Introduction
The origin of Electroconvulsive therapy (ECT) goes back by nearly eight decades, when (ECT) was employed to induce epileptic fits as the means to treat mood disorders. Though its use declined from about 1950 onwards, it continues to be used for the treatment of depression and schizophrenia, particularly in those cases that are resistant to pharmacological interventions. In recent times ECT has come into focus again, because of the its increasing use in combination with pharmacological intervention, reigniting the controversy related to its use as an intervention in mood disorders.
Electroconvulsive therapy (ECT)
Bennett 2006, p.79 defines ECT as “the brief discharge of an electric current through the brain with the aim of inducing a controlled epileptic convulsion to achieve an improvement in the abnormal mental state”. The ECT procedure involves the brief passing of current through the brain using electrodes that are placed on the scalp, for the purpose of causing generalized seizure activity. Body spasms are an issue with ECT and so an individual receiving ECT is placed under general anaesthesia and in addition muscle relaxants are given. When the electrodes for passing of current are placed on both sides of the head it is called bilateral placement and when it is placed only on one side of the head it is known as unilateral placement. Normally in unilateral placement the placement is done on the non-dominant side of the brain. The objective in the use of unilateral placement is to reduce the risk of cognitive side effects. The amount of current used in ECT for inducing seizures varies widely, as the seizure threshold of individuals are not the same (National Institute for Clinical Excellence, 2003). The mode of action through which the benefits of ECT are derived still remain elusive, though there is the suggestion that ECT acts by increasing the sensitivity to serotonin in the postsynaptic neurons present in the hippocampus, enhances the levels of GABA and lowers the levels of dopamine (Bennett, 2006).
The ECT Controversy
Most of the basis of the ECT controversy stems from moral grounds, rather than evidence of lack of effectiveness. Movies like One Flew over the Cuckoo’s Nest have contributed to the perception that ECT is an abusive form of treatment and some people are terrified on it being used. It is not that ECT is perfectly safe. It has its share of short-term risks that include use of an anaesthetic and fitting, tooth damage, vertebral compression fractures, peripheral nerve palsy and skin burns. However, the major issue with ECT is the problem of its effect on memory. Immediate to the treatment of ECT patients demonstrate an acute phase of confusion that takes five to ten minutes to dissipate. Impairment of the ability to learn and retain for some period of time subsequent to an ECT procedure has also been reported. In short ECT could bring about short or long term impairment of past events (retrograde amnesia) and also for current events (anterograde amnesia) (National Institute for Clinical Excellence, 2003). The advance from bilateral ECT to unilateral is found to reduce this impact on memory, but opponents to the use of ECT suggest that other interventional methods need to be dev eloped in place of ECT (Bennett, 2006).
ECT as an Effective Treatment
In spite of the opposition to its use from some quarters, the National Institute for Clinical Excellence (NICE) does not disallow its use in the United Kingdom. The NICE guidelines on the use of ECT maintain that ECT continues to be used as a treatment option for patients having depressive illness, catatonia, mania, and occasionally for schizophrenia. The guidelines recommend that ECT be used for the purposes of achieving rapid and short-term improvement in patients with severe depressive illness, catatonia, and prolonged or severe mania, when other treatment options have failed (National Institute for Clinical Excellence, 2003).
Evidence from recent studies however, project a greater role for ECT. Antunes et al, 2009 opine that the efficacy of ECT in the treatment of depression has been established for a long time from the evidence of several studies, making it the most effective biological treatment for the treatment of depression. Based on the findings of their studies the authors conclude that ECT is a “highly efficacious treatment for resistant depression (Antunes et al, 2009).
Evidence from studies also shows that ECT is effective in preventing relapse in treating depression. According to Lee 2007, relapse rates in major depression can be lowered through the combination therapy of ECT followed by lithium maintenance. Evidence on the efficacy of ECT in the treatment of depression is growing. Substantiating its efficacy is its widespread use through its demonstration of higher success rates than is seen with any other forms or modalities of treatment (Lee, 2007).
Another issue to be taken into consideration in the debate on whether to use ECT or not is to take cognizance of what would happen in the absence of the use of ECT. In the first place it must be remembered that ECT is recommended for use only in those cases that are resistant to pharmacological interventions. This means that were the use of ECT stopped there would be no effective interventions for these patients. In the absence of the use of ECT such patients would be doomed to certain deterioration in their condition with the risk of their taking their own lives. In taking the decision for any intervention strategy there is the evaluation of risk benefit ratio. The risks involved in the ECT procedure are slight in comparison to the improved quality of life of the patient that the use of the procedure results in and giving the patient something to live for. Use of ECT can only be faulted, when it is used without proper consent or in an individual not capable of consent. Therefore use of the effective ECT procedure needs to be continued, however, with proper imparting of the required information for informed consent, so that the patients receive dignity and humaneness which is due to them (Webber, 2008)
Conclusion
The controversy in the use of ECT is essentially based on moral use of a treatment procedure that is viewed as an abusive form treatment. Evidence from studies however shows that it is an effective treatment form for depression and mania.
References
Antunes, P. B., Rosa, M. A., Belmonte-de-Abreu, P. S., Lobato, M. I. & Fleck, M. P. (2009). Electroconvulsive therapy in major depression: current aspects. Revista brasileira de psiquiatria, 31(Suppl.1), S26-33.
Bennett, P. (2006). Abnormal and Clinical Psychology: An Introductory Textbook. Second Edition. Berkshire, England: McGraw-Hill Education.
Lee, L. W. (2007). Maintenance Therapy After Acute ECT Minimizes Relapse of Major Depression,from, Medscape Medical News, Medscape Today.
National Institute for Clinical Excellence. (2003). Guidance on the use of electroconvulsive therapy. Technology Appraisal 59. Web.
Webber, M. (2008). Electroconvulsive Therapy. BMJ, 337(2998). Web.