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The Debate Over Electroconvulsive Therapy

The conversation about the safety of electroconvulsive therapy rages on.

Key points

  • Electroconvulsive therapy reportedly works more quickly and efficiently than conventional antidepressants.
  • Doctors today administer shock therapy under anesthesia, making the procedure itself painless.
  • But shock therapy can cause cognitive deficits, such as memory loss, that sometimes persist.
Klaus Nielsen/Pexels
Source: Klaus Nielsen/Pexels

Each year, more than 100,000 Americans undergo electroconvulsive therapy, also known as "electroshock treatment" and "shock therapy."

Electroconvulsive therapy may seem like it's from medieval times, but the treatment wasn't invented until the early 1940s.

In the late 1930s, Ugo Cerletti, an Italian neurologist, was successfully using metrazol-induced convulsions to treat individuals with schizophrenia and depression. But the side effects of metrazol-induced convulsions were so extreme that Cerletti soon started looking for a safer alternative.

As a specialist in epilepsy, Carletti had studied electroshock-induced seizures in dogs, and it occurred to him that this method could be used to induce seizures in humans as well. Joined by two of his peers, he thus set out to develop a device that could deliver electric shocks to humans.

Once perfected, electroshock treatment did indeed turn out to be more effective than the metrazol paradigm.

However, it didn't take long before doctors worldwide started using the procedure systematically as a treatment protocol, not only for mental illness, but also for criminal behavior, memory loss, and "feeble-mindedness."

Often, the procedure—which reportedly was extremely painful—had no effects aside from its harsh side effects, as iconically depicted in Ken Kesey’s 1962 novel One Flew Over the Cuckoo's Nest.

Today, electroconvulsive therapy is mainly used to treat major depression and bipolar disorder, and the use of muscle relaxers and anesthetics during the procedure has made it painless, as patients are unconscious while undergoing the treatment. Muscle aches, body soreness, and headache, along with nausea and confusion, following the treatment are quite common, however.

But shock therapy can also cause temporary, or less frequently, permanent brain injury, and patients do not always consent to the treatment, which has led some to regard the procedure as cruel and inhumane.

How Does Electroconvulsive Therapy Work?

In electroconvulsive therapy, an electric charge is delivered to the brain, which causes a whole-brain (or "grand mal") seizure. Seizures create random activity in the brain, and it is this random neural activity that is the primary therapeutic agent of the treatment.

Clinical data show that the symptoms of major depression often start improving within two weeks of electroshock treatment, which is significantly faster than the 6-8 weeks it can take for SSRIs—the most commonly prescribed antidepressants—to start working in those individuals who respond to them.

While no one knows exactly why seizures can improve the symptoms of major depression, the random activity is believed to "kickstart" the brain's neurotransmitter system, resulting in increased brain levels of the neurotransmitters dopamine, norepinephrine, and serotonin. The brain's levels of some or all of these neurotransmitters appear to be significantly reduced in individuals with major depressive disorder.

But is electroconvulsive therapy safe?

Brain Damage as a Result of Shock Therapy?

In a study involving more than 300 patients, Harold Sackeim, a previous defender of shock therapy, and his team reported that electroconvulsive therapy could cause adverse cognitive effects, such as early onset dementia and cognitive decline. However, there have been too few clinical trials of the potentially adverse effects of shock therapy to fully assess the dangers of this treatment regimen.

Some self-proclaimed shock-survivor activists argue that the negative effects of electroshock outweigh its benefits and that the shock industry has concealed its true consequences.

Others argue that electroshock therapy has failed to meet normal standards of approval, and that the shock industry and organized psychiatry have relied on public-relations campaigns rather than clinical trials to improve its reputation.

There is no doubt that electroconvulsive therapy has severe side effects. The treatment regimen produces short-term memory loss and, in some cases, long-term memory loss and an inability to think abstract thoughts.

Impairment of thought and memory functions is a kind of temporary, and in some cases permanent, brain damage—comparable to traumatic brain injury.

Even the most outspoken proponents of shock therapy underscore the rather severe side effects of the treatment. However, they argue that the life-saving effects of the procedure in severely depressed individuals—who need acute treatment or who fail to respond to conventional antidepressants—outweigh the risks of receiving electroshock.

How Does Electroshock Treatment Measure Up to Newer Treatments?

It may be true that electroconvulsive therapy can benefit some severely ill patients who fail to respond to conventional drugs like SSRIs. The question remains, however, whether shock therapy is a safe and effective alternative to newer technologies, such as transcranial magnetic stimulation and experimental drug therapies such as ketamine and psilocybin.

While no doctor can legally prescribe psilocybin—the active ingredient in magic mushrooms, ketamine is a legal drug, and doctors and clinics around the world prescribe it off-label to patients with treatment-resistant mood disorders.

Thus far, the side effects of both alternative brain technologies like transcranial magnetic stimulation and experimental drug therapies like psilocybin and ketamine seem less detrimental than those of electroconvulsive therapy. But the jury is still out.

More from Berit Brogaard D.M.Sci., Ph.D
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