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article imageEssential Science: Electroconvulsive shock treatment on the rise

By Tim Sandle     Aug 22, 2016 in Science
Electroconvulsive shock treatment, once a fairly common treatment for mental illness, is regaining popularity and could be set to make a comeback to the psychiatric mainstream.
Electric shock treatment is associated perhaps most with the 1950s and the questionable practices of sectioning people of various eccentricities and locking them up in asylums, as well as to the iconic 1975 movie One Flew Over The Cuckoos Nest (directed by Milos Forman and featuring Jack Nicholson and Louise Fletcher). There was a science behind the "therapy", although as time progressed the results were called into question.
These popular perceptions carry a ring of truth. Between the 1950s to 1970s the treatment was used more often than it is today. The treatment was administered without anaesthetic and quite often without patient consent. According to the U.K. mental health charity Mind, there was a perception that the process was more like a punishment rather than a treatment. Use of the treatment waned in the U.S. after the devices used to send electricity to the brain were re-categorized as Class III category devices (that is high risk) by the U.S. Food and Drug Administration in 1976. It is this categorization that has recently 'sparked' interest.
The correct name for the therapy is electroconvulsive therapy (or ECT). The procedure is carried out under general anesthesia, together with the use of muscle relaxants. The process involves sending small electric currents to the head and passing these through the brain. This activates a brief seizure. The object is to alter the brain chemistry and to reverse the symptoms of certain mental illnesses.
Although not as common as it was, and based on a more select range of conditions, ECT never totally went away. ECT is generally used if a patient has
severe, life-threatening depression'
has not responded to medication or talking treatments,
has found it helpful in the past and have asked to receive it again,
has severe postnatal depression.
Despite the long-history, exactly how ECT 'works' is uncertain. The electricity appears to exert an affect upon the blood flow in the brain and this triggers changes in brain chemistry.
Jack Lewis (@DrJackLewis) "Don’t call it a comeback… it’s been here for years. ElectroConvulsive Therapy for major depression, would you?"
ECT could be set to make a comeback. The signal for this comes in a new report from New Scientist magazine. Here it has been noted that a group of manufacturers of ECT devices are attempting to have the devices reclassified by the FDA from Class III devices to Class II. This would make access to ECT machines much easier for clinicians. Class II devices includes motorized wheelchairs, contact lens care products and condoms.
Concerns with the expansion of the use of ECT relate to its effectiveness; the fact that scientists do not know how it works; and due to side-effects (many of which remain unchanged since the dark period of ECT treatment between the 1950s and 1970s). Side-effects include memory loss and lasting anxiety.
Interviewed by the charity CCHR, psychiatrist Dr. John Breeding stated that he was alarmed by the prospect of ECT being used on a wider basis. Adding to the list of side-effects, Dr. Breeding adds cardiovascular complications, epilepsy, and, sometimes, death.
The medical doctor also adds: “The brain naturally operates in millivolts of electricity, and ECT administers on average between 150 and 400 volts of electricity to the brain, a force sufficient to induce a grand mal seizure, rupture the protective blood-brain barrier, and incite glutamate toxicity."
Explaining this further, Dr. Breeding notes: "Glutamate is a powerful neurotransmitter released by nerve cells in the brain and is responsible for sending signals between nerve cells. In glutamate toxicity there is too much glutamate that leads to over-excitation of the receiving nerve cell, which can cause cell damage and/or death.”
To add to this, the British National Institute for Health and Care Excellence has reported that the "study of the scale and longevity of cognitive impairments caused by ECT has been neglected."
These concerns, however, are not supported by all medics. For instance, Dr. Gary Kennedy, who is director of geriatric psychiatry at Montefiore Medical Center in New York, told the website Health.com that ECT is an effective cure for depression: "It reboots the system", he said simply, adding the way that electricity seemingly restores some neuroconnections or reconnect nerves is "like turning a computer off and when it comes back on they are not as depressed."
Similarly, Dr. Kenneth Melman, a psychiatrist at Swedish Medical Center in Seattle told NBC News "there aren't any other treatments for depression that have been found to be superior to ECT."
Coming out in the middle of the debate, a review article, published in the medical journal The Lancet a few years ago, concluded that ECT is an effective short-term treatment for depression (and better than many drugs); however, the longer-term side-effects are potentially severe.
Based on these contrasting viewpoints, the renewed interest in ECT is likely to continue to divide medical and social opinion. As it stands ECT is still not understood, although it is favored by some psychiatrists, seen by others as a treatment of last resort, and rejected by the remainder.
HInsurance (@insurancehnews) "Electroconvulsive therapy changes key areas of the human brain that play a role in memory and emotion."
This article is part of Digital Journal's regular Essential Science columns. Each week we explore a topical and important scientific issue. Last week we looked at the complexities of sleep deprivation and how affects the brain in different ways. The week before we found out how spider webs are inspiring research into next generation electronics.
More about electric shock treatment, Electric shock, Psychology, Psychiatry, Mental health
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