Ect_in_Modern_Psychology

ECT in Recent Psychiatry The use of electroconvulsive therapy in present day psychiatry is a widely debated subject. It is one of the oldest psychiatric methods used, dating back to the 1930's. The side effects are considered to be very scary to many patients. Current studies have been done to find out the side effects directly attributed to electroconvulsive therapy and what ones result from remission of the illness. Some psychiatrist consider it the the most effective treatment in this day and age, claiming numbers of 80%-85% success rate. The other side of the argument states that electroconvulsive therapy is a short term solution to a long term problem. Each side has its own reasonable points, like with any treatment the patient must make a choice about the possible adverse side effects they might have. For many mentally ill electroconvulsive therapy is the only chance they have at having a natural life with their families. ECT is one of the most controversial treatments in psychiatric therapy today. On one side critics say it is a crude harmful tool. They feel that electroconvulsive therapy is a invasive and brain damaging treatment. The critics also feel that no reasonably sane person can give informed consent to such a treatment. The idea behind these feeling is the memory loss associated with the treatment. Along with the memory loss there is the fact that with out other treatment electroconvulsive therapy's effectiveness only last around 6 months, and a relapse is almost guaranteed. Some researchers even insist that no study shows improvement past 4 weeks. There are also patients that claim that electroconvulsive therapy has left them worse then they was before the treatments. The infamous electroconvulsive therapy will stay controversial because of its effectiveness and it potential cognitive side effects related to the treatment.(Reddy 105) The infamy behind electroconvulsive therapy comes from many places, some are the natural fear of electricity and epileptic seizures. Others are the competing ideas within psychiatry, old health care vs the new, and the misdirected desires of medical personnel to follow the public opinion. As to not scare patients the use of electroconvulsive therapy is often left to being a last resort. To avoid conflict with families and patients the recommendation for electroconvulsive therapy is often left until all other means are exhausted. These treatments are as Ottosson puts it “even many with lesser efficacy and unproven safety, have been tried and failed and the illness has become severe and persistent”. Ottosson then goes on to say “Claims of misuse, concerns about the properties of the treatment, ideological conflicts with psychiatry, and economic factors dominate its stigmatization”(Ottoson and Fink 10-17). A specific patient named Melissa Holliday says electroconvulsive therapy destroyed her life. Melissa stated “Now, everyday is like the Olympics for me. I don't want another person to go through what I've been through. Electroshock is not a form of therapy. Doctors are getting rich off doing brain damage to people". Holliday also goes on to say "They'd given me so many drugs, I didn't know if I was coming or going," she said, "A week after I got there, the doctor mentioned shock. She didn't ask me if I wanted it. She said if I didn't want it, I'd go to the fourth floor, a lock-up ward. Then nobody could see me and I couldn't go outside." She also filed a lawsuit against the hospital and the three physicians for assault and battery. (Makeig) There is also the polar opposite side, many advocates say that it is the most effective, and life saving treatment to date. They mention that among the actual psychiatrist there is little controversy. Stating that the National Institute of Mental Health, the American Psychiatric Association, the American Medical Association, and the U.S. Surgeon General all believe electroconvulsive therapy is a valuable tool in certain psychiatric disorders, such as depression. (Como) Opposite of Melissa Holliday is Kitty Dukakis who says electroconvulsive therapy saved her life. She said that after her first electroconvulsive therapy treatment she did not have any loss of cognitive function. She remembers getting her anesthesia as well as counting down after it. Upon waking up she wasn’t even sure that she got the treatment, the only way she could tell was feeling the goo on her head and having a slight headache. She then goes on to say “there is one more sign that I did in fact have my first session of seizure therapy: I feel good – I feel alive”. Another woman that did suffer from memory loss after the treatment compared herself to a “cancer victim who must choose the horrible side effects of chemotherapy over certain death to the disease” ("ABC Good Morning America"). In Larry and Kitty's book they talk about the twenty patients along with Kitty that volunteer for electroconvulsive therapy every week. Tye then says “All are tormented by depression too deep to defy or another disabling disease of the mind, and all, like kitty, are counting on twenty volts of electricity to jolt their brains back into equilibrium”. Tye's next sentence explains the current evolution in electroconvulsive therapy and how it currently performed “Muscle relaxant ensures that the only signal of their seizure will be a twitch of the tow; anesthesia guarantees that they will not remember the paralysis or anything else leasing to the convulsion” (Dukakis and Tye 3-5). Kitty also talks about how common electroconvulsive therapy is today. She states “More than 100,000 Americans a year get electroconvulsive therapy for ailments ranging from mania to catatonia, with ten to twenty times that many worldwide”. Kitty then compares it to other common treatments “Electroconvulsive therapy is now as ordinary as a hysterectomy and twice as common as knee replacement surgery”. She also talks about how after its almost extinction it has been quietly resurrected and could some day rank up right along with penicillin and Prozac. The reasoning behind its almost abolishment was how it was considered so barbaric. (Dukakis and Tye 5-7) The idea that electroconvulsive therapy directly effects cognitive function is a widely debated subject, and one that has no definitive answer. The reason for this is it is hard to directly separate the cognitive functions that are attributed with having depression. A study was done in Delft, The Netherlands to try and correlate the two. Bosboom talks about the results stating “ Our hypothesis that both electroconvulsive therapy and reduced depression specifically affect cognitive function was confirmed”. The way Bosboom and Deijen did their study allowed them to separate the two going on to say “first the electroconvulsive therapy treatment improves nearly all tapped cognitive domains. electroconvulsive therapy per se affects not only memory at short term and at long term, and speed of information processes, but also the quality of visual organization and mental control”. He then explains how reduced depression affects cognitive function stating “Reduced depression improves memory, speed of information processing, and inhibition”.(Bosboom and Deijen 97-99) From the natural fear of losing memories and having brain damage there has been a report focusing on cognitive function in the elderly but also a younger age group. In one study Stek reported “no single significant difference in memory functioning before electroconvulsive therapy and 1-3 years after ECT. Even after 4 years the same improvement in global cognitive functioning was reported in a group of patients with pretreatment cognitive impairment.”(Stek 792). He then goes on to say “learning and recalling new verbal information decreased directly after ECT”; although, “Visual memory was stable or improved”. Stek then explains that “Negative effects on memory scores directly after electroconvulsive therapy disappeared only 2 and 4 weeks later”. Stek then reports finding with maintenance electroconvulsive therapy or electroconvulsive therapy with continued use after the initial treatment. Stek states “Three studies analyzed cognitive functioning in M-ECT. Global cognitive functioning was roughly stable after receiving M-ECT for at least 1 year”(Stek 793). ECT can be administered in two different ways unilateral and bilateral. The difference between the two are nothing more then placement and side effects. When unilateral electroconvulsive therapy is used the electrodes are placed on only one side of the head. When bilateral is used the electrodes are placed opposite sides of the head. After the specific electroconvulsive therapy is chosen the treatments are similar in every other way. Carefully the psychiatrist will pass a electrical current through the patients brain causing a seizure. The electricity is passed between the two electrodes placed on the scalp. When the seizure is induced it typically last between 30 seconds to 1 minute. Patients who must receive electroconvulsive therapy feel no pain during the procedure, because they are unconscious. They also don't actually convulse, they are given strong muscle relaxants to stop them (Mental Health America). The number of treatments differs from person to person but the normal range is 6 to 12 treatments. Normally they are given two to three times a week on Monday, Wednesday, or Friday. The amount of times a patient must undergo electroconvulsive therapy depends on the severity of their symptoms and how fast they respond to the treatment. When a patient is given unilateral treatments the side effects are lessened. This treatment is associated with less memory side effects. With bilateral electroconvulsive therapy has more memory side effects though it works faster then unilateral. Bilateral is usually only used first if the patient severely mentally ill or if unilateral fails to work ("Mental Health America"). Still to this day neuroscientist and psychiatrists do not exactly know why electroconvulsive therapy works at all. The idea behind the treatment is that in certain mental conditions are believed to be caused by an imbalance in the brains chemical messenger system. The seizure associated with electroconvulsive therapy causes these chemicals to “reset” themselves, and by doing this it can help with symptoms. Research in rodents has been started to see if electroconvulsive therapy effects the structure of synapses in the brain. Changes to the synapses would effect memory, learning, and mood. This research is only in it beginning stages of development though. (Como) The Indian Journal of Psychological Medicine gives some great current statistics in the remission and relapse rates with patients treated with electroconvulsive therapy “The Consortium for Research in Electroconvulsive Therapy (CORE) reported a 75% remission in depression which is supported by the UK electroconvulsive therapy Review group. Patients with psychotic subtype of depression respond much higher. But there are reports that success rates in community hospital settings have been less at 30-45% as reported by Prudic. There was another report by Sackeim. that documented remission rates in depression with electroconvulsive therapy at 54%. Another interesting component of this study was that without any form of maintenance treatment 84% of patients relapsed at the end of 6-month follow-up. The CORE group also reported 46% relapse at the end of 6 months”(Reddy 103). Electroconvulsive therapy is a very infamous and controversial treatments in today’s society. It is often put on the back burner when it comes to treatments using less efficient treatments first allowing the illness to get worse. On one hand people claim they are worse then before, stating that they are brain damaged and cannot do common tasks with ease. There are critics who say the treatment is barbaric and in humane. Many patients claim it has also saved their lives, and some talk about the positives out weighing the negative. Electroconvulsive therapy today is a very common practice, and it is done two times as much as knee replacement surgery. Psychiatrist have tried to do studies to see what effects cognitive function more electroconvulsive therapy or the illness they have. In today’s day and age people should consider electroconvulsive therapy a double bladed sword. One side electroconvulsive therapy is the fastest and most effective treatment in psychiatry to date, and on the other side it one of the scariest and possibly very harmful treatments as well; Therefore, patients must weigh the risks to the benefits. Works Cited Reddy, M. S. "Electro-convulsive Therapy: A Few Lingering Thoughts/Doubts!." Indian Journal of Psychological Medicine July 2011: 103+. Academic Search Complete. Web. 19 Feb. 2012. Max L. Stek, et al. "The Effects Of ECT On Cognitive Functioning In The Elderly: A Review." International Journal Of Geriatric Psychiatry 23.8 (2008): 789-795.Academic Search Complete. Web. 19 Feb. 2012. Bosboom, P. R., and J. B. Deijen. "Age-Related Cognitive Effects Of ECT And ECT-Induced Mood Improvement In Depressive Patients." Depression & Anxiety (1091-4269) 23.2 (2006): 93-101. Academic Search Complete. Web. 20 Feb. 2012. Dukakis, Kitty, and Larry Tye. Shock: The healing power of Electroconvulsive Therapy. 1st edition. New York: Penguin Group, 2007. Print.  Ottoson, Jan-Otto, and Max Fink. Ethics in electroconvulsive therapy. New York: Brunner-Routledge, 2004. 161. Print. Makeig, John. "Woman Says Electric Shock Treatment Ruined Her Life." Houston Chronicle [Houston] 26 Jun 1996, n. pag. Web. 19 Feb. 2012. "Electroconvulsive Therapy." Mental Health America. Mental Health America, n.d. Web. 20 Feb 2012. . Como, Peter. "Research Findings on Memory and cognitive Impairment in ECT." Psych Central. U.S. Food and Drug Administration, Jan 2011. Web. 20 Feb 2012. "Kitty Dukakis: Shock Therapy Saved My Life." ABC Good Morning America. ABC, 16 Sep 2006. Web. 20 Feb 2012.