Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a medical procedure, carried out under general anesthesia, where the cerebral tissue of the patient is stimulated through regulated and painless electrical impulses. The electrical impulses are administered with alternative polarity and a pulse-pair frequency of up to 120 Hz, with a maximum train duration of 8 seconds. Consequently, they provoke a global cerebral seizure, perceived through the manifestation of a tremor in the foot.

These patients have various brain changes, including reduction of the hippocampus and amygdala. The dopamine system is also affected. The hormone affects pleasure, thinking, and planning. Side effects may include temporary memory loss and confusion, but they improve over time. However, the fully exact mechanism of how it works is not fully known yet.

The resulting seizure caused by ECT can lead to temporary increases in blood pressure, myocardial oxygen consumption, heart rate, and intracranial pressure. The existing stigma associated with this practice primarily arises from misinformation regarding the procedural methodology.

It is administered following strict guidelines, with a focus on ensuring the safety and effectiveness of the patients. Other preferred alternatives are attempted first, such as medication and psychotherapy.

Remission rates are between 60-85%. In some clinical conditions, the efficacy is close to 100%. In addition, when the perturbation puts the person's own life at imminent risk, the response to this treatment is faster than with other therapeutic modalities.

It is used in the treatment of mood disorders, major depressive disorder, and in the various stages of bipolar disorder. Moreover, it is used in schizophrenia, catatonia, malignant neuropleticus syndrome, status epilepticus, confusional state, suicidal behaviours, among other disorders.

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References

Deng, Z.-D., Robins, P. L., Regenold, W., Rohde, P., Dannhauer, M., & Lisanby, S. H. (2023). How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both? Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 1–13. doi:10.1038/s41386-023-01677-2

Salik, I., & Marwaha, R. (2022). Electroconvulsive Therapy. StatPearls Publishing.