Electroconvulsive Therapy

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Category: Medical Options

What is it?

Electroconvulsive therapy (ECT), also known as electroshock, is a controversial psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening. It is often targeted to individuals with such conditions as severe depressive illness, disturbance of motor behavior or a prolonged or severe manic episode.

How does it work?

The brain functions using electrochemical messages and it is thought that ECT-induced seizures interrupt these messages and ‘reset’ the brain. ECT is often used when other forms of treatment, including medication and psychotherapy, have failed. Generally, ECT is performed under supervision by a psychiatrist. The patient is anaesthetised and given muscle relaxants. The electrodes are placed at strategic points on the patient’s skull. Depending on the patient, one or both sides of the head will be stimulated, known as unilateral or bilateral ECT respectively. A series of brief, low frequency electrical pulses prompt a convulsion. The patient won’t feel the convulsion because of the anaesthesia, and won’t have muscle spasm or move because of the muscle relaxants. The patient wakes up after a few minutes. ECT is typically administered three times per week for six to nine treatments, but the exact course of treatment depends on the nature of the illness and the patient's response to treatment.

Is it effective?

A study published in 2003 reviewed the literature on the effectiveness of ECT for depression. This study found it was effective in the short term compared to pharmacotherapy on depressive symptoms measured with questionnaires and cognitive functioning such as memory. However the use of ECT for PTSD has not been researched adequately to identify its effectiveness.

Are there any disadvantages?

Research has shown that ECT doesn’t cause brain damage because the amount of electricity used is too small to harm tissue. Like any operation involving anaesthesia, ECT carries a small degree of risk. Some of the immediate side effects of ECT can include headache, sore muscles, queasiness and confusion. During the course of the treatment, many patients experience problems with short term memory, but this side effect only lasts a few days or weeks. A few individuals, however, experience long term difficulties with memory. This effect is more common in patients who undergo bilateral, rather than unilateral ECT.

Where do you get it?

The Sane Australia webpage provides information on ECT and contact details for persons seeking this form of treatment. While these strategies are pursued, it is also important that the person with PTSD is under the care of a certified health professional.

What are the evidence limitations?

There is currently no explicit evidence to support ECT as an independent intervention for PTSD. Much of the evidence base is derived from lower levels of evidence such as expert opinion and clinical experiences. Therefore interpreting this evidence should be undertaken with caution.

Recommendations

Based on the current lack of high quality evidence, the use of electroconvulsive therapy as a treatment for PTSD cannot be recommended. More research is required. It may be considered as an adjunct to other PTSD interventions, such as psychological and pharmacological interventions.

Key References

National Institute for Health and Clinical Excellence 2005, ‘Guidance on the use of electroconvulsive therapy’, viewed 11 December 2008,
http://www.guideline.gov/summary/summary.aspx?doc_id=9098&nbr=4912&ss=6&xl=999

The UK ECT Review Group, 2003, ‘Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis’, Lancet, vol. 361, pp. 799–808.

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