Electric Shock Treatment for Depression
Electroshock therapy is an organic method of treatment for psychiatric disorders. It is more technically known as electric convulsive therapy, or ECT.
To administer the treatment, the therapist places electrodes on the patient's temples, and current is applied for periods up to half a second. The current induces convulsions.
To minimize the risk of cardiovascular failure or fractures of the spine or legs, patients are given muscle relaxants. Before the drug is administered, the patient is anesthetized, frequently with a barbiturate. During the convulsions the patient is unconscious, but regains consciousness after a few minutes. Patients almost invariably suffer memory loss, but this condition gradually improves.
Development and Use of ECT
The electric convulsive technique was developed in Italy in 1938 as a treatment for schizophrenia. Electric current replaced chemical means such as insulin and metrazol as agents for producing convulsions.
Use of the technique spread to other countries. In the United States it was found helpful with depressed patients who were suicidal risks, with the result that the so-called "suicide wards" in state mental hospitals were all but eliminated. By 1954, for example, New York state hospitals were maintaining 4,500 patients a year on ECT.
ECT is used to treat schizophrenia, especially during acute episodes. The treatment also continues to be effective with patients who have acute suicidal depressions, and it may produce an immediate and dramatic improvement. ECT may be used when the patient is not in a condition to benefit from psychotherapy. The electric therapy is usually stopped when the patient's depressive symptoms have been relieved enough so that psychological treatment can begin.
ECT thus has short-term benefits for some patients and may reduce the time they spend in hospitals. Over the long range, however, improvement with ECT may be no greater than the improvement that might occur spontaneously or with other forms of therapy. Large numbers of patients do not improve with ECT. Some show only a partial improvement, and relapse is frequent after results that temporarily appear highly successful. Patients who relapse may be given further electric convulsive treatments, but with each successive course of treatment the results are more and more disappointing.
Since the mid-1950's large numbers of patients who would formerly have been treated by ECT have been given antidepressants, psychic energizers, or tranquilizers. Patients who receive ECT frequently get antidepressant medication as well.
Attempts to Explain ECT
More than 50 theories have been formulated to explain how ECT affects patients. Some theories postulate a temporary paralysis of brain circuits. Another theory is that the shock produces a period of organic confusion, thus giving the ego a breathing spell, a chance to reintegrate itself. Another theory is that shock treatment serves the patient's masochistic need for self-punishment or expiation of guilt. Still another is that the treatment facilitates tendencies toward spontaneous remission of symptoms. No theory has won general acceptance among psychiatrists.
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