Shock Therapy
Electroconvulsive therapy (ECT) is a psychiatric treatment that causes a generalized seizure by passing electrical current through the brain. ECT is often used as an intervention for mental disorders when other treatments are inadequate. Conditions responsive to ECT include major depressive disorder, mania, and catatonia.
ECT evolved from early seizure-inducing treatments and 18th–19th century electrical experiments into a formal procedure in the 1930s, later becoming widely used in the 1940s–50s. It then declined in use due to safety concerns and negative public perception. With the introduction of anesthesia, muscle relaxants, and improved techniques, it became safer and more regulated, leading to its modern use as an effective treatment for severe, treatment-resistant psychiatric conditions.
The general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment, the most common adverse effects are confusion and transient memory loss. Among treatments for severely depressed pregnant individuals, ECT is one of the least harmful to the fetus.
The usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ECT is administered under anesthesia with a muscle relaxant. ECT can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. Differences in these parameters affect symptom remission and adverse side effects. ECT can be administered bilaterally or unilaterally, with high-dose unilateral matching efficacy but causing fewer cognitive effects. ECT is typically reserved for severe or treatment-resistant major depressive disorder, where it shows high efficacy and remission rates (around 50–60%), reduces suicide risk, and outperforms alternatives like antidepressants and repetitive transcranial magnetic stimulation, though relapse is common without maintenance treatment.
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