Electroconvulsive therapy was invented as early as 1937 by two Italian doctors, Bini and Cerletti, to treat and alleviate mental disorders. Although this form of therapy is still used in psychiatry today, it is considered controversial even among experts. Studies have demonstrated its benefits in certain psychiatric conditions.
What is electroconvulsive therapy?
Electroconvulsive therapy or electroconvulsive therapy, ECT, is a form of treatment that has served and occasionally still serves exclusively for the treatment of mental disorders and psychiatric clinical pictures. ECT works with electric current, which is why the term electroshock therapy was also used for a long time, but this has completely disappeared from medical usage. Electroconvulsive therapy, ECT, is a form of treatment that has served exclusively for the treatment of mental disorders and psychiatric clinical pictures, and is still used in isolated cases. In the 1970s and 1980s electroconvulsive therapy completely disappeared from the psychiatric treatment spectrum. The method was so controversial during these decades that even the most severe cases were no longer treated with it. Initially forgotten, electroconvulsive therapy is, however, somewhat increasingly used again nowadays. A treatment sequence is only possible with strict indication and under specialist psychiatric supervision. Since its invention two years before the outbreak of World War II, electroconvulsive therapy has been the subject of fierce controversy, including public debate. Due to the alleged work with electric shocks, this form of therapy had a bad reputation from the beginning, and this has not changed until today. Even if there is an indication, it is still difficult to explain to a patient’s relatives why electroconvulsive therapy in particular should be used.
Function, effect, and goals
The first experiments with electroconvulsive therapy were carried out on a psychologically completely healthy subject, however, against his will. This patient was made available to the two inventors of the method by the police for therapy testing, a procedure that would be unthinkable today. In the first years after the testing phase, electroconvulsive therapy was actually intended to treat homosexuality. Under National Socialism, ECT was even used entirely without indication and for punishment. These facts sometimes resulted in the poor image of this form of therapy to this day. The literary film adaptation “One Flew Over the Cuckoo’s Nest” shows the broad use of electroconvulsive therapy for punishment purposes. The benefit of electroconvulsive therapy for some psychiatric diseases is still undisputed. For example, the so-called pernicious catatonia would lead to death without the use of electroconvulsive therapy. Main indications of electroconvulsive therapy are so-called endogenous delusional depressions with and without risk of suicide, all forms of catatonia and as therapy of choice in case of complete failure of neuroleptic treatment. Since the aforementioned pernicious catatonia is usually particularly fulminant, the rapid use of electroconvulsive therapy has been the only life-saving measure to date. Much research has been done on the subject of electroconvulsive therapy, but its exact mechanism of action is still not clearly understood. One theory is that if a patient suffers a seizure, hormones and neurotransmitters in the bloodstream become completely unbalanced. The immediate use of ECT would cause a sudden reorganization, a reset, so to speak, of the imbalanced structures. But even this theory, which is common among experts, is by no means scientifically proven. Patients usually have to undergo the procedure more often, because in order to achieve a lasting effect, up to 12 applications are required at intervals of at least 2 days. The maximum application rate must not exceed 3 times a week, otherwise the side effects would jeopardize any therapeutic success. If possible, the patient and his relatives must be informed before each therapy session; only in life-threatening emergencies is direct consent not required.Prior to the actual ECT, a short anesthesia with stable muscle relaxation and oxygen ventilation should be induced by an experienced anesthesiologist. Ventilation and intubation facilities should be available in case of emergency, but prophylactic intubation is not foreseen when performing ECT. Overall, the intubation rate for electroconvulsive therapy is very low. To prevent injury to the lips and teeth during therapy, dental protection is required. Next, a generator is used to turn on the current for a period of 3 to 5 seconds and at a rate of 600 milliamperes. This procedure induces a seizure. Placement of the electrodes is unilateral and never on the dominant hemisphere. This is an empirical value from many treatments, because many more side effects occurred with the bilateral leads that were often used.
Risks, side effects, and dangers
The application of electroconvulsive therapy involves risks, sometimes severe side effects, dangers and peculiarities. The side effects always appear after the treatment, for example, in the form of states of confusion and mild memory impairment. However, these phenomena are reversible, i.e. they disappear spontaneously on their own after a few hours or days. Amnestic impairment was common, but is a rare occurrence since unilateral leads have been preferred. The most important contraindications to electroconvulsive therapy are increased intracranial pressure, aneurysms, vascular outpouchings of the large blood vessels and in the brain, and acute myocardial infarction. However, the presence of a pacemaker or pregnancy do not constitute contraindications to treatment with ECT. Appropriate, thorough examinations are therefore necessary before treatment. Permanent brain damage is not to be expected even after repeated use of electroconvulsive therapy.
