What is electroshock therapy?

Electroshock therapy involves administering shocks of electricity to a person’s brain. This electrical current causes a seizure, which disrupts the normal pattern of brainwaves. The idea is that by shocking the brain like this you can disrupt the patterns of brainwaves that are creating psychological distress. It’s essentially psychology’s version of trying to reset a computer by turning it off and then back on again.

What is shock therapy used for?

Shock therapy is primarily used to treat severe depression. In the past it was also routinely used for things such as schizophrenia or psychotic disorders, but such uses are far less common these days.

The effectiveness of shock therapy: How does electroshock therapy work?

Nobody seems to know how (or if) electroshock therapy actually works, which is one of our primary reserves about this method. A review in Harvard Mental Health Letter states that “the mechanism of ECT action is not understood, but the seizure seems to restore the brain’s ability to regulate mood. It may enhance the transmission of chemical signals or improve blood flow to the brain; animal studies suggest it may stimulate the creation of new brain cells. It is the seizure (not the electrical stimulus) that generates improvement.” (Harvard Mental Health Letter, 2009, p. 2)

In other words, the philosophy behind ECT boils down to this: zap a patient’s brain and hope something good happens. It’s possible that one of these conjectured hypotheses does indeed bring about psychological changes that help treat depression. But it’s also possible that ECT treatment is little more than an elaborate placebo with the potential for harmful side effects.

Shock therapy procedure: What happens during electroshock treatments?

Before the treatment, a patient is given a short-acting anesthetic to put them under, and other drugs are typically administered to relax the muscles. While the patient is unconscious, the psychiatrist will administer an electrical shock that stimulates the brain and induces a seizure. Though there are usually no outward signs of this seizure (no flailing or flopping around), the doctor will watch it occur on a monitor that measures electrical activity in the brain on a device similar to an electroencephalogram, or EEG. Electrodes that shock the patient may be placed over both hemispheres of the brain or strategically placed to stimulate a particular region. The length of the electrical pulse wave can also be adjusted.

Duration of shock therapy

Therapy usually consists of three ECT sessions per week over the course of two to four weeks.

Side effects of electroshock therapy

The most common side effects from electroshock therapy are memory and thinking problems, along with headache or nausea afterwards, the latter of which may be due to the anesthetic patients are given rather than the treatment itself. Patients have reported memory problems and difficulty thinking, as well as retrograde amnesia (problems recalling past events) or anterograde amnesia (impairment of new information).

Who benefits from shock therapy?

  1. ECT is usually administered as a last resort for patients who have found no relief after trying 3 or more different drugs, and/or those who are at high risk of suicide and thus in need of some type of immediate intervention. It also may be an option for women who are pregnant or nursing and do not want to risk the possible side effects of exposing their baby to antidepressant drugs.

 

  1. Some report that ECT treatment seems to bring faster relief to depression than antidepressants or talk therapy, and it appears (at this point, at least) that the seizures don’t do any permanent damage, so it may even be less destructive than drugs.

 

The drawbacks of electroshock therapy

  1. We would not recommend electroshock treatment for children or teens, although the American Academy of Child and Adolescent Psychiatry does publish guidelines for the use of this therapy in adolescents. Again, it should be a last resort.

  1. One of the big drawbacks of ECT is that many studies show high rates of relapse. One study found that 84% of patients had relapsed 6 months after electroshock treatments had ended. (Bauldauf, 2009) So like medications, it seems to offer only temporary relief without addressing the underlying causes of the symptoms.

 

  1. Studies are mixed. Some show the therapy produces remission rates of 55% to 86%, which means it would be fairly effective as an intervention for depression. Other studies of real-world use in community hospitals report that only 30% to 47% of patients find relief from their depression after ECT, which would put it more on par with a placebo.

 

Additional references: Fink et al., 2007; Lisanby, 2007