It’s not your grandparents’ ECT

Randle McMurphy chomps down on a bite block, electrodes are placed on both sides of his head, the juice flows, and the seizure begins. Several weeks later his limp body, forehead scarred, is returned to the ward.

In the film, One Flew Over the Cuckoo’s Nest, Randle’s first procedure was electroconvulsive therapy (ECT) c.1963. The final procedure was a lobotomy.

Lobotomies are no longer performed. ECT is, but it looks a lot different than Randle’s and the 1957 shot in the image above.

Though highly stigmatized, electroconvulsive therapy is an effective and safe intervention for those enduring treatment-resistant emotional and mental conditions.

It’s definitely not your grandparents’ ECT.

Along with some new and important research, let’s talk about it…

What is electroconvulsive therapy?

How ‘bout we start with the brain stimulation interventions ECT isn’t: deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS).

Okay, electroconvulsive therapy is a psychiatric treatment that uses electrical stimulation to induce a generalized seizure. The recipient is under general anesthesia and muscle relaxers are administered to eliminate contractions.

ECT is most often used for cases of treatment-resistant depression, suicidality, bipolar illness, psychosis, and catatonia.

A few quick tidbits…

• Some one million people worldwide have ECT each year.
• Approximately 70% of ECT patients are women.
• In excess of one-third of ECT patients are age 65 and older.
• Use in children and teens remains relatively rare and is prohibited in some U.S. states.

Types of ECT

In mainstream use, there are two types of ECT…

• Bilateral: electrodes are placed on both sides of the head. The goal is to affect the entire brain.
• Unilateral: an electrode is placed on top of the head and another on the temple, usually the right. It limits current to one side of the brain.

A newer ECT technique, right unilateral ultrabrief pulse, may allow for fewer memory issues.

Electrode placement, treatment frequency, and the electrical waveform of the stimulus are huge treatment considerations.

The number and type of treatments one needs depends on the condition being treated and its severity. ECT is typically given two to three times a week initially for an average of six to 12 sessions and is often tapered over time.

What is ECT used for?

We reviewed a handful of conditions ECT is used for, but let’s take a deeper look. As we do, keep in mind that ECT is most often used when other treatments don’t work. And it’s used when quick results are crucial.

The highlights…

• Aggression and agitation in dementia patients.
• Catatonia
• Parkinson’s disease, particularly Parkinson’s related depression and intractable seizure disorders.
• Postpartum psychosis and severe depression: ECT can reduce the need for potentially dangerous medications.
• Psychotic disorders and symptoms
• Depression: unipolar and bipolar.
• Mania
• Immediate threat of suicide

Can you begin to see the value of ECT?

Why does ECT work?

Welcome to the world of emotional and mental disorders. Antidepressants, antipsychotics, transcranial magnetic stimulation, ketamine, psilocybin, ECT – when it comes to the bottom-line, scientists don’t know why they work.

Now, if you’ve lived in this neck of the woods for a decent amount of time, you know that theories are everywhere. I mean, it has to be something, right?

When it comes to why ECT works, the general idea is it helps to correct imbalances in the brain’s chemical messenger system. Let’s say that the induced seizure “resets” the brain.

Now, I’m not a scientist, but I could have come up with that. You too, right? Stay tuned, later on we’ll review recent research that’ll get us closer to the bottom-line.

The ECT procedure

ECT can be performed during a hospital stay or on an outpatient basis. Medical clearance is a necessity.

Very simply! After an IV is inserted, a short-acting general anesthetic is administered, as well as a muscle relaxant to prevent contractions during the seizure.

Two sets of electrodes are placed on the head. One of them monitors brain activity and the other delivers the electric current. While asleep, a small amount of electric current is delivered for 100 milliseconds to six seconds. It generates seizure activity in the brain for approximately 40 seconds.

Patients typically awaken in a recovery area several minutes after the procedure and ready to roll within hours. Of course, a ride is required for outpatient procedures.

Take a look…

Side effects of ECT

Like most any emotional or mental health treatment involving the body, ECT can cause side effects.

Perhaps the one that gets the most attention is memory loss. Post-ECT memory loss is usually short-term and typically involves things learned in the recent past.

Other possible side effects…

• Headache
• Hypotension or hypertension
• Confusion
• Cognitive impairment
• Increased risk of cardiac issues, particularly in those with coronary artery disease
• Jaw pain
• Muscle aches
• Nausea

As you consider reported side effects, keep in mind that ECT is used for a variety of conditions all over the demographic board.

Does ECT work?

What ECT is, what it’s used for, why it works, side effects – they’re all important. But for most people’s dough, it’s about whether or not it works.

Before we jump in, let’s grab a little perspective. Folks turn to ECT because previous interventions haven’t worked. That generates a ton of pressure and expectation, which can affect objective assessment. We deserve relief, but keeping an open mind regarding results is helpful.

For the treatment of depression without melancholia, some studies have shown an efficacy rate of 80%. It drops to 60% with melancholia. Research suggests that ECT works well in 80%-100% of catatonia patients. And it’s known that ECT gives older psychotic depression patients their best chance at reducing the risk of relapse.

Of great significance, studies have found that ECT can significantly improve suicidal ideation – quickly.

New research: Is this why ECT works?

Okay, let’s wrap this baby up with some very recent and important news regarding why ECT works.

The story was told in two studies conducted by researchers from the University of California San Diego. Their work was published November 16, 2023 in the journal, Translational Psychiatry.

According to study first author Sydney Smith, the research mission went well beyond solving an almost century-old puzzle. The team wanted to demystify one of the most effective, yet highly stigmatized, treatments for severe depression.

From senior author Dr. Bradley Voytek…

…in people for whom medications don’t work, electroconvulsive therapy can be life-saving. Understanding how it works will help us discover ways to increase the benefits while minimizing side effects.

The team have a curious and altruistic mindset. Let’s see what they came up with.

Aperiodic activity

Smith describes aperiodic activity as the brain’s background noise. He notes that scientists traditionally haven’t paid much attention to it, but that’s changing.

The billions of neurons in our brain are constantly going through cycles of excitation and inhibition – turning on and turning off – that correspond with the mental states we’re all too familiar with.

One of the functions of aperiodic activity is to assist in managing the commotion. And it does it by boosting inhibitory activity – effectively slowing things down.

How’d they figure that out?

The team used electroencephalography (EEG) to analyze the brain activity of the study participants who received ECT for depression, as well as those who received a similar form of treatment known as magnetic seizure therapy (MST).  MST uses magnets to induce a seizure, not electrodes. By the way, we’ll be hearing more about MST.

When the team reviewed EEGs of those who received ECT and MST, a slowing pattern of brain electrical activity was observed. It’s believed the inhibitory effects of aperiodic activity helps explain it.

Now, the findings may not provide all the answers, but the link between aperiodic activity and ECT benefits is established. And good things can flow from there.

The UC San Diego team stands ready to apply the insights learned from their work to future investigations. For instance, the team are exploring the possibility of using aperiodic activity as a metric of treatment effectiveness in other depression treatments, such as medications.

I don’t know about you, but I’m thankful for research.

That’ll do it

It’s a given, electroconvulsive therapy has a dicey reputation, which encourages stigma and discourages use.

In so many ways, that’s unfair.

No, electroconvulsive therapy isn’t always a sure thing. Yes, it can have side effects. But it also has a record of effectiveness and relief. And for someone who’s down to very few options, that’s all that matters..

It’s not your grandparents’ ECT (or Randle’s).

Once again, turned to Verywell Mind for info assistance. Electroconvulsive Therapy (ECT): Definition, Types, Techniques, Efficacy written by Kendra Cherry, MEd.

Here’s the University of California San Diego news piece. It includes links to the studies: New Studies of Brain Activity Explain Benefits of Electroconvulsive Therapy

Those Chipur emotional and mental health info and inspiration articles: pick one out.

Featured image: Author: University of Liverpool Faculty of Health & Life Sciences from Liverpool, United Kingdom. Minimally cropped. This file is licensed under the Creative Commons Attribution-Share Alike 2.0 Generic license.

Bill White is not a physician and provides this information for educational purposes only. Always contact your physician with questions and for advice and recommendations.