ECT-It’s not barbaric. It’s very often successful

 

ECT (Electro Convulsive Therapy) has a bad name and I do not agree with that.

I personally have never had ECT, but I very much would. Why? Because I have had an independent look at the subject and know friends and contacts that have gone under general anaesthetic and had positive results with ECT.

The public tend to think ECT is a barbaric treatment and wholly negative, something used in the infamous Irish institutions we are all too familiar with. There is a view that ECT is a brain shock and you are left with unknown after effects. Some people I have spoken to are very surprised that it’s still used, other people are more surprised I support it.  I hasten to say I support the use or trial of ECT

One Flew Over the Cuckoo’s Nest is a “classic example” of ECT’s use as a negative force – Nurse Ratched holds the keys to the “Shock Shop” and we see it dished out as a punishment. Ironically when was created in 1938, ECT was seen as hugely significant “win “. Film portrayals in the 1940s were quite favorable, but that didn’t last long and the 50’s were unkind to ECT.

What is it used for?

ECT is used to treat certain mood disorders , primarily Depression, Treatment Resistant Depression.

In Ireland, approx. half million are affected by depression at any one time, Over 6,000 people (careful estimate) in severe stages of depression are admitted to Irish psychiatric hospitals every year

Its important to say there are various types of Depression – Situational, Clinical, Bipolar and Treatment Resistant Depression . It’s the last category (Treatment Resistant Disorder) that appears the best fit for ECT.

Some interesting facts about ECT:
Paradoxically, the worse the depression, the better ECT will help. Those who are acutely ill or psychotic have about an 80-90 per cent chance of recovery with ECT.

Approx 250 people in Ireland will have ECT and Worldwide, some 1.4 million people receive ECT every year!

So how does it all work?

The brain is stimulated by passing electricity through electrodes placed on the head. This induces a brief seizure.

The excellent news is that patients may see an improvement after about five or six sessions or two to three weeks. ECT works by promoting the growth of new connections in brain regions, including in the hippocampus, which plays a core role in mood and memory. ECT is backed up significantly in scientific journals. This is a short piece, so I do not propose to cite scientific journals.

The controversy

ECT remains controversial. In Ireland and across the globe
One major concern has to do with its side effects, the most common being diminished short-term memory
Here is where Ireland take the lead. Professor Declan O’Loughlin of St Patrick’s University Hospital, Dublin led a team that trialled a different way of administering ECT.

The norm is “bitemporal” ECT, where electrodes are placed on each temple to administer the shock. McLoughlin trialed “Unilateral” ECT where they found that by using a stronger charge and placing one electrode on the temple, and the second nearer the top of the head (“unilateral” ECT), the side effects were diminished.
This trial led to less side effects and no reduction in ECT benefits (which was a fear)
O’Loughlin’s line of thinking appears to be : reduce the side effects and reduce the fear of ECT and increase its commonality.

He remarks and I would agree, that after the trial of three or four anti depressants with no benefit, the chances of another anti depressant being effective are very slim.

There is a mass of evidence supporting ECT , but opposition argue side effects and a lot more (there are some very far wing sites on ECT online)They sometimes argue consent, but we have the Mental Health Act in Ireland and patient rights are protected. Regretfully, we need more centres around Ireland that can administer ECT and we need more medics thinking progressively and liaising with their academic peers and conducting further trials into ECT including the positioning of the pads..

Me? If I had severe depression and 5 medications failed, I am opting for ECT.

AOC