CZ:Featured article/Current
Electroconvulsive therapy
by Gareth Leng
Electroconvulsive therapy (ECT) is a psychiatric treatment that involves inducing a seizure in a patient by passing electricity through the brain. ECT was introduced for treating schizophrenia by the Italian neurologist Ugo Cerletti in the 1930s, and became a common treatment for mood disorders. While many psychiatrists believe that properly administered ECT is a safe and effective treatment for some conditions, some psychiatrists, former patients, antipsychiatry activists, and others warn that ECT might harm the patients' subsequent mental state.
ECT was a common treatment until the late 20th century, when better drug therapies became available for more conditions. It is now reserved for severe cases of clinical depression and bipolar disorder that do not respond to other treatments. When still in common use, ECT was sometimes abused by mental health professionals to punish or control uncooperative patients. Many people came to view ECT unfavorably after negative depictions of it in several books and films, and the treatment is still controversial.
In its early days, ECT was given without anaesthesia or muscle relaxants, and patients were often injured as a side effect of the seizure. Now, ECT is given under anaesthesia and with muscle relaxants. ECT without anaesthesia is known as "unmodified ECT", or "direct ECT", and is illegal in most countries.
Current use
ECT is mainly used to treat severe depression, particularly if complicated by psychosis[1]. It is also used in cases of severe depression when antidepressant medication, psychotherapy, or both, have been ineffective, when medication cannot be taken, or when other treatments would be too slow (e.g. in a person with delusional depression and intense, unremitting suicidal tendencies). Specific indications include depression accompanied by a physical illness or pregnancy, which makes the usually preferred antidepressants dangerous to the patient or to a developing fetus. It is also sometimes used to treat the manic phase of bipolar disorder and the rare condition of catatonia. In the USA, modern use of ECT is generally limited to evidence-based indications. [2] Accurate statistics about the frequency, context and circumstances of ECT in the USA are hard to obtain, as few states have laws that require this information to be given to state authorities. [3]
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