Exploring the Effectiveness, Advantages, and Potential Risks of Electroconvulsive Therapy in Treating Depression and Other Mental Health Disorders

When various therapies have failed to help patients with mental disorders, electroconvulsive therapy (ECT) is frequently employed. It is a treatment carried out while the patient is under general anesthesia in which tiny electric currents are purposely used to cause a short seizure in the brain. ECT appears to alter brain chemistry, which can swiftly alleviate the signs of some mental health disorders. After other therapies have failed and the entire course of treatment has been completed, ECT frequently helps, but not always. A significant portion of the stigma surrounding ECT stems from early procedures in which excessive amounts of electricity were given without anesthetic, causing memory loss, bone fractures, and other devastating adverse effects. Today’s ECT is substantially safer. Even though ECT still has some potential side effects, it currently makes use of regulated electric currents to deliver the greatest benefit with the least amount of danger. Although it is generally used to treat individuals with severe depression, patients with schizophrenia, catatonia, schizoaffective disorder, neuroleptic malignant syndrome, and bipolar disorder may also gain from it.

Electroconvulsive Therapy

Electroconvulsive Therapy

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The technique

The majority of the time, ECT is carried out on an outpatient basis in a designated suite, a post-anesthesia care facility, or an ambulatory surgery facility. Individuals who are severely disabled and have significant physical or mental illnesses may begin their treatment as inpatients and then switch to outpatient care if necessary. Before the surgery, patients should be suitably nil per os (NPO), which includes abstaining from light meals for six hours, full-fat meals for eight hours, and clear drinks for two hours. Continuously recorded vital indicators include blood oxygen saturation, ECG, and EEG activity. Right foot EMG is taken in order to gauge the motor component of seizure activity. Succinylcholine, a depolarizing muscle relaxant used to lessen tonic-clonic contractions throughout the treatment, is monitored using a nerve stimulator. The ECT stimulus is either an ultra-brief pulse waveform (less than 0.5 milliseconds) or a brief pulse waveform (0.5 to 2.0 milliseconds). The ultra-short pulse is said to be more bearable even though the brief pulse is regarded as typical. [15] Effectiveness, response time, and negative cognitive effects are all impacted by electricity dose. During the initial treatment session, the seizure threshold is established through trial and error with progressively greater current dosages.

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Clinical evidence

A systematic review was carried out by a group of scientists to present an overall picture of efficacy and identify the differentiating elements by describing the variables used in the study of efficacy, outcomes taken into account, safety, tolerability, and recurrence. Although the summary of research done up to the year 2020 indicates that ECT is extremely safe, tolerable, has few, moderate side effects that pass quickly, and is highly effective for treating medication-resistant depression, this therapy is still frowned upon and treated with stigma. As a result, it is rarely used and is the last option for treatment. Although the study included more than 30 years of research on the effectiveness of ECT on major depressive disorder (MDD), it only included and summarized a total of 38 papers, meta-analyses, and reviews. A particular study was analyzed and it was discovered that there were improvements in outcomes in the overall cognitive state throughout the short and long term, even when subacute impairment was present in pre-treatment scores. The results of the preceding study are supported by a second investigation of 44 individuals who had deficits in memory, executive functioning, and processing speed at baseline. The results indicated temporary memory and executive function impairment, which improved or stabilized over the following six months. This study found that cognition was unaffected by ECT treatment and only experienced minor, temporary side effects afterward. According to a study involving 311 depressed patients, patients with melancholy depression had a remission rate of 62.1%, while those with depression without melancholy had a remission rate of 78.7%. Also, it was discovered in an examination conducted over the following six months that individuals who got ECT had a reduced recurrence rate than those who received medication treatment.

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Benefits and risks

Patients with severe major depression that interferes with everyday activities or depression that is resistant to treatment might consider getting ECT. Depression that is recalcitrant to numerous antidepressant medication trials is referred to as a treatment-resistant depression. There are also recommendations for ECT as a treatment for catatonia, severe psychosis, secondary depression-related food refusal, and suicidality. Those who have manic or depressed bipolar disorder may also benefit from ECT. According to the National Health Service (NHS), ECT is generally safe. Compared to other minor surgeries, the fatality rate after ECT is lower. There is no proof that ECT is any riskier than other procedures requiring a general anesthetic. Before beginning the ECT procedure, an anesthetist will do an assessment. They won’t do ECT if they believe using an anesthetic is unsafe. There is an increased risk of mortality due to factors like age advancement and the presence of chronic illness. 

Conclusion

Findings show that, when specific monitoring and benefit/risk ratios are taken into account, ECT is efficient and generally safe. This kind of intervention has seen significant development throughout time, and it is now carried out using anesthetic agents. If the patient and the caregivers are given enough information, it may be the first-choice treatment in severe cases of depressive disorders.

References

https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894

https://www.ncbi.nlm.nih.gov/books/NBK538266/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461517/

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