Monday, January 13, 2014

Lexicon of Madness -- Electroconvulsive Therapy

 A vintage electroconvulsive therapy (ECT) unit at the HCMC History Museum in Minneapolis, MN.

Electroconvulsive Therapy (ECT): A safe and effective, even life-saving, treatment for severe depression, mania, and acute schizophrenia. It is unfortunately underutilized and many patients are thus denied a treatment that could have provided rapid relief from serious psychiatric symptoms, including psychosis and acute suicidality. Because ECT employs electricity to produce a seizure, the procedure is frightening to the uninformed. It doesn't help that in ECT "the mechanism of action is unclear," i.e., no one really knows why producing a seizure helps or what exactly happens in the brains of patients during and after treatment. The Academy Award winning film One Flew Over the Cuckoo's Nest (1975) did much to discredit ECT in the eyes of both laypersons and clinicians, as did unsubstantiated claims that ECT causes brain damage. In 1938 in Rome, Italy, Ugo Cerletti and Lucio Bini administered the first "electroshock" treatment. The administration of muscle relaxants prior to seizure-production has eliminated the severe, full body contractions and bone fractures that plagued the earlier form of the treatment. Modern ECT is a remarkably uninteresting procedure to observe. Ladislas von Meduna had introduced Metrazol convulsive therapy in 1934, basing his actions partly on the (erroneous) observation that schizophrenia and epilepsy are never comorbid (i.e., there is no such thing as an epileptic schizophrenic). Metrazol treatment had drawbacks, including feelings of intense dread in patients during the period between administration and effect. Metrozol therapy was superior to Manfred Sakel's Insulin Coma Therapy (1933), however, in that the latter had a death rate of up to 10% (putting people in and out of hypoglycemic comas 40 or 50 times during the course of a single treatment was a risky endeavor). The mortality rate for modern ECT compares favorably to those of childbirth or general anesthesia. The most important question is: How many psychiatric patients have died by suicide because they did not have access to ECT?

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