“Shock Therapy” – Fact & Fiction

multicoloured network of neurons

When you think of shock therapy, what comes to mind?  If you’re of a certain age, it would probably be the movie One Flew Over the Cuckoo’s Nest, in which a shock is delivered to Jack Nicholson’s character while he’s awake as a form of punishment.

Well, as Loretta Lynn sang, We’ve Come a Long Way, Baby.

Electroconvulsive therapy (ECT) continues to be performed, and while stigmatized views characterize it as barbaric, the reality is very different.  I’ve seen that reality as both a mental health nurse and a patient.

What it’s used for

ECT is primarily used for depression, although it may also be used for mania or for psychotic disorders.  It’s particularly good for depression with catatonic, melancholic, or psychotic features.  For patients at a high risk of suicide, ECT would start to take effect well before medications would.  As counterintuitive as it may seem, it’s safe in pregnancy, and safer than some of the medication options.

A number of different mechanisms have been proposed for how ECT works, but a firm answer hasn’t been established that.  What is known, though, is that it works.

How ECT is performed

ECT involves applying an electrical stimulus across the head to produce a seizure.  It’s performed under general anaesthetic, often using the drug propofol.  The muscle relaxant succinylcholine is also used, which prevents a visible seizure.

Before the procedure starts, the patient is hooked up to various monitors.  An IV is inserted, and a mask is applied to load the patient up with extra oxygen.  Once everything’s set up, the anaesthesiologist administers the anaesthetic and muscle relaxant, and it’s time for the actual ECT to begin.  The image below shows what the patient is hooked up to.

Electroconvulsive therapy monitoring equipment
I couldn’t find a diagram in English, but this one gives a good general idea

The black rods shown on either side of the patient’s head in the above image are the electrodes through which the electrical stimulus is applied.  The treatment may be bilateral (as shown above) or unilateral, with both electrodes on the same side of the patient’s head.

The patient wakes up not too long after the procedure.  While some people might feel a bit groggy from the anaesthetic, I always felt clearly awake.  The patient’s vital signs are monitored for a while, and then they are either sent back to their ward or sent home.

Side effects

There may be a headache and/or jaw pain that occur shortly after treatment; these are usually side effects of the muscle relaxant rather than effects of the seizure.  Both the muscle relaxant and the anaesthetic can lower blood pressure, which can result in lightheadedness.

The most significant side effect is memory loss.  For most people this is mild, but for others it can be much more prominent.  It mostly affects memories from the time frame when the treatment is occurring, but it can go further back.  The ability to form new memories after completing a course of ECT is nor normally affected.  Effects on memory are greater with bilateral treatments than with unilateral.

ECT can be done on either an inpatient or outpatient basis.  As an inpatient, it would typically be administered 2-3 times per week.  Outpatient is usually less often, but it can pose some logistical hurdles as typically ECT programs require to have a babysitter, essentially, each treatment day because of the anaesthetic used during the procedure.  A typical course of treatment is somewhere in the range of 6-12 treatments, but the exact number is determined by how the patient is doing.  During both my first and second hospitalization I had 17 treatments.

No more barbaric practices

Some people still describe ECT as barbaric, and there is a great deal of stigma around it.  However, it’s a safe and effective treatment that can save lives.  It’s certainly helped me a great deal when I’ve had it in the past.  Like any form of treatment, it’s not right for everyone, and for some people, the side effects will outweigh the benefits.  For myself, even though I had significant memory effects, that was acceptable given the level of benefit.

As currently practiced, there is nothing barbaric about ECT.  It’s not something that is only used as a last resort, and there is plenty of research evidence to support its effectiveness, especially for people who are the sickest and hardest to treat.

The stereotypes likely aren’t going anywhere anytime soon, but that just makes it all the more important that those of us who’ve had ECT talk about.

About the guest author:

Ashleyleia is a talented blogger and author from Canada. Her entertaining and informative blog is called: Mental Health @ Home.

Published by ashleyleia

I'm a mental health nurse and author of three books, and I live with major depressive disorder. My goal with MH@H is to fight stigma and empower others to make informed decisions about managing their own mental health and to raise their own voices.

29 thoughts on ““Shock Therapy” – Fact & Fiction

  1. Thank you for this article. My husband ran an ECT unit and it was remarkable how much it helped many of his patients. Hopefully, through continued outreach, such as this article, ECT will be viewed to the public as a viable, safe treatment. 🙂

    Liked by 3 people

  2. When it appeared I was quite med resistant, my psychiatrist recommended me for ECT. I did it has an outpatient. Unfotunately, it was not helpful for me. I do have the side effect of memory loss, very much of it being around the time of treatment, but of a few years before as well. I never thought memory loss would be as frustrating as it is. I have gaps in my life, where other ppl tell things happened, and I have no recollection. I have a suicide attempt that I don’t remember, my psychologist told me about it. To this day, I cannot put a date or a year to a an incident. I’m not really sure what year I did ECT in, but alot of 2010 to 2015 is missing. This in itself triggers more depression for me. Being med resistant, there aren’t alot of meds that I haven’t tried. My psych ARNP that manages my meds, wants me to try TMS. Being med resistant, and resistant to ECT, I’m very hesitant to try it. It is a huge commitment, 5x/ week for 8-9 weeks. My insurance will pay for it, I just have to pay my copay… Which is still $40 a visit.
    I’m just starting to climb out off a financial crisis, and have to put myself into one all over again, especially if it doesn’t help. I have so much anxiety right now between this and a neurological problem im also having right now, my instinct is to of course just give up. It’s confusing, part of me wants to take control by giving and killing myself, and part of me feels like, it’s not my life, and I should just give in, and do whatever my ARNP says.

    Liked by 1 person

    1. That’s horrible that you had such memory loss. My memory loss only went back a few months. It’s a very strange feeling to be told about things that happened by have no memory.

      I agree, TMS is a massive commitment, and that’s certainly made me reluctant to try it.

      Like

  3. Thanks for this – my Mum used to have to undergo ELectric shock therapy – here was quite barbaric to begin with I believe however the treatment has changed now which I’m relieved to note. It’s just good to know a bit more about the process. It was an amazing help to her

    Liked by 3 people

    1. It is not barbaric at all any more. The attach electrodes to your scalp in order to try and induce a small seizure of the brain only. Not a full on visible seizure. It’s sort of like a hardwire reset for your brain. If she still needs it, and it worked for her do it again.

      Liked by 2 people

  4. I find that doctors don’t propose it that much. But maybe that is because it’s ‘just’ recommended in certain cases. In my opinion they leave it out a little too much, not to say that it needs to be introduced right away. But stigma keeps existing that way.
    I wonder how does the effect feel and how do you know how long the effect will last? Does it have a maximum time? Are they people where the treatment is not recommended? I mean, why don’t they ‘shock’ people from episode to episode? Are there riskfactors for your brain? Is it sometimes used without medication? I have a lot of questions here, I know 😳 but that is because it’s so interesting.

    Liked by 1 person

    1. I felt a little bit lighter, for lack of a better word, later the day of and again the day after. It can get people into remission (although that didn’t happen for me), and then meds or another strategy would ideally be able to keep the person there. Some people do get maintenance ECT long-term. There are a few medical contraindications, but it’s safe for most people. And I think concern about stigma impacts how often doctors offer it; not that the doctor endorses stigmatized beliefs necessarily, but they anticipate that the patient does.

      Liked by 1 person

      1. Thank you for answering all of my questions!! I’ve seen it used with severe psychosis (a schizophrenic lady who lost her husband) and then the medications were of course also in place.
        Doctors always explained it solely to the patient (+ family) but not that much to the team.

        Liked by 1 person

  5. With all due respect, I consider memory loss a significant side effect. There might be other ways in which various brain functions are impacted that we are simply not aware of yet. That said, I don’t doubt the body of research that indicates its effectiveness.

    Liked by 1 person

    1. For me memory loss is a huge side effect! After ECT, I went thru chemo, so I have “chemo brain” memory loss as well. So I have several years that are missing. Places that I’ve worked and don’t remember them. Interviews I’ve done, and don’t remember. If like to try and go back to work part time, but have no idea how to reconstruct my resume. And with all of that, it was not effective for me. But that is me, I’ve heard it works for others. There is also a new treatment, TMS, that leaves no side effects.

      Liked by 3 people

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