2. History of ECT Ancient Times Electric eels and fish were used for headaches and mental illness. 1936 Based on findings by Hungarian psychiatrist that epilepsy and schizophrenia have opposite effects Theory that inducing epileptic seizure in schizophrenic person could alter brain chemistry enough to alleviate symptoms Used drugs to induce seizures and seemed to work UgoCerletti and LucinoBini Experiment on animals to investigate epilepsy and find that electricity is more efficient in inducing seizures. Kill many animals by placing electrodes on either end of animal. Bini realizes that placing electrodes on sides of the head prevents heart damage.
3. History of ECT (cont’d) 1938 Cerletti and Bini apply electroshock to first human patient. Very successful Extremely schizophrenic man is able to live normally with this new therapy. 1930s & 1940s ECT becomes a very popular treatment. Accepted readily because no better alternatives and high demand (like lobotomies) 1950s Arrival of Thorazine Medication for treating schizophrenia ECT becomes 2nd choice/last resort Current Day has regained popularity Technological advancement decreased risk 100,000+ Americans treated with ECT yearly 10 to 20 times this number worldwide
7. Refusal to eatMania That hasn’t improved with medications Schizophrenia When medications are insufficient or symptoms are severe
8. Procedure Time: 10-15 +time for prep & recovery Intravenous (IV) catheter is inserted in the arm or hand Oxygen mask may be given Electrodes are placed on the head Unilateral: one side receives electricity Bilateral: both sides Anesthetic is injected into IV. Unconscious and unaware of procedure Muscle relaxant is injected into IV. Prevent violent convulsions Blood pressure cuff placed around forearm or ankle Prevents muscle relaxant from paralyzing, so doctor can confirm seizure with movement of hand/foot Electric current is sent through electrodes to brain. Seizure lasts 30-60 sec. Few minutes later, anesthetic and muscle relaxant wear off.
9. Risks & Side Effects Impairment of Cognition Period of confusion immediately after ECT May not know where you are or why you are there Generally lasts few min. to several hrs. Memory Loss May forget weeks/months before treatment, during treatment, or after treatment has stopped Usually improves within couple of months Permanent in relatively rare cases Medical Complications Heart problems Small risk of death same as other procedures using anesthesia Physical Symptoms Nausea Vomiting Headache Muscle ache Jaw pain
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11. Portrayed as primitive and ineffective instrument for social controlStrongly influential in affecting a public disapproval of ECT Girl, Interrupted (1999) Lisa runs away because of “shocks” given to her. Films present inaccurately negative representations of modern-day ECT.
12. Effectiveness & Controversy 80% success rate (APA) vs. 50-60% success rate of most antidepressants Thing of the Past Many people still believe that ECT is still the crude and painful procedure it was half a century ago. Opponents believe ECT is barbaric and outdated. Effectiveness vs. Side Effects Risk of permanent cognitive impairment and memory loss Some studies find that relapse is high, even for patients who take medications afterwards. Some researchers insist that no study proves that ECT is effective for more than 4 weeks.
13. Conclusion: Why ECT is Important Despite its stigma, ECT is still practiced fairly commonly to this day. ECT is much safer than before due to the precision in administering electric currents offered by modern-day technology, which minimizes sides effects. Complications, such as memory loss, still arise in patients who are treated with ECT, and this causes many people to oppose it. Notwithstanding the controversy, ECT has the highest success rate of any other treatment for Major Depressive Disorder and is a plausible option for individuals suffering from severe forms of this illness.
14. Philadelphia Area Resources Belmont Behavioral Health 4200 Monument Rd Philadelphia, PA 19131 (215) 877-2000 Friends Hospital 4641 Roosevelt Blvd Philadelphia, Pa 19124 (215) 831-4600 Pennsylvania Hospital 800 Spruce St Philadelphia, Pa 19107 (215) 829-3000
15. Sources http://www.pbs.org/wgbh/aso/databank/entries/dh38el.html http://psychcentral.com/lib/2006/an-overview-of-electroconvulsive-therapy-ect/ http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129/DSECTION=why%2Dits%2Ddone http://www.psychiatrictimes.com/web/10168/login http://www.electroboy.com/electroshocktherapy.htm http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129 http://www.nmha.org/go/information/get-info/treatment/electroconvulsive-therapy-ect http://www.medhelp.org/lib/ect.htm http://www.shockmd.com/wp-content/ect-0903-13.jpg http://cristinalaird.files.wordpress.com/2009/06/depression.jpg http://www.ccp.edu/vpst-aff/studentlife/Career%20Services/question-mark_cartoon.jpeg http://trinitypastor.files.wordpress.com/2008/12/nicholson.jpg http://friendshospital.com/about/mission_statement/ One Flew Over the Cuckoo’s Nest (1975) Girl, Interrupted (1999) Shock: The Healing Power of Electroconvulsive Therapy (2006) by Kitty Dukakis and Larry Tye
