Why Are We Still Using Electroconvulsive Therapy?
The idea of treating a psychiatric illness by passing a jolt of electricity through the brain was one of the most controversial in 20th Century medicine.
So why are we still using a procedure described by its critics as barbaric and ineffective?
Sixty-four-year-old John Wattie says his breakdown in the late 1990s was triggered by the collapse of his marriage and stress at work.
“We had a nice house and a nice lifestyle, but it was all just crumbling away. My depression was starting to overwhelm me. I lost control, I became violent,” he explains.
John likens the feeling to being in a hole, a hole he could not get out of despite courses of pills and talking therapies.
But now, he says, all of that has changed thanks to what is one of the least understood treatments in psychiatry – electroconvulsive therapy (ECT).
“Before ECT I was the walking dead. I had no interest in life, I just wanted to disappear. After ECT I felt like there was a way out of it. I felt dramatically better.”
The use of electricity to treat mental illness started out as an experiment. In the 1930s psychiatrists noticed some heavily distressed patients would suddenly improve after an epileptic fit.
Passing a strong electric current through the brain could trigger a similar seizure and – they hoped – a similar response.
By the 1960s it was being widely used to treat a variety of conditions, notably severe depression.
But as the old mental asylums closed down and aggressive physical interventions like lobotomies fell out of favour, so too did electroshock treatment, as ECT was previously known.
The infamous ECT scene in One Flew Over the Cuckoo’s Nest cemented the idea in the public’s mind of a brutal treatment, although by the time the film was released in 1975 it was very rarely given without a general anaesthetic.
Perhaps more significantly, new anti-depressant drugs introduced in the 1970-80s gave doctors new ways to treat long-term mental illness.
But for a group of the most severely depressed patients, ECT has remained one of the last options on the table when other therapies have failed.
Annually in the UK around 4,000 patients, of which John is one, still undergo ECT.
“It’s not intuitive that causing seizures can be good for depression but it’s long been determined that ECT is effective,” says Professor Ian Reid at the University of Aberdeen, who heads up the team treating John.
In the 75 years since ECT was first used scientists have argued about why and how it might work. The latest theories build on the idea of hyperconnectivity.
This new concept in psychiatry suggests parts of the brain can start to transmit signals in a dysfunctional way, overloading the system and leading to conditions from depression to autism.
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