Electroconvulsive Therapy

Introduction:

Electroconvulsive therapy has traditionally been portrayed as a harsh treatment that verges on abuse, even though all therapies have negative effects. The protagonist of the film Beautiful Mind is restrained to a table and pleads to be released when this technique is employed. ECT works with people with extreme cases of depression, catatonia, and episodes of mania(1). Extreme cases are labeled if the patient is unresponsive to medications. It is normally used as a last resort due to its stigma(2). During the process, the patient is put on anesthesia, and gradual waves of electric currents are sent throughout the body to induce seizures (3). ECT treats many disorders as I have stated earlier, however, is it beneficial? Should we use pharmaceutical medicine more? I'll discuss both the indirect and direct consequences of ECT in this review. I'll also go over the process of getting an ECT referral from a psychiatrist. This will investigate whether Electroconvulsive Therapy should be used more frequently despite its risks or whether it should be outlawed or used less frequently. Additionally, I'll research which problems or diseases are better treated with drugs and which are better suited for electroconvulsive therapy.

How does ECT work?

We do not know exactly what happens during the ECT procedure or whether it helps people with certain illnesses. ECT is used commonly to treat people with Bipolar Disorder and Depression (4). ECT is generally used for psychiatric conditions for people who have symptoms like heart rate and blood pressure issues (5). We know that electrical currents activate the brain, but we are unsure how it works(6). Some scientists have, however, made hypotheses regarding what occurs to the chemicals and the neurons during the process. An experiment using rats and ECT was profiled on the Johns Hopkins website(7). According to the results of this experiment, neurons from the hypothalamic area of the brain are more receptive to antidepressants(7). Is it suggested by most administrators to take antidepressants before and after secession because relapse rates are significantly higher in patients who do not(8). According to this article, ECT combined with certain antidepressants may have unique advantages for the brain. Another theory is that it altered how neurons communicate and stimulated the growth of healthy neurons(9). Another hypothesis is the neuroendocrine hypothesis, which concludes that the seizures induced by ECT activate the hypothalamic-pituitary axis. By activating this part of the brain, there is an increase in adrenocorticotropic in blood, cortisol, and prolactin(10).

Does gender affect the effectiveness of ECT?

In one study, Manohar et al. decided to review the medical records of an institution in South India, specifically the doses for ECT. After reviewing the patients’ backgrounds, he concluded that gender does not affect the efficiency of ECT. They concluded that the difference in doses was because different disorders require more or fewer sessions of ECT(11). Another study came to the same conclusion by Bolu et al. They went to a hospital where they studied 176 medical records, 39 of which were females and 137 were males. The conclusion they came to was that while genders had different indications, ECT is equally effective for both genders(12). However, there is one outlier: schizophrenic patients. A retrospective chart review is a study where already existing data is studied(13). In this study, the effectiveness of ECT was compared for 20 men and 23 women with depression and 11 men and 19 women with schizophrenia(13). The scientist discovered that compared to their male counterparts, women required fewer antidepressant drug trials. Another finding of these researchers was that ECT more favorably impacted females than males (13).

Does race affect the effectiveness of ECT?

Foo’s team conducted a study that tested the relationship between people who had a higher chance of depression, genetically, and their response to ECT. They noticed a link between ECT response and MD(major depression). They concluded that ECT is more effective amongst people who do not have MD genes. However, race was not named as a specific factor that would intervene in the effectiveness of ECT(14). One pattern that has been noticed numerous times is that people of color have a lower chance of receiving ECT, compared to Caucasians. This can be for numerous reasons such as disparities in patients' willingness to consent and doctors' behavior (15).

Does age contribute to remission rates or the effectiveness of ECT?

In another study, Foo’s team investigated a correlation between ECT response and genetic risk for MD, or Major Depression. To calculate this, they used PRS, also known as a polygenic risk score. PRS calculates the number of genes associated with common risk variants associated with illness. This experiment concluded that remission rates in ECT were much higher in older people compared to younger patients. Certain ECT patients fall under a group of people who have a greater genetic burden because of their MD(16).

Should ECT be used more or less than pharmaceutical drugs?

It has been stated by some doctors that ECT is a better form of therapy than antidepressants (17). However, many do not choose ECT because of the pretense that it is unsafe compared to antidepressants(18). With modern-day technology and knowledge, ECT has been refined and is overall a better method than antidepressants (18). Li’s team conducted a study that compared symptoms and effects of ECT and antidepressants. They concluded that memory loss, a side effect associated with ECT, was worse in patients who solely relied on anti-depressants and that therapy significantly improved in patients who have undergone ECT (19). In addition, ECT managed to treat patients who were initially resistant to the antidepressants they were prescribed. This scientist concluded that schizophrenic patients and depressed patients should undergo ECT rather than other forms of therapy (19).

References:

Mind. “What Is Electroconvulsive Therapy (ECT)?” Mind, Mind, https://www.mind.org.uk/information-support/drugs-and-treatments/electroconvulsive-therapy-ect/about-ect/#:~:text=Electroconvulsive%20therapy%2C%20or%20ECT%20for,of%20some%20mental%20health%20problems.

Lauder, Jo. “A Last Resort: The Debate around Forced 'Shock Therapy'.” Triple j, Triple j, 16 Aug. 2017, https://www.abc.net.au/triplej/programs/hack/ect-shock-treatment/8814024.

“Electroconvulsive Therapy (ECT).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 12 Oct. 2018, https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894#:~:text=ECT%20is%20used%20to%20treat,with%20medications%20or%20other%20treatments.https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894#:~:text=ECT%20is%20used%20to%20treat,with%20medications%20or%20other%20treatments.

McDonald, William, and Laura Fochtmann. “What Is Electroconvulsive Therapy (ECT)?” Psychiatry.org - What Is Electroconvulsive Therapy (ECT)?, American Psychiatric Association, https://www.psychiatry.org/patients-families/ect.

WebMD Editorial Contributors. “Electroconvulsive Therapy for Depression: How It Works, Effects, and More.” WebMD, WebMD, 8 Sept. 2020, https://www.webmd.com/depression/electroconvulsive-therapy#:~:text=With%20ECT%2C%20an%20electrical%20stimulation,structural%20damage%20to%20the%20brain.

06/19/2018. “How ECT Relieves Depression.” How ECT Relieves Depression, Johns Hopkins Medicene, 19 June 2018, https://www.hopkinsmedicine.org/news/articles/how-ect-relieves-depression.

“Frequently Asked Questions about ECT.” MUSC Health | Charleston SC, Medical University of South Carolina, 2022, https://muschealth.org/medical-services/psychiatry/brain-stimulation/ect/faqs#:~:text=Although%20ECT%20is%20effective%20in,medication%20during%20and%20after%20ECT.

Singh, Amit, and Sujita Kumar Kar. “How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms.” Clinical Psychopharmacology and Neuroscience : the Official Scientific Journal of the Korean College of Neuropsychopharmacology, Korean College of Neuropsychopharmacology, 31 Aug. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565084/.

Charles H. Kellner, MD;Keith G. Rasmussen. “Contemporary ECT, Part 2: Mechanism of Action and Future Research Directions.” Psychiatric Times, MJH Life Sciences, 26 Aug. 2015, https://www.psychiatrictimes.com/view/contemporary-ect-part-2-mechanism-action-and-future-research-directions.

Manohar, Harshini, et al. “Does Gender Influence Electroconvulsive Therapy Sessions Required across Psychiatric Diagnoses? A 5-Year Experience from a Single Center.” Journal of Neurosciences in Rural Practice, Thieme Medical and Scientific Publishers Private Ltd., 3 Sept. 2019, https://www.thieme-connect.de/products/ejournals/html/10.4103/jnrp.jnrp_482_16.

Bolu, Abdullah. “Is There a Role of Gender in Electroconvulsive Therapy Response?” .Tandfonline, Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 8 Nov. 2016, https://www.tandfonline.com/doi/pdf/10.5455/bcp.20150207075355.

Bloch, Yuval, et al. “Gender Differences in Electroconvulsive Therapy: A Retrospective Chart Review.” Journal of Affective Disorders, Elsevier, 7 Dec. 2004, https://www.sciencedirect.com/science/article/abs/pii/S0165032704003647?via%3Dihub.

Foo, Jerome C, et al. “Evidence for Increased Genetic Risk Load for Major Depression in Patients Assigned to Electroconvulsive Therapy.” American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics : the Official Publication of the International Society of Psychiatric Genetics, John Wiley and Sons Inc., Jan. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368636/.

Breakey, William R., et al. “Racial Disparity in the Use of ECT for Affective Disorders.” American Journal of Psychiatry, The American Journal of Psychiatry, 1 Sept. 2004, https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.161.9.1635.

06/19/2018. “How ECT Relieves Depression.” How ECT Relieves Depression, Johns Hopkins Medicene, 19 June 2018, https://www.hopkinsmedicine.org/news/articles/how-ect-relieves-depression.

Jan-Otto Ottosson, MD. “Is ECT an Ethical Treatment?” Psychiatric Times, MJH Life Sciences, 2004, https://www.psychiatrictimes.com/view/ect-ethical-treatment.

Li, Ming, et al. “Effects of Electroconvulsive Therapy on Depression and Its Potential Mechanism.” Frontiers in Psychology, Frontiers Media S.A., 20 Feb. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044268/.

Electroconvulsive Therapy

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