Breaking Down the Stigma of Electroconvulsive Therapy

Breaking Down the Stigma of Electroconvulsive Therapy

Written By Kristin Lasseter MD

We used to use barbaric measures to perform surgeries on people. Similar to surgical procedures though, ECT, or shock therapy, has evolved into a safe and effective treatment in modern medicine.

I recall the first time that I saw a patient get electroconvulsive therapy, or ECT. It is so vivid in my memory not because it was anything to remember, but because it was so uneventful.

The patient came in and laid down on the hospital bed. The psychiatrist asked how much his mood was improving. The anesthesiologist started an IV. The respiratory therapist gave him some oxygen, and then the patient went to sleep and his body completely relaxed. The nurse took two electrodes and placed it on the right side of the patient’s head. The psychiatrist pushed a button, and then the patient's foot started twitching for less than a minute while the rest of his body remained still. The nurse took off the electrodes and a few minutes later the patient woke up.

I specifically remember asking, “it’s already done?” It was almost as if nothing happened.

Why does ECT, or “shock therapy,” have such a bad stigma around it? At that point in my medical career, I had been a physician for 2 years. Shouldn’t I have been educated enough by then to know what ECT was really like? How can we expect the general public to have an accurate understanding of ECT if we’re not even teaching medical students and physicians about it? Shock therapy originally got a bad reputation when it first came out because large amounts of electrical current were used in the procedure, and anesthesia and muscle relaxants were not used. That was a long time ago though. Since then, ECT has become way more advanced. It’s similar to surgical procedures - in the old days, surgeries were done with kitchen utensils without any anesthesia or antibiotics. Luckily, medicine has come a long way.

Here are some facts about ECT (no hype or drama):

  • It is 10 times safer than childbirth.
  • It induces a brief seizure, usually lasting less than 1 minute.
  • The entire procedure takes about 5-10 minutes, and recovery is about 15-20 minutes.
  • This seizure activity in the brain creates proteins that help neurons form new connections and improve their ability to function normally.
  • A muscle relaxant is given in the IV so the patient remains completely relaxed during the treatment.
  • Anesthetic is given in the IV, so the patient is briefly asleep during the treatment.
  • It is the most effective treatment available for depression.
  • It is a safer alternative to medications, and is often used in people who cannot or do not want to take medications, such as pregnant women and elderly.
  • It typically consists of 2-3 treatments a week, and most people feel dramatically better within 1-2 weeks of starting treatment.

The side effects of ECT are pretty small when you’re comparing it to the long list of side effects that usually accompanies medication treatment. Side effects often only occur right after the procedure, and can include:

  • Muscle aches
  • Nausea
  • Headaches
  • Brief confusion
  • Memory loss
  • High blood pressure or fast heart rate

Probably the most bothersome risk factor is memory loss, so I’d like to take a moment to discuss what this is usually like during ECT. Most of the time, someone receiving ECT cannot form memories as well as they usually can while they are receiving treatment. Sometimes ECT will also cause someone to forget events that may have happened in the weeks or months before they started treatment. In the vast majority of patients, memory loss improves once they have finished ECT or within the first few months after.

There is no evidence showing that ECT causes any kind of brain damage, in fact there is substantial scientific evidence showing it does the opposite.

References

  1. Mayo Clinic. Electroconvulsive Therapy (ECT). Retrieved from https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894
  1. McClean Hospital. (2020, August 21). Why ECT Is Becoming a Preferred Depression Treatment. Retrieved from https://www.mcleanhospital.org/essential/ect-shouldnt-be-last-resort-treatment
  1. Riley, A. (2018, May 3). The surprising benefits of electroconvulsive therapy. Retrieved from https://www.bbc.com/future/article/20180502-the-surprising-benefits-of-electroshock-therapy-or-ect
  1. Sane Australia. (2018, March 2). Electroconvulsive Therapy (ECT). Retrieved from https://www.sane.org/information-stories/facts-and-guides/electroconvulsive-therapy-ect
  1. Seiner, SJ. (2017, December 1). Spreading the Truth about ECT: Facts Help Break Down Stigma Against This Important Depression Treatment. Retrieved from https://www.mcleanhospital.org/essential/spreading-truth-about-ect-facts-help-break-down-stigma-against-important-depression

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