to become effective. Sometimes when a patient's signs and symptoms are overwhelming, interfering with their daily life, time is of the essence and ECT provides a quicker relief for individuals with immediate risk. After several years and improvement technology, ECT has become much safer in the past, presenting minimal possible risks - memory loss, confusion, headache or muscle ache - to the
When ECT “hit” the medical scene in the 40s and 50s, it was unsafe and gruesome (Dahl, 2008). Treatment was often performed while the patient was awake, and their convulsions were not controlled at all – they were often strong enough to break bones. ECT hit its peak in the 1960s when three tenths of a million US citizens underwent the therapy yearly (Dahl, 2008). At that point, however, it was still “absolutely a cruel procedure” (Dahl, 2008). It is still yet to recover from its ghastly past, the general public still thinks of ECT as how it was portrayed in One Flew Over the Coocoo's Nest, and more recently, Requiem for a Dream (Fitzgerald, 2011). A psychiatrist summed up the current status of ECT very well saying, “Quite frankly, the stigma pushes people away from it, and it pushes some psychiatrists away from even recommending ECT, but most of the stigma related to ECT really is related to misconception” (Dahl, 2008).
There is a debate on the ethics of using ECT, primarily because it often takes place without the consent of the individual and we don’t know how it works!
Much of the controversy surrounding this topic revolves around its effectiveness vs. the side effects, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization. Because of the concern about permanent memory loss and confusion related to ECT treatment, some researchers recommend that the treatment only be used as a last resort. It is also unclear whether or not ECT is effective. However, other studies indicate that the relapse rate is high, even for patients who take medication after ECT. Some researchers insist that no study proves that ECT is effective for more than four weeks.
The groundwork for the development of electroshock therapy was laid in 1935, when a Budapest psychiatrist, Von Meduna, observed that
seizure through controlled electric shock, under anesthesia. The process itself is under scrutiny because it is not entirely understood, which is main a reason why it is only considered in the direst of cases. ECT tends to have severe physical health risks and with the introduction of newer and less harmful antidepressant drugs, it is being used far less often (Comer, 2005). This new class of drugs includes three main types; monoamine oxidase (MAOI) inhibitors, tricyclics and selective serotonin reuptake inhibitors (SSRIs).
The rationale for ECT is to provide relief from the signs and symptoms of mental illnesses such as severe depression,