CTIP - The Committee for Truth in Psychiatry

What is ECT?

Electroconvulsive therapy (ECT), also known as shock treatment, consists of a series of grand mal seizures induced by electric shocks to the brain.

The essence of a grand mal epileptic seizure is the intensely rapid "firing" of every brain cell. In a natural seizure this brain activity causes the body to thrash about wildly; but when a seizure is induced in ECT the bodily movements are largely suppressed by a drug. In either case, the person is unconscious.

What is ECT good for?

ECT is good for the intense physical and emotional suffering that accompanies a derangement of the nervous system resulting either from an overload of normal emotion -a "nervous breakdown" - or from imbalances in body chemicals that affect emotions.

ECT produces profound emotional relaxation. The patient sleeps and eats well and his body has an opportunity for rest and repair. When the relaxing effect wears off, in a few days or weeks, the patient may remain well or he may relapse.

How is ECT given?

ECT is usually given in the morning before breakfast. First the patient receives an injection to reduce secretions in the mouth. Then he is taken to the treatment room, where he is given a general anesthetic through a vein in the arm. This takes effect quickly and is followed by another drug through the same needle, to suppress muscle movement. The anesthetic is not necessary for the shock treatment as such, because the shock would produce unconsciousness, but it is given to spare the patient the feeling of becoming paralyzed. Next, two electrodes are applied to the head and a current passed briefly between them. (Most commonly, the electrodes are on the temples and the shock is at about 140 volts for half a second, but these particulars may vary.) 'Me brain seizure that is triggered by the shock lasts about a minute.

The patient does not experience pain or discomfort during the procedure, but he awakens soon afterward in a state of confusion. When the confusion subsides, he can resume his daily routine. Headache, mild muscle soreness, or nausea sometimes occur, but these usually respond to simple medication.

Treatments are usually given three times a week, and a typical course of ECT consists of from six to 10 treatments.

Are there adverse effects or risks?

ECT has one adverse effect that occurs in all cases. That is memory loss.

During a course of treatment the patient experiences a cumulative eradication of memory, which begins with recent events and learning and thoughts (including worries), and gradually extends to the distant past. Once the course is ended, memory gradually returns in the opposite time order until, in about a month, the patient has regained the main outlines of his personal history and also knowledge and skills acquired early in life.

After this length of time there is little further automatic return of memory, though a good deal more has become strong enough that it can be later revived by reminders or efforts at relearning.

The extent of the permanent loss varies with number of treatments, age of patient, placement of electrodes, and other factors, but the pattern of the loss is the same for all patients. 'Me loss is total or near total for the period of the ECT course and tapers back over previous years with smoothly diminishing severity and no precise cut-off point.

The patient's remaining memory appears "spotty" in that the smooth amnesic blanket has merely dimmed some memories but submerged others, depending upon their original relative clarity.

In addition to this erasure of preshock memory, which is certain to occur, there may also be a permanent adverse effect upon memory function after the shocking. That is, the patient's memory for new experiences and new learning may fade rapidly.

Some patients do not mind their memory changes and seldom have occasion to notice them. At the opposite extreme are persons whose work or way of life is made impossible by them. In between are persons who gradually adjust to various degrees of disability.

Aside from adverse effects on memory, ECT carries with it - as do other major medical and surgical procedures - some element of ordinary risk. Fatalities are rare, but there is a slight possibility that a stroke or heart attack could occur during a treatment.

There is also the possibility that a particular individual may experience one or more untoward after-effects in addition to the expected deleterious effect on memory.

How does ECT work?

ECT is one of a number of drastic psychiatric treatments, including insulin coma and psychosurgery, that relieve suffering temporarily. All of them "work" by destroying brain tissue. That is their common denominator.

In ECT both the electrical shocks and the grand mal seizures are destructive. For some still unknown reason, reducing the size of the brain not only reduces the amount of stored memory but also counteracts states of physical pain and any kind of emotion.