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Electroconvulsive therapy

January 24, 2023

"Electroshock" redirects here. For other uses, see Electroshock (disambiguation).

Electroconvulsive therapy (ECT) is a psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.[1] Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple (bilateral ECT) or from front to back of one side of the head (unilateral ECT). However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.[2]

Electroconvulsive therapy
MECTA spECTrum 5000Q with electroencephalography (EEG) in a modern ECT suite
Other namesElectroshock therapy
ICD-10-PCSGZB
ICD-9-CM94.27
MeSHD004565
OPS-301 code8-630
MedlinePlus007474
[edit on Wikidata]

The ECT procedure was first conducted in 1938 by Italian psychiatrist Ugo Cerletti[3] and rapidly replaced less safe and effective forms of biological treatments in use at the time. ECT is often used with informed consent[4] as a safe and effective intervention for major depressive disorder, mania, and catatonia.[5] ECT machines were originally placed in the Class III category by the United States Food and Drug Administration (FDA) in 1976.[6] They were re-classified as Class II devices, for treatment of catatonia, major depressive disorder, and bipolar disorder, in 2018.[7]

Aside from effects on the brain, the general physical risks of ECT are similar to those of brief general anesthesia.[8]: 259  Immediately following treatment, the most common adverse effects are confusion and transient memory loss.[5][9] Among treatments for severely depressed pregnant women, ECT is one of the least harmful to the fetus.[10]

A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ECT is administered under anesthesia with a muscle relaxant.[11] ECT can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient.

Placement can be bilateral, where the electric current is passed from one side of the brain to the other, or unilateral, in which the current is solely passed across one hemisphere of the brain. High-dose unilateral ECT has some cognitive advantages compared to moderate-dose bilateral ECT while showing no difference in antidepressant efficacy.[12]

ECT appears to work in the short term via an anticonvulsant effect primarily in the frontal lobes and longer term via neurotrophic effects primarily in the medial temporal lobe.[13]

Medical use

ECT is used, where possible, with informed consent[4] in treatment-resistant major depressive disorder, treatment-resistant catatonia, prolonged or severe mania, and in conditions where "there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by stupor, marked psychomotor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania)."[5][14] It has also been used to treat autism in adults with an intellectual disability, yet findings from a systematic review found this an unestablished intervention.[15]

Major depressive disorder

For major depressive disorder, despite a Canadian guideline and some experts arguing for using ECT as a first line treatment,[16][17][18] ECT is generally used only when one or other treatments have failed, or in emergencies, such as imminent suicide.[5][19][20] ECT has also been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson's disease, Huntington's chorea, developmental delay, brain arteriovenous malformations, and hydrocephalus.[21]

Efficacy

A meta-analysis on the effectiveness of ECT in unipolar and bipolar depression was conducted in 2012. Results indicated that although patients with unipolar depression and bipolar depression responded to other medical treatments very differently, both groups responded equally well to ECT. Overall remission rate for patients given a round of ECT treatment was 50.9% for those with unipolar depression and 53.2% for those with bipolar depression. The severity of each patient's depression was assessed at the same baseline in each group. Most severely depressed patients respond to ECT.[22]

In 2004, a meta-analytic review paper found in terms of efficacy, "a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus tricyclics and ECT versus monoamine oxidase inhibitors."[23]

In 2003, The UK ECT Review Group published a systematic review and meta-analysis comparing ECT to placebo and antidepressant drugs. This meta-analysis demonstrated a large effect size (high efficacy relative to the mean in terms of the standard deviation) for ECT versus placebo, and versus antidepressant drugs.[24]

Compared with repetitive transcranial magnetic stimulation (rTMS) for people with treatment-resistant major depressive disorder, ECT relieves depression as shown by reducing the score on the Hamilton Rating Scale for Depression by about 15 points, while rTMS reduced it by 9 points.[25]

The response rate is from 50 to 60% in treatment-resistant patients.[26] Efficacity does not depend on depression subtype.[17]

Follow-up

There is little agreement on the most appropriate follow-up to ECT for people with major depressive disorder.[27] When ECT is followed by treatment with antidepressants, about 50% of people relapsed by 12 months following successful initial treatment with ECT, with about 37% relapsing within the first 6 months. About twice as many relapsed with no antidepressants. Most of the evidence for continuation therapy is with tricyclic antidepressants; evidence for relapse prevention with newer antidepressants is lacking.[27]

Lithium has also been found to reduce the risk of relapse; especially in younger patients.[28]

Catatonia

ECT is generally a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia.[5][29][30] There is a plethora of evidence for its efficacy, notwithstanding a lack of randomised controlled trials, such that "the excellent efficacy of ECT in catatonia is generally acknowledged".[29] For people with autism spectrum disorders who have catatonia, there is little published evidence about the efficacy of ECT; as of 2014 there were twelve case reports.[31]

Mania

ECT is used to treat people who have severe or prolonged mania;[5] NICE recommends it only in life-threatening situations or when other treatments have failed[32] and as a second-line treatment for bipolar mania.[33][34]

Schizophrenia

ECT is widely used worldwide in the treatment of schizophrenia, but in North America and Western Europe it is invariably used only in treatment resistant schizophrenia when symptoms show little response to antipsychotics; there is comprehensive research evidence for such practice.[35] It is useful in the case of severe exacerbations of catatonic schizophrenia, whether excited or stuporous.[5][32] There are also case reports of ECT improving persistent psychotic symptoms associated with stimulant-induced psychosis.[36][37]

Effects

Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia; the US Surgeon General's report says that there are "no absolute health contraindications" to its use.[8]: 259  Immediately following treatment, the most common adverse effects are confusion and memory loss. Some patients experience muscle soreness after ECT. A meta-analysis from 2017 found that the death rate of ECT is around 2.1 per 100,000 procedures.[38] There is evidence and rationale to support giving low doses of benzodiazepines or otherwise low doses of general anesthetics, which induce sedation but not anesthesia, to patients to reduce adverse effects of ECT.[39]

While there are no absolute contraindications for ECT, there is increased risk for patients who have unstable or severe cardiovascular conditions or aneurysms; who have recently had a stroke; who have increased intracranial pressure (for instance, due to a solid brain tumor), or who have severe pulmonary conditions, or who are generally at high risk for receiving anesthesia.[9]: 30 

In adolescents, ECT is highly efficient for several psychiatric disorders, with few and relatively benign adverse effects.[40][41][42]

Cognitive impairment

Cognitive impairment is sometimes noticed after ECT.[43][44][45][46] It has been claimed by some non-medical authors that retrograde amnesia occurs to some extent in almost all patients receiving ECT.[47] The American Psychiatric Association (APA) report in 2001 acknowledges: "In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss".[9] After treatment, drug therapy is usually continued and some patients will continue to receive maintenance ECT treatments.[5] It is the purported effects of ECT on long-term memory that give rise to much of the concern surrounding its use.[48] However, the methods used to measure memory loss are generally poor, and their application to people with depression, who have cognitive deficits including problems with memory, have been problematic.[49]

The acute effects of ECT can include amnesia, both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment).[50] Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents. The use of either constant or pulsing electrical impulses also varied the memory loss results in patients. Patients who received pulsing electrical impulses, as opposed to a steady flow, seemed to incur less memory loss. The vast majority of modern treatment uses brief pulse currents.[50]

Retrograde amnesia is most marked for events occurring in the weeks or months before treatment, with one study showing that although some people lose memories from years prior to treatment, recovery of such memories was "virtually complete" by seven months post-treatment, with the only enduring loss being memories in the weeks and months prior to the treatment.[51][52] Anterograde memory loss is usually limited to the time of treatment itself or shortly afterwards. In the weeks and months following ECT these memory problems gradually improve, but some people have persistent losses, especially with bilateral ECT.[1][50] One published review summarizing the results of questionnaires about subjective memory loss found that between 29% and 55% of respondents believed they experienced long-lasting or permanent memory changes.[53] In 2000, American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with more persistently impaired memory of public events as compared to right unilateral ECT.[48]

Effects on brain structure

Considerable controversy exists over the effects of ECT on brain tissue, although a number of mental health associations—including the APA—have concluded that there is no evidence that ECT causes structural brain damage.[9][20] A 1999 report by the US Surgeon General states: "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals."[54]

Many expert proponents of ECT maintain that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent ECT researcher and former chief editor of the Journal of ECT, stated in a 2007 interview that, "There are a number of well-designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT."[55] Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments.[56] Kellner stated "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness." Two meta-analyses find that ECT is associated with brain matter growth.[57][58]

Effects in pregnancy

If steps are taken to decrease potential risks, ECT is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments.[10][59] Suggested preparation for ECT during pregnancy includes a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended.[10] In many instances of active mood disorder during pregnancy, the risks of untreated symptoms may outweigh the risks of ECT. Potential complications of ECT during pregnancy can be minimized by modifications in technique. The use of ECT during pregnancy requires thorough evaluation of the patient's capacity for informed consent.[60]

Effects on the heart

ECT can cause a lack of blood flow and oxygen to the heart, heart arrhythmia, and "persistent asystole". Deaths, however, are very rare after ECT: 6 per 100,000 treatments. If they do occur, cardiovascular complications are considered as causal in about 30%.[61]

Procedure

 
Electroconvulsive therapy machine on display at Glenside Museum in Bristol, England
 
ECT device produced by Siemens and used for example at the Asyl psychiatric hospital in Kristiansand, Norway from the 1960s to the 1980s

The placement of electrodes, as well as the dose and duration of the stimulation is determined on a per-patient basis.[1]: 1881 

In unilateral ECT, both electrodes are placed on the same side of the patient's head. Unilateral ECT may be used first to minimize side effects such as memory loss.

In bilateral ECT, the two electrodes are placed on opposite sides of the head. Usually bitemporal placement is used, whereby the electrodes are placed on the temples. Uncommonly bifrontal placement is used; this involves positioning the electrodes on the patient's forehead, roughly above each eye.

Unilateral ECT is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses.[1]: 1881  Most patients in the US[62] and almost all in the UK[63][64][65] receive bilateral ECT.

The electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT.[1]: 1881  Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe cognitive impairment without additional therapeutic gains.[66] Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex.[62] Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold.

Immediately prior to treatment, a patient is given a short-acting anesthetic such as methohexital, etomidate, or thiopental,[1] a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation.[1]: 1882  In a minority of countries such as Japan,[67] India,[68] and Nigeria,[69] ECT may be used without anesthesia. The Union Health Ministry of India recommended a ban on ECT without anesthesia in India's Mental Health Care Bill of 2010 and the Mental Health Care Bill of 2013.[70][71] The practice was abolished in Turkey's largest psychiatric hospital in 2008.[72]

The patient's EEG, ECG, and blood oxygen levels are monitored during treatment.[1]: 1882 

ECT is usually administered three times a week, on alternate days, over a course of two to four weeks.[1]: 1882–1883 

 
An illustration depicting electroconvulsive therapy

Neuroimaging prior to ECT

Neuroimaging prior to ECT may be useful for detecting intracranial pressure or mass given that patients respond less when one of these conditions exist. Nonetheless, it is not indicated due to high cost and low prevalence of these conditions in patients needing ECT.[73]

Concurrent pharmacotherapy

Whether psychiatric medications are terminated prior to treatment or maintained, varies.[1]: 1885 [74] However, drugs that are known to cause toxicity in combination with ECT, such as lithium, are discontinued, and benzodiazepines, which increase the seizure threshold,[75] are either discontinued, a benzodiazepine antagonist is administered at each ECT session, or the ECT treatment is adjusted accordingly.[1]: 1875, 1879 

A 2009 RCT provides some evidence indicating that concurrent use of some antidepressant improves ECT efficacy.[17]

Course

ECT is usually done from 6 to 12 times in 2 to 4 weeks but can sometimes exceed 12 rounds.[17] It is also recommended to not do ECT more than 3 times per week.[17]

Treatment team

In the US, the medical team performing the procedure typically consists of a psychiatrist, an anesthetist, an ECT treatment nurse or qualified assistant, and one or more recovery nurses.[9]: 109  Medical trainees may assist, but only under the direct supervision of credentialed attending physicians and staff.[9]: 110 

Devices

 
ECT machine from before 1960.

Most modern ECT devices deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in ECT.[1] A small minority of psychiatrists in the US still use sine-wave stimuli.[62] Sine-wave is no longer used in the UK or Ireland.[65] Typically, the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts, and the current flows for between one and six seconds.[66]

In the US, ECT devices are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta.[76] In the UK, the market for ECT devices was long monopolized by Ectron Ltd, which was set up by psychiatrist Robert Russell.[77]

Mechanism of action

Despite decades of research, the exact mechanism of action of ECT remains elusive. Neuroimaging studies in people who have had ECT, investigating differences between responders and nonresponders, and people who relapse, find that responders have anticonvulsant effects mostly in the frontal lobes, which corresponds to immediate responses, and neurotrophic effects primarily in the medial temporal lobe. The anticonvulsant effects are decreased blood flow and decreased metabolism, while the neurotrophic effects are opposite – increased perfusion and metabolism, as well as increased volume of the hippocampus.[13]

Another proposed mechanism of action is that the seizures induced by ECT cause a profound change in sleep architecture (a reversible inhibition of REM sleep); it is this change in the state of the organism that drives the therapeutic effects of ECT and not any simple change in the release of neurotransmitters, neurotrophic factors and/or hormones.[78]

Use

As of 2001, it was estimated that about one million people received ECT annually.[79]

There is wide variation in ECT use between different countries, different hospitals, and different psychiatrists.[1][79] International practice varies considerably from widespread use of the therapy in many Western countries to a small minority of countries that do not use ECT at all, such as Slovenia.[80]

About 70 percent of ECT patients are women.[1] This may be because women are more likely to be diagnosed with depression.[1][81] Older and more affluent patients are also more likely to receive ECT. The use of ECT is not as common in ethnic minorities.[81][82]

Sarah Hall reports, "ECT has been dogged by conflict between psychiatrists who swear by it, and some patients and families of patients who say that their lives have been ruined by it. It is controversial in some European countries such as the Netherlands and Italy, where its use is severely restricted".[83]

United States

ECT became popular in the US in the 1940s. At the time, psychiatric hospitals were overrun with patients whom doctors were desperate to treat and cure. Whereas lobotomies would reduce a patient to a more manageable submissive state, ECT helped to improve mood in those with severe depression. A survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received ECT annually, with wide variation between metropolitan statistical areas.[84] Accurate statistics about the frequency, context and circumstances of ECT in the US are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information.[85] In 13 of the 50 states, the practice of ECT is regulated by law.[86] In the mid-1990s in Texas, ECT was used in about one third of psychiatric facilities and given to about 1,650 people annually.[81] Usage of ECT has since declined slightly; in 2000–01 ECT was given to about 1,500 people aged from 16 to 97 (in Texas it is illegal to give ECT to anyone under sixteen).[87] ECT is more commonly used in private psychiatric hospitals than in public hospitals, and minority patients are underrepresented in the ECT statistics.[1] In the United States, ECT is usually given three times a week; in the United Kingdom, it is usually given twice a week.[1] Occasionally it is given on a daily basis.[1] A course usually consists of 6–12 treatments, but may be more or fewer. Following a course of ECT some patients may be given continuation or maintenance ECT with further treatments at weekly, fortnightly or monthly intervals.[1] A few psychiatrists in the US use multiple-monitored ECT (MMECT), where patients receive more than one treatment per anesthetic.[1] Electroconvulsive therapy is not a required subject in US medical schools and not a required skill in psychiatric residency training. Privileging for ECT practice at institutions is a local option: no national certification standards are established, and no ECT-specific continuing training experiences are required of ECT practitioners.[88]

United Kingdom

In the UK in 1980, an estimated 50,000 people received ECT annually, with use declining steadily since then[89] to about 12,000 per annum in 2002.[90] It is still used in nearly all psychiatric hospitals, with a survey of ECT use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age. Eighty-one percent had a diagnosis of mood disorder; schizophrenia was the next most common diagnosis. Sixteen percent were treated without their consent.[90] In 2003, the National Institute for Health and Care Excellence, a government body which was set up to standardize treatment throughout the National Health Service in England and Wales, issued guidance on the use of ECT. Its use was recommended "only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode".[91]

The guidance received a mixed reception. It was welcomed by an editorial in the British Medical Journal[92] but the Royal College of Psychiatrists launched an unsuccessful appeal.[93] The NICE guidance, as the British Medical Journal editorial points out, is only a policy statement and psychiatrists may deviate from it if they see fit. Adherence to standards has not been universal in the past. A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that two-thirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure.[94] A voluntary accreditation scheme, ECTAS, was set up in 2004 by the Royal College, and as of 2017 the vast majority of ECT clinics in England, Wales, Northern Ireland and the Republic of Ireland have signed up.[95]

The Mental Health Act 2007 allows people to be treated against their will. This law has extra protections regarding ECT. A patient capable of making the decision can decline the treatment, and in that case treatment cannot be given unless it will save that patient's life or is immediately necessary to prevent deterioration of the patient's condition. A patient may not be capable of making the decision (they "lack capacity"), and in that situation ECT can be given if it is appropriate and also if there are no advance directives that prevent the use of ECT.[96]

China

ECT was introduced in China in the early 1950s and while it was originally practiced without anesthesia, as of 2012 almost all procedures were conducted with it. As of 2012, there are approximately 400 ECT machines in China, and 150,000 ECT treatments are performed each year.[97] Chinese national practice guidelines recommend ECT for the treatment of schizophrenia, depressive disorders, and bipolar disorder and in the Chinese literature, ECT is an effective treatment for schizophrenia and mood disorders.[97]

Although the Chinese government stopped classifying homosexuality as an illness in 2001, electroconvulsive therapy is still used by some establishments as a form of "conversion therapy".[98][99] Alleged Internet addiction (or general unruliness) in adolescents is also known to have been treated with ECT, sometimes without anestheia, most notably by Yang Yongxin. The practice was banned in 2009 after news on Yang broke out.[100]

History

 
A Bergonic chair, a device "for giving general electric treatment for psychological effect, in psycho-neurotic cases", according to original photo description. World War I era.
Further information: History of electroconvulsive therapy in the United Kingdom and History of electroconvulsive therapy in the United States

As early as the 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, the therapeutic use of seizure induction was documented in the London Medical and Surgical Journal.[1][101] As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of Electricity and Medicine. Treatment and cure of hysterical blindness was documented eleven years later. Benjamin Franklin wrote that an electrostatic machine cured "a woman of hysterical fits." By 1801, James Lind[102] as well as Giovanni Aldini had used galvanism to treat patients with various mental disorders.[103] G.B.C. Duchenne, the mid-19th century "Father of Electrotherapy", said its use was integral to a neurological practice.[104]

In the second half of the 19th century, such efforts were frequent enough in British asylums as to make it notable.[105]

Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol).[106][107] Meduna is thought to be the father of convulsive therapy.[108] In 1937, the first international meeting on schizophrenia and convulsive therapy was held in Switzerland by the Swiss psychiatrist Max Müller.[109] The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide.[107] Italian professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant Lucio Bini at Sapienza University of Rome developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1938, experimented for the first time on a person affected by delusions. It was believed early on that inducing convulsions aided in helping those with severe schizophrenia but later found to be most useful with affective disorders such as depression. Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state.[110] Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on patients, they found that after 10-20 treatments the results were significant. Patients had much improved. A positive side effect to the treatment was retrograde amnesia. It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it.[110] ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient.[111] Cerletti and Bini were nominated for a Nobel Prize but did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria, it was promoted by Friedrich Meggendorfer. Through the 1940s and 1950s, the use of ECT became widespread. At the time the ECT device was patented and commercialized abroad, the two Italian inventors had competitive tensions that damaged their relationship.[112] In the 1960s, despite a climate of condemnation, the original Cerletti-Bini ECT apparatus prototype was hotly contended by scientific museums between Italy and the USA.[113] The ECT apparatus prototype is now owned and displayed by the Sapienza Museum of the History of Medicine in Rome.[113]

In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse. It took many years for brief-pulse equipment to be widely adopted.[114] In the 1940s and early 1950s ECT, was usually given in "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s, psychiatrists began to experiment with curare, the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of suxamethonium (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants.[114]

The steady growth of antidepressant use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s. The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media."[115] The New York Times described the public's negative perception of ECT as being caused mainly by one movie: "For Big Nurse in One Flew Over the Cuckoo's Nest, it was a tool of terror, and, in the public mind, shock therapy has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and overused".[116]

In 1976, Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although as of 2012 some ECT clinics still were using sine-wave devices.[79] The 1970s saw the publication of the first American Psychiatric Association (APA) task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT.[117] Specifically, critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression".[115] In 1985, the National Institute of Mental Health and National Institutes of Health convened a consensus development conference on ECT and concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for a narrow range of severe psychiatric disorders.[118]

Because of the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978, the American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally, in 2001 the American Psychiatric Association released its latest task force report.[9] This report emphasizes the importance of informed consent, and the expanded role that the procedure has in modern medicine. By 2017, ECT was routinely covered by insurance companies for providing the "biggest bang for the buck" for otherwise intractable cases of severe mental illness, was receiving favorable media coverage, and was being provided in regional medical centers.[119]

Though ECT use declined with the advent of modern antidepressants, there has been a resurgence of ECT with new modern technologies and techniques.[120] Modern shock voltage is given for a shorter duration of 0.5 milliseconds where conventional brief pulse is 1.5 milliseconds.[121]

Society and culture

Controversy

Surveys of public opinion, the testimony of former patients, legal restrictions on the use of ECT and disputes as to the efficacy, ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial.[122][123][124][125][126][127][128] This is reflected in the January 2011 vote by the FDA's Neurological Devices Advisory Panel to recommend that FDA maintain ECT devices in the Class III device category for high risk devices, except for patients with catatonia, major depressive disorder, and bipolar disorder.[7] This may result in the manufacturers of such devices having to do controlled trials on their safety and efficacy for the first time.[5][129][130] In justifying their position, panelists referred to the memory loss associated with ECT and the lack of long-term data.[131]

Legal status

Informed consent

The World Health Organization (2005) advises that ECT should be used only with the informed consent of the patient (or their guardian if their incapacity to consent has been established).[14]

In the US, this doctrine places a legal obligation on a doctor to make a patient aware of the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment. The patient is then given the opportunity to accept or reject the treatment. The form states how many treatments are recommended and also makes the patient aware that consent may be revoked and treatment discontinued at any time during a course of ECT.[8] The US Surgeon General's Report on Mental Health states that patients should be warned that the benefits of ECT are short-lived without active continuation treatment in the form of drugs or further ECT, and that there may be some risk of permanent, severe memory loss after ECT.[8] The report advises psychiatrists to involve patients in discussion, possibly with the aid of leaflets or videos, both before and during a course of ECT.

According to the US Surgeon General, involuntary treatment is uncommon in the US and is typically used only in cases of great extremity, and only when all other treatment options have been exhausted. The use of ECT is believed to be a potentially life-saving treatment.[54]

In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent.[132]

In the UK, in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects.[133] One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects[134] and another survey found that about fifty percent of psychiatrists and nurses agreed with them.[135]

A 2005 study published in the British Journal of Psychiatry described patients' perspectives on the adequacy of informed consent before ECT.[134] The study found that "About half (45–55%) of patients reported they were given an adequate explanation of ECT, implying a similar percentage felt they were not." The authors also stated:

Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. The proportion who feel they did not freely choose the treatment has actually increased over time. The same themes arise whether the patient had received treatment a year ago or 30 years ago. Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.[134]

Involuntary ECT

Procedures for involuntary ECT vary from country to country depending on local mental health laws.

United States

In most states in the US, a judicial order following a formal hearing is needed before a patient can be forced to undergo involuntary ECT.[8] However, ECT can also be involuntarily administered in situations with less immediate danger. Suicidal intent is a common justification for its involuntary use, especially when other treatments are ineffective.[8]

United Kingdom

Until 2007 in England and Wales, the Mental Health Act 1983 allowed the use of ECT on detained patients whether or not they had capacity to consent to it. However, following amendments which took effect in 2007, ECT may not generally be given to a patient who has capacity and refuses it, irrespective of his or her detention under the Act.[136] In fact, even if a patient is deemed to lack capacity, if they made a valid advance decision refusing ECT then they should not be given it; and even if they do not have an advance decision, the psychiatrist must obtain an independent second opinion (which is also the case if the patient is under age of consent).[137] However, there is an exception regardless of consent and capacity; under Section 62 of the Act, if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization.[138] From 2003 to 2005, about 2,000 people a year in England and Wales were treated without their consent under the Mental Health Act.[139] Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments, and that there is a worrying lack of independent advocacy.[140] In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 also gives patients with capacity the right to refuse ECT.[141]

Regulation

In the US, ECT devices came into existence prior to medical devices being regulated by the Food and Drug Administration. In 1976, the Medical Device Regulation Act required the FDA to retrospectively review already existing devices, classify them, and determine whether clinical trials were needed to prove efficacy and safety. The FDA initially classified the devices used to administer ECT as Class III medical devices. In 2014, the American Psychiatric Association petitioned the FDA to reclassify ECT devices from Class III (high-risk) to Class II (medium-risk), which would significantly improve access to an effective and potentially lifesaving treatment. A similar reclassification proposal in 2010 met significant resistance from anti-psychiatry groups and did not pass.[142] In 2018, the FDA re-classified ECT devices as Class II devices when used to treat catatonia or a severe major depressive episode associated with major depressive disorder or bipolar disorder.[7]

Public perception

A questionnaire survey of 379 members of the general public in Australia indicated that more than 60% of respondents had some knowledge about the main aspects of ECT. Participants were generally opposed to the use of ECT on depressed individuals with psychosocial issues, on children, and on involuntary patients. Public perceptions of ECT were found to be mainly negative.[128] A sample of the general public, medical students, and psychiatry trainees in the United Kingdom found that the psychiatry trainees were more knowledgeable and had more favorable opinions of ECT than did the other groups.[143] More members of the general public believed that ECT was used for control or punishment purposes than medical students or psychiatry trainees.[143]

Famous cases

Main article: List of people who have undergone electroconvulsive therapy

Ernest Hemingway, an American author, died by suicide shortly after ECT at the Mayo Clinic in 1961.[144] He is reported to have said to his biographer, "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient."[145]

Robert Pirsig had a nervous breakdown and spent time in and out of psychiatric hospitals between 1961 and 1963.[146] He was diagnosed with paranoid schizophrenia and clinical depression as a result of an evaluation conducted by psychoanalysts, and was treated with electroconvulsive therapy on numerous occasions,[147] a treatment he discusses in his novel, Zen and the Art of Motorcycle Maintenance.[148]

Thomas Eagleton, United States Senator from Missouri, was dropped from the Democratic ticket in the 1972 United States Presidential Election as the party's vice presidential candidate after it was revealed that he had received electroshock treatment in the past for depression. Presidential nominee George McGovern replaced him with Sargent Shriver, and later went on to lose by a landslide to Richard Nixon.

American surgeon and award-winning author Sherwin B. Nuland is another notable person who has undergone ECT.[149] In his 40s, this successful surgeon's depression became so severe that he had to be institutionalized. After exhausting all treatment options, a young resident assigned to his case suggested ECT, which ended up being successful.[150]

Author David Foster Wallace also received ECT for many years, beginning as a teenager, before his suicide at age 46.[151]

New Zealand author Janet Frame experienced both insulin coma therapy and ECT (but without the use of anesthesia or muscle relaxants).[152] She wrote about this in her autobiography, An Angel at My Table (1984),[152] which was later adapted into a film (1990).[153]

American actor Carrie Fisher wrote about her experience with memory loss after ECT treatments in her memoir Wishful Drinking.[154]

Fictional examples

Electroconvulsive therapy has been depicted in fiction, including fictional works partly based on true experiences. These include Sylvia Plath's autobiographical novel, The Bell Jar, Ken Loach's film Family Life, and Ken Kesey's novel One Flew Over the Cuckoo's Nest; Kesey's novel is a direct product of his time working the graveyard shift as an orderly at a mental health facility in Menlo Park, California.[155][156]

Special populations

Sex difference

Throughout the history of ECT, women have received it two to three times as often as men.[157] Currently, about 70 percent of ECT patients are women.[1] This may be because women are more likely to be diagnosed with depression.[1][81] A 1974 study of ECT in Massachusetts reported that women made up 69 percent of those given ECT.[158] The Ministry of Health in Canada reported that from 1999 until 2000 in the province of Ontario, women were 71 percent of those given ECT in provincial psychiatric institutions, and 75 percent of the total ECT given was given to women.[159]

See also

References

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w Rudorfer, MV, Henry, ME, Sackeim, HA (2003). "Electroconvulsive therapy" 2007-08-10 at the Wayback Machine. In A Tasman, J Kay, JA Lieberman (eds) Psychiatry, Second Edition. Chichester: John Wiley & Sons Ltd, 1865–1901.
  2. ^ Solano, Juanjo (2009-04-20). "Electroconvulsive Therapy" (PDF). p. 4. (PDF) from the original on 2022-02-18. Retrieved 2022-05-17.
  3. ^ Rudorfer, M. V., Henry, M. E., & Sackheim, H. A. (1997). "Electroconvulsive therapy". In A. Tasman, J. & J. A Lieberman (Eds.), Psychiatry (1535–1556)
  4. ^ a b Beloucif S (2013). "Informed consent for special procedures: electroconvulsive therapy and psychosurgery". Curr Opin Anesthesiol. 26 (2): 182–185. doi:10.1097/ACO.0b013e32835e7380. PMID 23385317. S2CID 36643014.
  5. ^ a b c d e f g h i FDA. FDA Executive Summary. Prepared for the January 27–28, 2011 meeting of the Neurological Devices Panel Meeting to Discuss the Classification of Electroconvulsive Therapy Devices (ECT). Quote, p. 38: "Three major practice guidelines have been published on ECT. These guidelines include: APA Task Force on ECT (2001); Third report of the Royal College of Psychiatrists' Special Committee on ECT (2004); National Institute for Health and Clinical Excellence (NICE 2003; NICE 2009). There is significant agreement between the three sets of recommendations."
  6. ^ "CFR – Code of Federal Regulations Title 21".
  7. ^ a b c US Food and Drug Administration (2018-12-21). "FDA In Brief: FDA takes action to ensure regulation of electroconvulsive therapy devices better protects patients, reflects current understanding of safety and effectiveness" (Press release).
  8. ^ a b c d e f Surgeon General (1999). Mental Health: A Report of the Surgeon General, chapter 4.
  9. ^ a b c d e f g American Psychiatric Association; Committee on Electroconvulsive Therapy; Richard D. Weiner (chairperson); et al. (2001). The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging (2nd ed.). Washington, DC: American Psychiatric Publishing. ISBN 978-0890422069.
  10. ^ a b c Pompili M, et al. (Dec 2014). "Electroconvulsive treatment during pregnancy: a systematic review". Expert Rev Neurother. 14 (12): 1377–1390. doi:10.1586/14737175.2014.972373. PMID 25346216. S2CID 31209001.
  11. ^ Margarita Tartakovsky (2012) Psych Central. 5 Outdated Beliefs About ECT 2013-08-08 at the Wayback Machine
  12. ^ Kolshus E, Jelovac A, McLoughlin DM (2017). "Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials" (PDF). Psychol Med. 47 (3): 518–530. doi:10.1017/S0033291716002737. PMID 27780482. S2CID 10711085. (PDF) from the original on 2021-06-16.
  13. ^ a b Abbott CC, et al. (Mar 2014). "A review of longitudinal electroconvulsive therapy: neuroimaging investigations". J Geriatr Psychiatry Neurol. 27 (1): 33–46. doi:10.1177/0891988713516542. PMC 6624835. PMID 24381234.
  14. ^ a b World Health Organisation (2005). WHO Resource Book on Mental Health, Human Rights and Legislation 2006-12-06 at the Wayback Machine. Geneva, 64.
  15. ^ Benevides, Teal W; Shore, Stephen M; Andresen, May-Lynn; Caplan, Reid; Cook, Barb; Gassner, Dena L; Erves, Jasmine M; Hazlewood, Taylor M; King, M Caroline; Morgan, Lisa; Murphy, Lauren E (2020). "Interventions to address health outcomes among autistic adults: A systematic review". Autism. 24 (6): 1345–1359. doi:10.1177/1362361320913664. ISSN 1362-3613. PMC 7787674. PMID 32390461. S2CID 218586379.
  16. ^ Lipsman N, et al. (Jan 2014). "Neuromodulation for treatment-refractory major depressive disorder". Canadian Medical Association Journal. 186 (1): 33–39. doi:10.1503/cmaj.121317. PMC 3883821. PMID 23897945.
  17. ^ a b c d e Tasman, Allan; Kay, Jerald; Lieberman, Jeffrey A.; First, Michael B.; Riba, Michelle B., eds. (2015). Psychiatry. Chichester, UK: John Wiley & Sons, Ltd. doi:10.1002/9781118753378. ISBN 978-1118753378.
  18. ^ Bolwig, Tom G (2005). "First-line Use of ECT". The Journal of ECT. Ovid Technologies (Wolters Kluwer Health). 21 (1): 51. doi:10.1097/01.yct.0000158271.45828.76. ISSN 1095-0680. PMID 15791182.
  19. ^ Fitzgerald, P. B (2013). "Non-pharmacological biological treatment approaches to difficult-to-treat depression". The Medical Journal of Australia. 199 (6 Suppl): S48–51. doi:10.5694/mja12.10509. PMID 25370288. S2CID 204073048.
  20. ^ a b "Depression in adults: The treatment and management of depression in adults. NICE guidelines CG90". National Institute for Clinical Excellence. 2009.
  21. ^ Murray ED, Buttner N, Price BH (2012). "Depression and Psychosis in Neurological Practice". In Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.). Bradley's Neurology in Clinical Practice: Expert Consult. Vol. 1 (6th ed.). Philadelphia: Elsevier/Saunders. pp. 114–115. ISBN 978-1437704341.
  22. ^ Dierckx, Bram; Heijnen, Willemijn T; van den Broek, Walter W; Birkenhäger, Tom K (2012). "Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis". Bipolar Disorders. Wiley. 14 (2): 146–150. doi:10.1111/j.1399-5618.2012.00997.x. ISSN 1398-5647. PMID 22420590. S2CID 44280002.
  23. ^ Pagnin D, de Queiroz V, Pini S, Cassano GB (2004). "Efficacy of ECT in depression: a meta-analytic review". The Journal of ECT. 20 (1): 13–20. doi:10.1097/00124509-200403000-00004. PMID 15087991. S2CID 25843283.
  24. ^ UK ECT Review Group (2003). "Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis". The Lancet. 361 (9360): 799–808. doi:10.1016/S0140-6736(03)12705-5. PMID 12642045. S2CID 28964580.
  25. ^ Micallef-Trigona B (2014). "Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression: a systematic review and meta-analysis". Depress Res Treat. 2014: 135049. doi:10.1155/2014/135049. PMC 4131106. PMID 25143831.
  26. ^ Shelton, Richard C.; Osuntokun, Olawale; Heinloth, Alexandra N.; Corya, Sara A. (2010). "Therapeutic Options for Treatment-Resistant Depression". CNS Drugs. Springer Science and Business Media LLC. 24 (2): 131–161. doi:10.2165/11530280-000000000-00000. ISSN 1172-7047. PMID 20088620. S2CID 32936223.
  27. ^ a b Jelovac A, et al. (Nov 2013). "Relapse following successful electroconvulsive therapy for major depression: a meta-analysis". Neuropsychopharmacology. 38 (12): 2467–2474. doi:10.1038/npp.2013.149. PMC 3799066. PMID 23774532.
  28. ^ Lambrichts, S; Detraux, J; Vansteelandt, K; Nordenskjöld, A; Obbels, J; Schrijvers, D; Sienaert, P (2021). "Does lithium prevent relapse following successful electroconvulsive therapy for major depression? A systematic review and meta-analysis". Acta Psychiatrica Scandinavica. 143 (4): 294–306. doi:10.1111/acps.13277. ISSN 0001-690X. PMID 33506961. S2CID 231759831.
  29. ^ a b Sienaert P, et al. (Dec 2014). "A clinical review of the treatment of catatonia". Front Psychiatry. 5: 181. doi:10.3389/fpsyt.2014.00181. PMC 4260674. PMID 25538636.
  30. ^ Leroy, Arnaud; Naudet, Florian; Vaiva, Guillaume; Francis, Andrew; Thomas, Pierre; Amad, Ali (2018). "Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis". European Archives of Psychiatry and Clinical Neuroscience. 268 (7): 675–687. doi:10.1007/s00406-017-0819-5. ISSN 0940-1334. PMID 28639007. S2CID 4013882.
  31. ^ DeJong H, et al. (Sep 2014). "A systematic review of interventions used to treat catatonic symptoms in people with autistic spectrum disorders". J Autism Dev Disord. 44 (9): 2127–2136. doi:10.1007/s10803-014-2085-y. PMID 24643578. S2CID 22002956.
  32. ^ a b NICE Guidance on the use of electroconvulsive therapy. NICE technology appraisals TA59. Published date: April 2003
  33. ^ Kanba S, Kato T, Terao T, Yamada K (Jul 2013). "Guideline for treatment of bipolar disorder by the Japanese Society of Mood Disorders, 2012". Psychiatry Clin Neurosci. 67 (5): 285–300. doi:10.1111/pcn.12060. PMID 23773266. S2CID 2058163.
  34. ^ Malhi GS, et al. (Dec 2012). "Mania: diagnosis and treatment recommendations". Curr Psychiatry Rep. 14 (6): 676–686. doi:10.1007/s11920-012-0324-5. PMID 22986995. S2CID 37771648.
  35. ^ Tharyan P, Adams CE (2005). Tharyan P (ed.). "Electroconvulsive therapy for schizophrenia". The Cochrane Database of Systematic Reviews (2): CD000076. doi:10.1002/14651858.CD000076.pub2. PMID 15846598.
  36. ^ Penders TM, Gestring RE, Vilensky DA (November 2012). "Intoxication delirium following use of synthetic cathinone derivatives". The American Journal of Drug and Alcohol Abuse. 38 (6): 616–617. doi:10.3109/00952990.2012.694535. PMID 22783894. S2CID 207428569.
  37. ^ Penders TM, et al. (December 2013). "Electroconvulsive Therapy Improves Persistent Psychosis After Repeated Use of Methylenedioxypyrovalerone ("Bath Salts")". The Journal of ECT. 29 (4): 59–60. doi:10.1097/YCT.0b013e3182887bc2. PMID 23609518. S2CID 45842375.
  38. ^ Tørring, N.; Sanghani, S. N.; Petrides, G.; Kellner, C. H.; Østergaard, S. D. (2017). "The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis". Acta Psychiatrica Scandinavica. 135 (5): 388–397. doi:10.1111/acps.12721. ISSN 1600-0447. PMID 28332236. S2CID 31879446.
  39. ^ Gallegos J; Vaidya P; D'Agati D; et al. (June 2012). "Decreasing adverse outcomes of unmodified electroconvulsive therapy: suggestions and possibilities". J ECT. 28 (2): 77–81. doi:10.1097/YCT.0b013e3182359314. PMID 22531198. S2CID 6423840.
  40. ^ Neera Ghaziuddin, Garry Walter (eds.): Electroconvulsive Therapy in Children and Adolescents, Oxford University Press, 2013, ISBN 978-0199937899, pp. 161–280.
  41. ^ Lima, Nádia NR; Nascimento, Vânia B; Peixoto, Jorge AC; Moreira, Marcial M; Neto, Modesto LR; Almeida, José C; Vasconcelos, Carlos AC; Teixeira, Saulo A; Júnior, Jucier G; Junior, Francisco TC; Guimarães, Diego DM; Brasil, Aline Q; Cartaxo, Jesus S; Akerman, Marco; Reis, Alberto OA (2013). "Electroconvulsive therapy use in adolescents: a systematic review". Annals of General Psychiatry. 12 (1): 17. doi:10.1186/1744-859X-12-17. ISSN 1744-859X. PMC 3680000. PMID 23718899.
  42. ^ Benson NM, Seiner SJ (2019). "Electroconvulsive Therapy in Children and Adolescents: Clinical Indications and Special Considerations". Harv Rev Psychiatry. 27 (6): 354–358. doi:10.1097/HRP.0000000000000236. PMID 31714466. S2CID 207934946.
  43. ^ Holtzheimer PE 3rd, Mayberg HS (2010). "Deep brain stimulation for treatment-resistant depression". Am J Psychiatry. 167 (12): 1437–1444. doi:10.1176/appi.ajp.2010.10010141. PMC 4413473. PMID 21131410.
  44. ^ McClintock SM, Choi J, Deng ZD, Appelbaum LG, Krystal AD, Lisanby SH (2014). "Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy". J ECT. 30 (2): 165–176. doi:10.1097/YCT.0000000000000137. hdl:10161/10644. PMC 4143898. PMID 24820942.
  45. ^ Loo CK, Katalinic N, Smith DJ, Ingram A, Dowling N, Martin D, Addison K, Hadzi-Pavlovic D, Simpson B, Schweitzer I (2014). "A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy". Int. J. Neuropsychopharmacol. 18 (1): pyu045. doi:10.1093/ijnp/pyu045. PMC 4368876. PMID 25522389.
  46. ^ Kellner CH, Knapp R, Husain MM, Rasmussen K, Sampson S, Cullum M, McClintock SM, Tobias KG, Martino C, Mueller M, Bailine SH, Fink M, Petrides G (2010). "Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial". Br J Psychiatry. 196 (3): 226–234. doi:10.1192/bjp.bp.109.066183. PMC 2830057. PMID 20194546.
  47. ^ Read, J; Bentall, R (Oct–Dec 2010). (PDF). Epidemiologia e Psichiatria Sociale. 19 (4): 333–347. doi:10.1017/S1121189X00000671. PMID 21322506. S2CID 15118442. Archived from the original (PDF) on 2012-05-24. Retrieved 2012-01-23.
  48. ^ a b Lisanby SH, Maddox JH, Prudic J, Devanand DP, Sackeim HA (June 2000). "The effects of electroconvulsive therapy on memory of autobiographical and public events". Arch. Gen. Psychiatry. 57 (6): 581–590. doi:10.1001/archpsyc.57.6.581. PMID 10839336.
  49. ^ Semkovska M, McLoughlin DM (Jun 2013). "Measuring retrograde autobiographical amnesia following electroconvulsive therapy: historical perspective and current issues". J ECT. 29 (2): 127–133. doi:10.1097/YCT.0b013e318279c2c9. PMID 23303426. S2CID 45019739.
  50. ^ a b c Benbow, SM (2004) "Adverse effects of ECT". In AIF Scott (ed.) The ECT Handbook, second edition. 2012-04-21 at the Wayback Machine London: The Royal College of Psychiatrists, pp. 170–174.
  51. ^ Squire LR, Slater PC, Miller PL (January 1981). "Retrograde amnesia and bilateral electroconvulsive therapy. Long-term follow-up". Arch. Gen. Psychiatry. 38 (1): 89–95. doi:10.1001/archpsyc.1981.01780260091010. PMID 7458573.
  52. ^ Squire LR, Slater PC (January 1983). "Electroconvulsive therapy and complaints of memory dysfunction: a prospective three-year follow-up study". Br J Psychiatry. 142: 1–8. doi:10.1192/bjp.142.1.1. PMID 6831121. S2CID 22600323.
  53. ^ Rose, D; Fleischmann, P; Wykes, T; Leese, M; Bindman, J (2003). "Patients' perspectives on electroconvulsive therapy: systematic review". British Medical Journal. 326 (7403): 1363–1365. doi:10.1136/bmj.326.7403.1363. PMC 162130. PMID 12816822.
  54. ^ a b "Chapter 4". Mental Health: A Report of the Surgeon General (Report). Office of the Surgeon General (US). Retrieved 2007-12-29.
  55. ^ Sussman, Norman (March 2007). . Primary Psychiatry. 14 (3): 34–37. Archived from the original on 2011-05-16. Retrieved 2009-10-17.
  56. ^ Devanand DP; Sackeim HA; et al. (July 1991). "Absence of cognitive impairment after more than 100 lifetime ECT treatments". The American Journal of Psychiatry. 148 (7): 929–932. doi:10.1176/ajp.148.7.929. PMID 2053635.
  57. ^ Gbyl, K.; Videbech, P. (September 2018). "Electroconvulsive therapy increases brain volume in major depression: a systematic review and meta-analysis". Acta Psychiatrica Scandinavica. 138 (3): 180–195. doi:10.1111/acps.12884. ISSN 1600-0447. PMID 29707778. S2CID 14042369.
  58. ^ Wilkinson, Samuel T.; Sanacora, Gerard; Bloch, Michael H. (May 2017). "Hippocampal volume changes following electroconvulsive therapy: a systematic review and meta-analysis". Biological Psychiatry. Cognitive Neuroscience and Neuroimaging. 2 (4): 327–335. doi:10.1016/j.bpsc.2017.01.011. ISSN 2451-9030. PMC 5627663. PMID 28989984.
  59. ^ Richards EM, Payne JL (Oct 2013). "The management of mood disorders in pregnancy: alternatives to antidepressants". CNS Spectr (Submitted manuscript). 18 (5): 261–271. doi:10.1017/S1092852913000151. PMID 23570692. S2CID 24489076.
  60. ^ Miller, Laura J. (1994). "Use of Electroconvulsive Therapy During Pregnancy". Psychiatric Services. 45 (5): 444–450. doi:10.1176/ps.45.5.444. ISSN 1075-2730. PMID 8045538.
  61. ^ Duma A, Maleczek M, Panjikaran B, Herkner H, Karrison T, Nagele P (2019). "Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy: A Systematic Review and Meta-analysis". Anesthesiology. 130 (1): 83–91. doi:10.1097/ALN.0000000000002488. PMC 6300062. PMID 30557212.
  62. ^ a b c Prudic J, Olfson M, Sackeim HA (July 2001). "Electro-convulsive therapy practices in the community". Psychol Med. 31 (5): 929–934. doi:10.1017/S0033291701003750. PMID 11459391. S2CID 12210381.
  63. ^ Dr.Barnes, Richard. "Information on ECT". Royal College of Psychiatrists' Special Committee on ECT and related treatment. Retrieved 3 November 2013.
  64. ^ Royal College of Psychiatrists. Council Report. The ECT Handbook: The Third Report of the Royal College of Psychiatrists' Special Committee of ECT. RCPsych Publications, 2005 ISBN 978-1904671220
  65. ^ a b Duffett R, Lelliott P (1998). "Auditing electroconvulsive therapy. The third cycle". Br J Psychiatry. 172 (5): 401–405. doi:10.1192/bjp.172.5.401. PMID 9747401. S2CID 23584054.
  66. ^ a b Lock, T (1995). "Stimulus dosing". In C Freeman (ed.) The ECT Handbook. London: Royal College of Psychiatrists, 72–87.
  67. ^ Motohashi N, Awata S, Higuchi T (2004). "A questionnaire survey of ECT practice in university hospitals and national hospitals in Japan". J ECT. 20 (1): 21–23. doi:10.1097/00124509-200403000-00005. PMID 15087992. S2CID 41654261.
  68. ^ Chanpattana W, Kunigiri G, Kramer BA, Gangadhar BN (2005). "Survey of the practice of electroconvulsive therapy in teaching hospitals in India". J ECT. 21 (2): 100–104. doi:10.1097/01.yct.0000166634.73555.e6. PMID 15905751. S2CID 5985564.
  69. ^ Ikeji OC, Ohaeri JU, Osahon RO, Agidee RO (1999). "Naturalistic comparative study of outcome and cognitive effects of unmodified electro-convulsive therapy in schizophrenia, mania and severe depression in Nigeria". East Afr Med J. 76 (11): 644–50. PMID 10734527.
  70. ^ Teena Thacker for Indian Express. Mar 23 2011 Electroshocks for mentally ill patients to be banned
  71. ^ Kala, A (2013). "Time to face new realities; mental health care bill-2013". Indian Journal of Psychiatry. 55 (3): 216–219. doi:10.4103/0019-5545.117129. PMC 3777341. PMID 24082240.
  72. ^ . Disabled Peoples' International. Archived from the original on 2007-10-12. Retrieved 2008-03-25.
  73. ^ Narang, P.; Swenson, A.; Lippmann, S. (2019). "The Journal of ECT". LWW. 35 (1): e5–e6. doi:10.1097/YCT.0000000000000515. PMID 29944607. S2CID 49432743. Retrieved 2021-07-02.
  74. ^ Haskett, R. F.; Loo, C. (2010). "Role of Adjunctive Psychotropic Medications during ECT in the Treatment of Depression, Mania and Schizophrenia". The Journal of ECT. 26 (3): 196–201. doi:10.1097/YCT.0b013e3181eee13f. PMC 2952444. PMID 20805728.
  75. ^ Madhavan Seshadri; Nadeem Z Mazi-Kotwal. "Response Predictors in ECT: A discussion about Seizure Threshold". British Journal of Medical Practitioners. Retrieved 23 March 2016.
  76. ^ Corinne Slusher for MedScape. Updated: Jan 6, 2012 Electroconvulsive Therapy Machine
  77. ^ . Archived from the original on 2014-10-27. Retrieved 2015-01-07.
  78. ^ Tsoukalas Ioannis (2020). "How does ECT work? A new explanatory model and suggestions for non-convulsive applications". Medical Hypotheses. 145: 110337. doi:10.1016/j.mehy.2020.110337. PMID 33099256. S2CID 225063736.
  79. ^ a b c Leiknes, K. A.; Jarosh-von Schweder, L.; Høie, B. (2012). "Contemporary use and practice of electroconvulsive therapy worldwide". Brain and Behavior. 2 (3): 283–344. doi:10.1002/brb3.37. PMC 3381633. PMID 22741102.
  80. ^ See the Slovenian government website 2007-08-08 at the Wayback Machine for information about ECT in Slovenia.
  81. ^ a b c d Reid WH, Keller S, Leatherman M, Mason M (January 1998). "ECT in Texas: 19 months of mandatory reporting". J Clin Psychiatry. 59 (1): 8–13. doi:10.4088/JCP.v59n0103. PMID 9491059.
  82. ^ Euba R, Saiz A (2006). "A comparison of the ethnic distribution in the depressed inpatient population and in the electroconvulsive therapy clinic". J ECT. 22 (4): 235–236. doi:10.1097/01.yct.0000235928.39279.52. PMID 17143151. S2CID 28261416.
  83. ^ Rise In Electric Shock Therapy In County. 2011-05-01 at the Wayback Machine Sarah Hall, Norwich Evening News 24, June 4, 2008. Accessed: June 4, 2008.
  84. ^ Hermann R, Dorwart R, Hoover C, Brody J (1995). "Variation in ECT use in the United States". Am J Psychiatry. 152 (6): 869–875. doi:10.1176/ajp.152.6.869. PMID 7755116.
  85. ^ Cauchon, Dennis (1995-12-06). . USA Today. Archived from the original on 2008-01-15. Retrieved 2008-01-01.
  86. ^ "Electroconvulsive Therapy in Children | Psychology Today". www.psychologytoday.com.
  87. ^ Texas Department of State (2002) Electroconvulsive therapy reports 2007-08-10 at the Wayback Machine.
  88. ^ Fink, M. & Taylor, A.M. (2007) "Electroconvulsive therapy: Evidence and Challenges" JAMA Vol. 298 No. 3, pp. 330–332.
  89. ^ Pippard J, Ellam L (1981). "Electroconvulsion treatment in Great Britain 1980". Lancet. 2 (8256): 1160–1161. doi:10.1016/s0140-6736(81)90602-4. PMID 6118592. S2CID 30499609.
  90. ^ a b . Department of Health.
  91. ^ NICE 2003. Electroconvulsive therapy (ECT) 2008-09-08 at the Wayback Machine. Retrieved on 2007-12-29.
  92. ^ Carney, S; Geddes, J (2003). "Electroconvulsive therapy: recent recommendations are likely to improve standards and uniformity of use". British Medical Journal. 326 (7403): 1343–1344. doi:10.1136/bmj.326.7403.1343. PMC 1126234. PMID 12816798.
  93. ^ NICE (2003). Appraisal of electroconvulsive therapy: decision of the appeal panel 2007-05-21 at the Wayback Machine. London: NICE.
  94. ^ Duffett, R; Lelliott, P (1998). "Auditing electroconvulsive therapy: the third cycle". British Journal of Psychiatry. 172 (5): 401–405. doi:10.1192/bjp.172.5.401. PMID 9747401. S2CID 23584054.
  95. ^ Royal College of Psychiatrists (2017). [1] 2016–2017.
  96. ^ "Additional safeguards for ECT introduced in new s58A – Mental Health Law Online".
  97. ^ a b Tang YL, et al. (Dec 2012). "Electroconvulsive therapy in China: clinical practice and research on efficacy". J ECT. 28 (4): 206–212. doi:10.1097/YCT.0b013e31825957b1. PMID 22801297. S2CID 2743272.
  98. ^ Graham-Harrison, Emma; Connaire, Shaunagh (8 October 2015). "Chinese hospitals still offering gay 'cure' therapy, film reveals". The Guardian.
  99. ^ Hannah Beech (June 13, 2016). "This Man Was Sectioned in China for Being Gay. Now He's Fighting Back". Time. Retrieved October 20, 2017.
  100. ^ Stone, R. (2009-07-26). "China Reins in Wilder Impulses in Treatment of 'Internet Addiction'". Science. 324 (5935): 1630–1631. Bibcode:2009Sci...324.1630S. doi:10.1126/science.324_1630. PMID 19556477.
  101. ^ A History of Mental Institutions in the United States which says electrostatic machines were used in 1773
  102. ^ "Lind, James (1736–1812) on JSTOR". plants.jstor.org. Retrieved 2021-05-08.
  103. ^ Parent, Andre (2004). "Giovanni Aldini: from animal electricity to human brain stimulation". Can J Neurol Sci. 31 (4): 576–584. doi:10.1017/s0317167100003851. PMID 15595271.
  104. ^ Wright, Bruce A. M.D. "An Historical Review of Electro Convulsive Therapy". Jefferson Journal of Psychiatry: 66–74.
  105. ^ Beveridge, A. W.; Renvoize, E. B. (1988). (PDF). British Journal of Psychiatry. 153 (2): 157–162. doi:10.1192/bjp.153.2.157. PMID 3076490. S2CID 31015334. Archived from the original (PDF) on 23 September 2015. Retrieved 28 December 2014.
  106. ^ Berrios, G E (1997). "The scientific origins of electroconvulsive therapy". History of Psychiatry. 8 (29 pt 1): 105–119. doi:10.1177/0957154X9700802908. PMID 11619203. S2CID 12121233.
  107. ^ a b Fink, M (1984). "The origins of convulsive therapy". American Journal of Psychiatry. 141 (9): 1034–1041. doi:10.1176/ajp.141.9.1034. PMID 6147103.
  108. ^ Bolwig, T. (2011). "How does electroconvulsive therapy work? Theories on its mechanism". The Canadian Journal of Psychiatry. 56 (1): 13–18. doi:10.1177/070674371105600104. PMID 21324238.
  109. ^ Bangen, Hans: Geschichte der medikamentösen Therapie der Schizophrenie. Berlin, 1992, ISBN 3927408824
  110. ^ a b Sabbatini, R. "The history of shock therapy in psychiatry". Retrieved 2013-04-24.
  111. ^ Cerletti, U (1956). "Electroshock therapy". In AM Sackler et al. (eds) The Great Physiodynamic Therapies in Psychiatry: an historical appraisal. New York: Hoeber-Harper, 91–120.
  112. ^ Sirgiovanni, Elisabetta; Aruta, Alessandro (April 23, 2020). "From the Madhouse to the Docu-Museum: The Enigma Surrounding the Cerletti-Bini ECT Apparatus Prototype". Nuncius. 35 (1): 141. doi:10.1163/18253911-03501013. S2CID 218991982.
  113. ^ a b Sirgiovanni, E, Aruta, A (2020) "The Electroshock Triangle: Disputes about the ECT Apparatus Prototype and its Display in the 1960s, History of Psychiatry. First Published April 20, 2020: https://doi.org/10.1177/0957154X20916147.
  114. ^ a b Kiloh, LG, Smith, JS, Johnson, GF (1988). Physical Treatments in Psychiatry. Melbourne: Blackwell Scientific Publications, 190–208. ISBN 0867931124
  115. ^ a b Goode, Erica (1999-10-06). "Federal Report Praising Electroshock Stirs Uproar". The New York Times. Retrieved 2008-01-01.
  116. ^ Goleman, Daniel (1990-08-02). "The Quiet Comeback of Electroshock Therapy". The New York Times. p. B5. Retrieved 2008-01-01.
  117. ^ See:
    • Friedberg, J (1977). "Shock treatment, brain damage, and memory loss: a neurological perspective". American Journal of Psychiatry. American Psychiatric Association Publishing. 134 (9): 1010–1014. doi:10.1176/ajp.134.9.1010. ISSN 0002-953X. PMID 900284.
    • Breggin, PR (1979). Electroshock: its brain-disabling effects. New York: Springer. ISBN 082612710X. OCLC 5029460.
  118. ^ Blaine, JD; Clark, SM (1986). "Report of the NIMH–NIH consensus development conference on Electroconvulsive therapy". Psychopharmacology Bulletin. 22 (2): 445–452. PMID 3774937.
  119. ^ Dutton, Audrey (2017-02-18). "This mental health treatment isn't barbaric, it 'totally changed my life'".
  120. ^ "Electroconvulsive therapy: How modern techniques improve patient outcomes".
  121. ^ Hiroaki I, Hirohiko H, Masanari I (2012). "A case of schizophrenia successfully treated by m-ECT using 'long' brief pulse". International Journal of Case Reports and Images. 3 (7): 30. doi:10.5348/ijcri-2012-07-147-CR-8.
  122. ^ Fisher P (Dec 2012). "Psychological factors related to the experience of and reaction to electroconvulsive therapy". J Ment Health. 21 (6): 589–599. doi:10.3109/09638237.2012.734656. PMID 23216225. S2CID 42581352.
  123. ^ Philpot, M; Treloar, A; Gormley, N; Gustafson, L (2002). "Barriers to the use of electroconvulsive therapy in the elderly: a European survey". European Psychiatry. 17 (1): 41–45. doi:10.1016/S0924-9338(02)00620-X. PMID 11918992. S2CID 24740314.
  124. ^ Whitaker, Robert (2010). Mad in America: bad science, bad medicine, and the enduring mistreatment of the mentally ill (Rev. pbk. ed.). New York: Basic Books. pp. 102–106. ISBN 978-0465020140.
  125. ^ Golenkov, A.; Ungvari, G. S.; Gazdag, G. (21 February 2011). "Public attitudes towards electroconvulsive therapy in the Chuvash Republic". International Journal of Social Psychiatry. 58 (3): 289–294. doi:10.1177/0020764010394282. PMID 21339235. S2CID 6300979.
  126. ^ Committee on Mental Health (March 2002). . New York State Assembly. Archived from the original on 30 April 2011. Retrieved 8 March 2011.
  127. ^ Melding, P (2006-07-07). . The New Zealand Medical Journal. 119 (1237): U2051. PMID 16862197. Archived from the original on 2011-05-01. Retrieved 2011-03-08.
  128. ^ a b Teh, S.P.C.; Helmes, E.; Drake, D. (2007). "A Western Australian Survey On Public Attitudes Toward and Knowledge of Electroconvulsive Therapy". International Journal of Social Psychiatry. 53 (3): 247–271. doi:10.1177/0020764006074522. PMID 17569409. S2CID 40147979.
  129. ^ Kellner, Charles H. (2012-07-05). . Psychiatric Times. UBM Medica. Archived from the original on 2012-08-21. Retrieved 2012-10-25.
  130. ^ Duff Wilson for the New York Times. January 28, 2011 F.D.A. Panel Is Split on Electroshock Risks
  131. ^ Mechcatie, Elizabeth. "FDA Regulation of ECT Devices in Transition". Clinical Psychiatry News. Retrieved 8 March 2011.
  132. ^ Fergusson G, et al., eds. (2009). "The Scottish ECT Accreditation Network (SEÁN) Annual Report 2009" (PDF). Scottish ECT Accreditation Network. (PDF) from the original on 2011-04-29. Retrieved 2010-05-24.
  133. ^ Jones, R (1996) Mental Health Act Manual, 5th edition. London: Sweet and Maxwell, p. 225.
  134. ^ Lutchman, RD; et al. (2001). "Mental health professionals' attitudes towards and knowledge of electroconvulsive therapy". Journal of Mental Health. 10 (20): 141–150. doi:10.1080/09638230124779. S2CID 218906587.
  135. ^ The Mental Health Act 1983 (updated version) December 26, 2011, at the Wayback Machine Part IV, Section 58. Care Quality Commission
  136. ^ Care Quality Commission (2010) ECT: Your rights about consent to treatment
  137. ^ The Mental Health Act 1983 (updated version) Part IV, Section 62. Care Quality Commission
  138. ^ The Mental Health Act Commission (2005) In Place of Fear? eleventh biennial report, 2003–2005, 236. The Stationery Office.
  139. ^ "CQC says care for people treated under the Mental Health Act still needs to improve". Care Quality Commission. 8 December 2011. from the original on 21 May 2015.
  140. ^ The Mental Health (Care and Treatment) (Scotland) Act 2003, Part 16, sections 237–239.
  141. ^ Levin, Saul, M.D., M.P.A.; Binder, Renée M.D. "Time Is Now to Support the ECT Reclassification Effort". American Psychiatric Association. Retrieved 23 April 2017.
  142. ^ a b McFarquhar, Tara F.; Thompson, James (December 2008). "Knowledge and Attitudes Regarding Electroconvulsive Therapy Among Medical Students and the General Public". The Journal of ECT. 24 (4): 244–253. doi:10.1097/YCT.0b013e318168be4a. PMID 18648319. S2CID 11334694.
  143. ^ Smith, Daniel (2001-02-01). "Shock and Disbelief". Atlantic Monthly. 287 (2): 79–90. PMID 15997536. Retrieved 2019-12-30.
  144. ^ A. E. Hotchner, Papa Hemingway: A Personal Memoir, ISBN 0786705922; p. 280
  145. ^ "All About Heaven \e". allaboutheaven.org. Retrieved 2019-12-30.
  146. ^ Worth Books (2017). Summary and Analysis of Zen and the Art of Motorcycle Maintenance: An Inquiry into Values. Open Road Media. ISBN 978-1504046411.
  147. ^ Healy, David; Charlton, Bruce G. (May 2009). "Electroshock in Zen and the Art of Motorcycle Maintenance – fictional, not factual". Medical Hypotheses. 72 (5): 485–486. doi:10.1016/j.mehy.2008.12.026. ISSN 1532-2777. PMID 19201545.
  148. ^ "Sherwin Nuland: How electroshock therapy changed me | Talk Subtitles and Transcript". TED.com. 30 October 2007. Retrieved 2015-05-19.
  149. ^ Gellene, Denise (2014-03-04). "Sherwin B. Nuland, Author of 'How We Die,' is Dead at 83". The New York Times.
  150. ^ Lipsky, Dave (October 30, 2008). . Rolling Stone. Archived from the original on May 3, 2009. Retrieved June 5, 2017.
  151. ^ a b Lim, Xinhui; Galletly, Cherrie (4 April 2019). ""To suit the occasion, I wore my schizophrenic fancy dress" – the life of Janet Frame". Australasian Psychiatry. 27 (5): 469–471. doi:10.1177/1039856219839489. PMID 30945930. S2CID 93000402.
  152. ^ "Review/Film; 3 Novels Are Adapted For 'Angel at My Table'". The New York Times. 21 May 1991. Section C, p. 15. Retrieved 10 July 2020.
  153. ^ "Wishful Drinking with Carrie Fisher". NPR.
  154. ^ Kellner C.H. (2013). Electroconvulsive Therapy (ECT) in Literature: Sylvia Plath's 'The Bell Jar'. Prog. Brain Res. Progress in Brain Research. Vol. 206. pp. 219–228. doi:10.1016/B978-0-444-63364-4.00029-6. ISBN 978-0444633644. PMID 24290484.
  155. ^ Mitchell & Snyder, p. 174
  156. ^ "Report of the Electro-convulsive Therapy Review Committee." Toronto: Electro-convulsive Therapy Review Committee, 1985.
  157. ^ Grosser G (1975). "The Regulation of Electroshock Treatment in Massachusetts". Massachusetts Journal of Mental Health. 5: 12–25.
  158. ^ Weitz, D. "Ontario Electroshock Statistics." Figures released under the Freedom of Information Act. Toronto: Ontario. Ministry of Health, 2001.

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January 24, 2023
electroconvulsive, therapy, electroshock, redirects, here, other, uses, electroshock, disambiguation, psychiatric, treatment, where, generalized, seizure, without, muscular, convulsions, electrically, induced, manage, refractory, mental, disorders, typically, . Electroshock redirects here For other uses see Electroshock disambiguation Electroconvulsive therapy ECT is a psychiatric treatment where a generalized seizure without muscular convulsions is electrically induced to manage refractory mental disorders 1 Typically 70 to 120 volts are applied externally to the patient s head resulting in approximately 800 milliamperes of direct current passing between the electrodes for a duration of 100 milliseconds to 6 seconds either from temple to temple bilateral ECT or from front to back of one side of the head unilateral ECT However only about 1 of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance 2 Electroconvulsive therapyMECTA spECTrum 5000Q with electroencephalography EEG in a modern ECT suiteOther namesElectroshock therapyICD 10 PCSGZBICD 9 CM94 27MeSHD004565OPS 301 code8 630MedlinePlus007474 edit on Wikidata The ECT procedure was first conducted in 1938 by Italian psychiatrist Ugo Cerletti 3 and rapidly replaced less safe and effective forms of biological treatments in use at the time ECT is often used with informed consent 4 as a safe and effective intervention for major depressive disorder mania and catatonia 5 ECT machines were originally placed in the Class III category by the United States Food and Drug Administration FDA in 1976 6 They were re classified as Class II devices for treatment of catatonia major depressive disorder and bipolar disorder in 2018 7 Aside from effects on the brain the general physical risks of ECT are similar to those of brief general anesthesia 8 259 Immediately following treatment the most common adverse effects are confusion and transient memory loss 5 9 Among treatments for severely depressed pregnant women ECT is one of the least harmful to the fetus 10 A usual course of ECT involves multiple administrations typically given two or three times per week until the patient no longer has symptoms ECT is administered under anesthesia with a muscle relaxant 11 ECT can differ in its application in three ways electrode placement treatment frequency and the electrical waveform of the stimulus These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient Placement can be bilateral where the electric current is passed from one side of the brain to the other or unilateral in which the current is solely passed across one hemisphere of the brain High dose unilateral ECT has some cognitive advantages compared to moderate dose bilateral ECT while showing no difference in antidepressant efficacy 12 ECT appears to work in the short term via an anticonvulsant effect primarily in the frontal lobes and longer term via neurotrophic effects primarily in the medial temporal lobe 13 Contents 1 Medical use 1 1 Major depressive disorder 1 1 1 Efficacy 1 1 2 Follow up 1 2 Catatonia 1 3 Mania 1 4 Schizophrenia 2 Effects 2 1 Cognitive impairment 2 2 Effects on brain structure 2 3 Effects in pregnancy 2 4 Effects on the heart 3 Procedure 3 1 Neuroimaging prior to ECT 3 2 Concurrent pharmacotherapy 3 3 Course 3 4 Treatment team 3 5 Devices 4 Mechanism of action 5 Use 5 1 United States 5 2 United Kingdom 5 3 China 6 History 7 Society and culture 7 1 Controversy 7 2 Legal status 7 2 1 Informed consent 7 2 2 Involuntary ECT 7 2 2 1 United States 7 2 2 2 United Kingdom 7 2 3 Regulation 7 3 Public perception 7 4 Famous cases 7 5 Fictional examples 8 Special populations 8 1 Sex difference 9 See also 10 References 11 External linksMedical use EditECT is used where possible with informed consent 4 in treatment resistant major depressive disorder treatment resistant catatonia prolonged or severe mania and in conditions where there is a need for rapid definitive response because of the severity of a psychiatric or medical condition e g when illness is characterized by stupor marked psychomotor retardation depressive delusions or hallucinations or life threatening physical exhaustion associated with mania 5 14 It has also been used to treat autism in adults with an intellectual disability yet findings from a systematic review found this an unestablished intervention 15 Major depressive disorder Edit For major depressive disorder despite a Canadian guideline and some experts arguing for using ECT as a first line treatment 16 17 18 ECT is generally used only when one or other treatments have failed or in emergencies such as imminent suicide 5 19 20 ECT has also been used in selected cases of depression occurring in the setting of multiple sclerosis Parkinson s disease Huntington s chorea developmental delay brain arteriovenous malformations and hydrocephalus 21 Efficacy Edit A meta analysis on the effectiveness of ECT in unipolar and bipolar depression was conducted in 2012 Results indicated that although patients with unipolar depression and bipolar depression responded to other medical treatments very differently both groups responded equally well to ECT Overall remission rate for patients given a round of ECT treatment was 50 9 for those with unipolar depression and 53 2 for those with bipolar depression The severity of each patient s depression was assessed at the same baseline in each group Most severely depressed patients respond to ECT 22 In 2004 a meta analytic review paper found in terms of efficacy a significant superiority of ECT in all comparisons ECT versus simulated ECT ECT versus placebo ECT versus antidepressants in general ECT versus tricyclics and ECT versus monoamine oxidase inhibitors 23 In 2003 The UK ECT Review Group published a systematic review and meta analysis comparing ECT to placebo and antidepressant drugs This meta analysis demonstrated a large effect size high efficacy relative to the mean in terms of the standard deviation for ECT versus placebo and versus antidepressant drugs 24 Compared with repetitive transcranial magnetic stimulation rTMS for people with treatment resistant major depressive disorder ECT relieves depression as shown by reducing the score on the Hamilton Rating Scale for Depression by about 15 points while rTMS reduced it by 9 points 25 The response rate is from 50 to 60 in treatment resistant patients 26 Efficacity does not depend on depression subtype 17 Follow up Edit There is little agreement on the most appropriate follow up to ECT for people with major depressive disorder 27 When ECT is followed by treatment with antidepressants about 50 of people relapsed by 12 months following successful initial treatment with ECT with about 37 relapsing within the first 6 months About twice as many relapsed with no antidepressants Most of the evidence for continuation therapy is with tricyclic antidepressants evidence for relapse prevention with newer antidepressants is lacking 27 Lithium has also been found to reduce the risk of relapse especially in younger patients 28 Catatonia Edit ECT is generally a second line treatment for people with catatonia who do not respond to other treatments but is a first line treatment for severe or life threatening catatonia 5 29 30 There is a plethora of evidence for its efficacy notwithstanding a lack of randomised controlled trials such that the excellent efficacy of ECT in catatonia is generally acknowledged 29 For people with autism spectrum disorders who have catatonia there is little published evidence about the efficacy of ECT as of 2014 there were twelve case reports 31 Mania Edit ECT is used to treat people who have severe or prolonged mania 5 NICE recommends it only in life threatening situations or when other treatments have failed 32 and as a second line treatment for bipolar mania 33 34 Schizophrenia Edit ECT is widely used worldwide in the treatment of schizophrenia but in North America and Western Europe it is invariably used only in treatment resistant schizophrenia when symptoms show little response to antipsychotics there is comprehensive research evidence for such practice 35 It is useful in the case of severe exacerbations of catatonic schizophrenia whether excited or stuporous 5 32 There are also case reports of ECT improving persistent psychotic symptoms associated with stimulant induced psychosis 36 37 Effects EditAside from effects in the brain the general physical risks of ECT are similar to those of brief general anesthesia the US Surgeon General s report says that there are no absolute health contraindications to its use 8 259 Immediately following treatment the most common adverse effects are confusion and memory loss Some patients experience muscle soreness after ECT A meta analysis from 2017 found that the death rate of ECT is around 2 1 per 100 000 procedures 38 There is evidence and rationale to support giving low doses of benzodiazepines or otherwise low doses of general anesthetics which induce sedation but not anesthesia to patients to reduce adverse effects of ECT 39 While there are no absolute contraindications for ECT there is increased risk for patients who have unstable or severe cardiovascular conditions or aneurysms who have recently had a stroke who have increased intracranial pressure for instance due to a solid brain tumor or who have severe pulmonary conditions or who are generally at high risk for receiving anesthesia 9 30 In adolescents ECT is highly efficient for several psychiatric disorders with few and relatively benign adverse effects 40 41 42 Cognitive impairment Edit Cognitive impairment is sometimes noticed after ECT 43 44 45 46 It has been claimed by some non medical authors that retrograde amnesia occurs to some extent in almost all patients receiving ECT 47 The American Psychiatric Association APA report in 2001 acknowledges In some patients the recovery from retrograde amnesia will be incomplete and evidence has shown that ECT can result in persistent or permanent memory loss 9 After treatment drug therapy is usually continued and some patients will continue to receive maintenance ECT treatments 5 It is the purported effects of ECT on long term memory that give rise to much of the concern surrounding its use 48 However the methods used to measure memory loss are generally poor and their application to people with depression who have cognitive deficits including problems with memory have been problematic 49 The acute effects of ECT can include amnesia both retrograde for events occurring before the treatment and anterograde for events occurring after the treatment 50 Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral and with outdated sine wave rather than brief pulse currents The use of either constant or pulsing electrical impulses also varied the memory loss results in patients Patients who received pulsing electrical impulses as opposed to a steady flow seemed to incur less memory loss The vast majority of modern treatment uses brief pulse currents 50 Retrograde amnesia is most marked for events occurring in the weeks or months before treatment with one study showing that although some people lose memories from years prior to treatment recovery of such memories was virtually complete by seven months post treatment with the only enduring loss being memories in the weeks and months prior to the treatment 51 52 Anterograde memory loss is usually limited to the time of treatment itself or shortly afterwards In the weeks and months following ECT these memory problems gradually improve but some people have persistent losses especially with bilateral ECT 1 50 One published review summarizing the results of questionnaires about subjective memory loss found that between 29 and 55 of respondents believed they experienced long lasting or permanent memory changes 53 In 2000 American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with more persistently impaired memory of public events as compared to right unilateral ECT 48 Effects on brain structure Edit Considerable controversy exists over the effects of ECT on brain tissue although a number of mental health associations including the APA have concluded that there is no evidence that ECT causes structural brain damage 9 20 A 1999 report by the US Surgeon General states The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals 54 Many expert proponents of ECT maintain that the procedure is safe and does not cause brain damage Dr Charles Kellner a prominent ECT researcher and former chief editor of the Journal of ECT stated in a 2007 interview that There are a number of well designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT 55 Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments 56 Kellner stated Rather than cause brain damage there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness Two meta analyses find that ECT is associated with brain matter growth 57 58 Effects in pregnancy Edit If steps are taken to decrease potential risks ECT is generally accepted to be relatively safe during all trimesters of pregnancy particularly when compared to pharmacological treatments 10 59 Suggested preparation for ECT during pregnancy includes a pelvic examination discontinuation of nonessential anticholinergic medication uterine tocodynamometry intravenous hydration and administration of a nonparticulate antacid During ECT elevation of the pregnant woman s right hip external fetal cardiac monitoring intubation and avoidance of excessive hyperventilation are recommended 10 In many instances of active mood disorder during pregnancy the risks of untreated symptoms may outweigh the risks of ECT Potential complications of ECT during pregnancy can be minimized by modifications in technique The use of ECT during pregnancy requires thorough evaluation of the patient s capacity for informed consent 60 Effects on the heart Edit ECT can cause a lack of blood flow and oxygen to the heart heart arrhythmia and persistent asystole Deaths however are very rare after ECT 6 per 100 000 treatments If they do occur cardiovascular complications are considered as causal in about 30 61 Procedure Edit Electroconvulsive therapy machine on display at Glenside Museum in Bristol England ECT device produced by Siemens and used for example at the Asyl psychiatric hospital in Kristiansand Norway from the 1960s to the 1980s The placement of electrodes as well as the dose and duration of the stimulation is determined on a per patient basis 1 1881 In unilateral ECT both electrodes are placed on the same side of the patient s head Unilateral ECT may be used first to minimize side effects such as memory loss In bilateral ECT the two electrodes are placed on opposite sides of the head Usually bitemporal placement is used whereby the electrodes are placed on the temples Uncommonly bifrontal placement is used this involves positioning the electrodes on the patient s forehead roughly above each eye Unilateral ECT is thought to cause fewer cognitive effects than bilateral treatment but is less effective unless administered at higher doses 1 1881 Most patients in the US 62 and almost all in the UK 63 64 65 receive bilateral ECT The electrodes deliver an electrical stimulus The stimulus levels recommended for ECT are in excess of an individual s seizure threshold about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT 1 1881 Below these levels treatment may not be effective in spite of a seizure while doses massively above threshold level especially with bilateral ECT expose patients to the risk of more severe cognitive impairment without additional therapeutic gains 66 Seizure threshold is determined by trial and error dose titration Some psychiatrists use dose titration some still use fixed dose that is all patients are given the same dose and others compromise by roughly estimating a patient s threshold according to age and sex 62 Older men tend to have higher thresholds than younger women but it is not a hard and fast rule and other factors for example drugs affect seizure threshold Immediately prior to treatment a patient is given a short acting anesthetic such as methohexital etomidate or thiopental 1 a muscle relaxant such as suxamethonium succinylcholine and occasionally atropine to inhibit salivation 1 1882 In a minority of countries such as Japan 67 India 68 and Nigeria 69 ECT may be used without anesthesia The Union Health Ministry of India recommended a ban on ECT without anesthesia in India s Mental Health Care Bill of 2010 and the Mental Health Care Bill of 2013 70 71 The practice was abolished in Turkey s largest psychiatric hospital in 2008 72 The patient s EEG ECG and blood oxygen levels are monitored during treatment 1 1882 ECT is usually administered three times a week on alternate days over a course of two to four weeks 1 1882 1883 An illustration depicting electroconvulsive therapy Neuroimaging prior to ECT Edit Neuroimaging prior to ECT may be useful for detecting intracranial pressure or mass given that patients respond less when one of these conditions exist Nonetheless it is not indicated due to high cost and low prevalence of these conditions in patients needing ECT 73 Concurrent pharmacotherapy Edit Whether psychiatric medications are terminated prior to treatment or maintained varies 1 1885 74 However drugs that are known to cause toxicity in combination with ECT such as lithium are discontinued and benzodiazepines which increase the seizure threshold 75 are either discontinued a benzodiazepine antagonist is administered at each ECT session or the ECT treatment is adjusted accordingly 1 1875 1879 A 2009 RCT provides some evidence indicating that concurrent use of some antidepressant improves ECT efficacy 17 Course Edit ECT is usually done from 6 to 12 times in 2 to 4 weeks but can sometimes exceed 12 rounds 17 It is also recommended to not do ECT more than 3 times per week 17 Treatment team Edit In the US the medical team performing the procedure typically consists of a psychiatrist an anesthetist an ECT treatment nurse or qualified assistant and one or more recovery nurses 9 109 Medical trainees may assist but only under the direct supervision of credentialed attending physicians and staff 9 110 Devices Edit ECT machine from before 1960 Most modern ECT devices deliver a brief pulse current which is thought to cause fewer cognitive effects than the sine wave currents which were originally used in ECT 1 A small minority of psychiatrists in the US still use sine wave stimuli 62 Sine wave is no longer used in the UK or Ireland 65 Typically the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts and the current flows for between one and six seconds 66 In the US ECT devices are manufactured by two companies Somatics which is owned by psychiatrists Richard Abrams and Conrad Swartz and Mecta 76 In the UK the market for ECT devices was long monopolized by Ectron Ltd which was set up by psychiatrist Robert Russell 77 Mechanism of action EditDespite decades of research the exact mechanism of action of ECT remains elusive Neuroimaging studies in people who have had ECT investigating differences between responders and nonresponders and people who relapse find that responders have anticonvulsant effects mostly in the frontal lobes which corresponds to immediate responses and neurotrophic effects primarily in the medial temporal lobe The anticonvulsant effects are decreased blood flow and decreased metabolism while the neurotrophic effects are opposite increased perfusion and metabolism as well as increased volume of the hippocampus 13 Another proposed mechanism of action is that the seizures induced by ECT cause a profound change in sleep architecture a reversible inhibition of REM sleep it is this change in the state of the organism that drives the therapeutic effects of ECT and not any simple change in the release of neurotransmitters neurotrophic factors and or hormones 78 Use EditAs of 2001 it was estimated that about one million people received ECT annually 79 There is wide variation in ECT use between different countries different hospitals and different psychiatrists 1 79 International practice varies considerably from widespread use of the therapy in many Western countries to a small minority of countries that do not use ECT at all such as Slovenia 80 About 70 percent of ECT patients are women 1 This may be because women are more likely to be diagnosed with depression 1 81 Older and more affluent patients are also more likely to receive ECT The use of ECT is not as common in ethnic minorities 81 82 Sarah Hall reports ECT has been dogged by conflict between psychiatrists who swear by it and some patients and families of patients who say that their lives have been ruined by it It is controversial in some European countries such as the Netherlands and Italy where its use is severely restricted 83 United States Edit ECT became popular in the US in the 1940s At the time psychiatric hospitals were overrun with patients whom doctors were desperate to treat and cure Whereas lobotomies would reduce a patient to a more manageable submissive state ECT helped to improve mood in those with severe depression A survey of psychiatric practice in the late 1980s found that an estimated 100 000 people received ECT annually with wide variation between metropolitan statistical areas 84 Accurate statistics about the frequency context and circumstances of ECT in the US are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information 85 In 13 of the 50 states the practice of ECT is regulated by law 86 In the mid 1990s in Texas ECT was used in about one third of psychiatric facilities and given to about 1 650 people annually 81 Usage of ECT has since declined slightly in 2000 01 ECT was given to about 1 500 people aged from 16 to 97 in Texas it is illegal to give ECT to anyone under sixteen 87 ECT is more commonly used in private psychiatric hospitals than in public hospitals and minority patients are underrepresented in the ECT statistics 1 In the United States ECT is usually given three times a week in the United Kingdom it is usually given twice a week 1 Occasionally it is given on a daily basis 1 A course usually consists of 6 12 treatments but may be more or fewer Following a course of ECT some patients may be given continuation or maintenance ECT with further treatments at weekly fortnightly or monthly intervals 1 A few psychiatrists in the US use multiple monitored ECT MMECT where patients receive more than one treatment per anesthetic 1 Electroconvulsive therapy is not a required subject in US medical schools and not a required skill in psychiatric residency training Privileging for ECT practice at institutions is a local option no national certification standards are established and no ECT specific continuing training experiences are required of ECT practitioners 88 United Kingdom Edit In the UK in 1980 an estimated 50 000 people received ECT annually with use declining steadily since then 89 to about 12 000 per annum in 2002 90 It is still used in nearly all psychiatric hospitals with a survey of ECT use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age Eighty one percent had a diagnosis of mood disorder schizophrenia was the next most common diagnosis Sixteen percent were treated without their consent 90 In 2003 the National Institute for Health and Care Excellence a government body which was set up to standardize treatment throughout the National Health Service in England and Wales issued guidance on the use of ECT Its use was recommended only to achieve rapid and short term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and or when the condition is considered to be potentially life threatening in individuals with severe depressive illness catatonia or a prolonged manic episode 91 The guidance received a mixed reception It was welcomed by an editorial in the British Medical Journal 92 but the Royal College of Psychiatrists launched an unsuccessful appeal 93 The NICE guidance as the British Medical Journal editorial points out is only a policy statement and psychiatrists may deviate from it if they see fit Adherence to standards has not been universal in the past A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists with a later survey in 1998 finding that minimum standards were largely adhered to but that two thirds of clinics still fell short of current guidelines particularly in the training and supervision of junior doctors involved in the procedure 94 A voluntary accreditation scheme ECTAS was set up in 2004 by the Royal College and as of 2017 update the vast majority of ECT clinics in England Wales Northern Ireland and the Republic of Ireland have signed up 95 The Mental Health Act 2007 allows people to be treated against their will This law has extra protections regarding ECT A patient capable of making the decision can decline the treatment and in that case treatment cannot be given unless it will save that patient s life or is immediately necessary to prevent deterioration of the patient s condition A patient may not be capable of making the decision they lack capacity and in that situation ECT can be given if it is appropriate and also if there are no advance directives that prevent the use of ECT 96 China Edit ECT was introduced in China in the early 1950s and while it was originally practiced without anesthesia as of 2012 almost all procedures were conducted with it As of 2012 there are approximately 400 ECT machines in China and 150 000 ECT treatments are performed each year 97 Chinese national practice guidelines recommend ECT for the treatment of schizophrenia depressive disorders and bipolar disorder and in the Chinese literature ECT is an effective treatment for schizophrenia and mood disorders 97 Although the Chinese government stopped classifying homosexuality as an illness in 2001 electroconvulsive therapy is still used by some establishments as a form of conversion therapy 98 99 Alleged Internet addiction or general unruliness in adolescents is also known to have been treated with ECT sometimes without anestheia most notably by Yang Yongxin The practice was banned in 2009 after news on Yang broke out 100 History Edit A Bergonic chair a device for giving general electric treatment for psychological effect in psycho neurotic cases according to original photo description World War I era Further information History of electroconvulsive therapy in the United Kingdom and History of electroconvulsive therapy in the United States As early as the 16th century agents to induce seizures were used to treat psychiatric conditions In 1785 the therapeutic use of seizure induction was documented in the London Medical and Surgical Journal 1 101 As to its earliest antecedents one doctor claims 1744 as the dawn of electricity s therapeutic use as documented in the first issue of Electricity and Medicine Treatment and cure of hysterical blindness was documented eleven years later Benjamin Franklin wrote that an electrostatic machine cured a woman of hysterical fits By 1801 James Lind 102 as well as Giovanni Aldini had used galvanism to treat patients with various mental disorders 103 G B C Duchenne the mid 19th century Father of Electrotherapy said its use was integral to a neurological practice 104 In the second half of the 19th century such efforts were frequent enough in British asylums as to make it notable 105 Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J Meduna who believing mistakenly that schizophrenia and epilepsy were antagonistic disorders induced seizures first with camphor and then metrazol cardiazol 106 107 Meduna is thought to be the father of convulsive therapy 108 In 1937 the first international meeting on schizophrenia and convulsive therapy was held in Switzerland by the Swiss psychiatrist Max Muller 109 The proceedings were published in the American Journal of Psychiatry and within three years cardiazol convulsive therapy was being used worldwide 107 Italian professor of neuropsychiatry Ugo Cerletti who had been using electric shocks to produce seizures in animal experiments and his assistant Lucio Bini at Sapienza University of Rome developed the idea of using electricity as a substitute for metrazol in convulsive therapy and in 1938 experimented for the first time on a person affected by delusions It was believed early on that inducing convulsions aided in helping those with severe schizophrenia but later found to be most useful with affective disorders such as depression Cerletti had noted a shock to the head produced convulsions in dogs The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state 110 Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial Once they started trials on patients they found that after 10 20 treatments the results were significant Patients had much improved A positive side effect to the treatment was retrograde amnesia It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it 110 ECT soon replaced metrazol therapy all over the world because it was cheaper less frightening and more convenient 111 Cerletti and Bini were nominated for a Nobel Prize but did not receive one By 1940 the procedure was introduced to both England and the US In Germany and Austria it was promoted by Friedrich Meggendorfer Through the 1940s and 1950s the use of ECT became widespread At the time the ECT device was patented and commercialized abroad the two Italian inventors had competitive tensions that damaged their relationship 112 In the 1960s despite a climate of condemnation the original Cerletti Bini ECT apparatus prototype was hotly contended by scientific museums between Italy and the USA 113 The ECT apparatus prototype is now owned and displayed by the Sapienza Museum of the History of Medicine in Rome 113 In the early 1940s in an attempt to reduce the memory disturbance and confusion associated with treatment two modifications were introduced the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse It took many years for brief pulse equipment to be widely adopted 114 In the 1940s and early 1950s ECT was usually given in unmodified form without muscle relaxants and the seizure resulted in a full scale convulsion A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones In the 1940s psychiatrists began to experiment with curare the muscle paralysing South American poison in order to modify the convulsions The introduction of suxamethonium succinylcholine a safer synthetic alternative to curare in 1951 led to the more widespread use of modified ECT A short acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants 114 The steady growth of antidepressant use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given and that these now antiquated practices contributed to the negative portrayal of ECT in the popular media 115 The New York Times described the public s negative perception of ECT as being caused mainly by one movie For Big Nurse in One Flew Over the Cuckoo s Nest it was a tool of terror and in the public mind shock therapy has retained the tarnished image given it by Ken Kesey s novel dangerous inhumane and overused 116 In 1976 Dr Blatchley demonstrated the effectiveness of his constant current brief pulse device ECT This device eventually largely replaced earlier devices because of the reduction in cognitive side effects although as of 2012 some ECT clinics still were using sine wave devices 79 The 1970s saw the publication of the first American Psychiatric Association APA task force report on electroconvulsive therapy to be followed by further reports in 1990 and 2001 The report endorsed the use of ECT in the treatment of depression The decade also saw criticism of ECT 117 Specifically critics pointed to shortcomings such as noted side effects the procedure being used as a form of abuse and uneven application of ECT The use of ECT declined until the 1980s when use began to increase amid growing awareness of its benefits and cost effectiveness for treating severe depression 115 In 1985 the National Institute of Mental Health and National Institutes of Health convened a consensus development conference on ECT and concluded that while ECT was the most controversial treatment in psychiatry and had significant side effects it had been shown to be effective for a narrow range of severe psychiatric disorders 118 Because of the backlash noted previously national institutions reviewed past practices and set new standards In 1978 the American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery education and training of ECT were documented Finally in 2001 the American Psychiatric Association released its latest task force report 9 This report emphasizes the importance of informed consent and the expanded role that the procedure has in modern medicine By 2017 ECT was routinely covered by insurance companies for providing the biggest bang for the buck for otherwise intractable cases of severe mental illness was receiving favorable media coverage and was being provided in regional medical centers 119 Though ECT use declined with the advent of modern antidepressants there has been a resurgence of ECT with new modern technologies and techniques 120 Modern shock voltage is given for a shorter duration of 0 5 milliseconds where conventional brief pulse is 1 5 milliseconds 121 Society and culture EditControversy Edit Surveys of public opinion the testimony of former patients legal restrictions on the use of ECT and disputes as to the efficacy ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial 122 123 124 125 126 127 128 This is reflected in the January 2011 vote by the FDA s Neurological Devices Advisory Panel to recommend that FDA maintain ECT devices in the Class III device category for high risk devices except for patients with catatonia major depressive disorder and bipolar disorder 7 This may result in the manufacturers of such devices having to do controlled trials on their safety and efficacy for the first time 5 129 130 In justifying their position panelists referred to the memory loss associated with ECT and the lack of long term data 131 Legal status Edit Informed consent Edit The World Health Organization 2005 advises that ECT should be used only with the informed consent of the patient or their guardian if their incapacity to consent has been established 14 In the US this doctrine places a legal obligation on a doctor to make a patient aware of the reason for treatment the risks and benefits of a proposed treatment the risks and benefits of alternative treatment and the risks and benefits of receiving no treatment The patient is then given the opportunity to accept or reject the treatment The form states how many treatments are recommended and also makes the patient aware that consent may be revoked and treatment discontinued at any time during a course of ECT 8 The US Surgeon General s Report on Mental Health states that patients should be warned that the benefits of ECT are short lived without active continuation treatment in the form of drugs or further ECT and that there may be some risk of permanent severe memory loss after ECT 8 The report advises psychiatrists to involve patients in discussion possibly with the aid of leaflets or videos both before and during a course of ECT According to the US Surgeon General involuntary treatment is uncommon in the US and is typically used only in cases of great extremity and only when all other treatment options have been exhausted The use of ECT is believed to be a potentially life saving treatment 54 In one of the few jurisdictions where recent statistics on ECT usage are available a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77 of patients who received the treatment in 2008 were capable of giving informed consent 132 In the UK in order for consent to be valid it requires an explanation in broad terms of the nature of the procedure and its likely effects 133 One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects 134 and another survey found that about fifty percent of psychiatrists and nurses agreed with them 135 A 2005 study published in the British Journal of Psychiatry described patients perspectives on the adequacy of informed consent before ECT 134 The study found that About half 45 55 of patients reported they were given an adequate explanation of ECT implying a similar percentage felt they were not The authors also stated Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form The proportion who feel they did not freely choose the treatment has actually increased over time The same themes arise whether the patient had received treatment a year ago or 30 years ago Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT at least in England and Wales 134 Involuntary ECT Edit Procedures for involuntary ECT vary from country to country depending on local mental health laws United States Edit In most states in the US a judicial order following a formal hearing is needed before a patient can be forced to undergo involuntary ECT 8 However ECT can also be involuntarily administered in situations with less immediate danger Suicidal intent is a common justification for its involuntary use especially when other treatments are ineffective 8 United Kingdom Edit Until 2007 in England and Wales the Mental Health Act 1983 allowed the use of ECT on detained patients whether or not they had capacity to consent to it However following amendments which took effect in 2007 ECT may not generally be given to a patient who has capacity and refuses it irrespective of his or her detention under the Act 136 In fact even if a patient is deemed to lack capacity if they made a valid advance decision refusing ECT then they should not be given it and even if they do not have an advance decision the psychiatrist must obtain an independent second opinion which is also the case if the patient is under age of consent 137 However there is an exception regardless of consent and capacity under Section 62 of the Act if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization 138 From 2003 to 2005 about 2 000 people a year in England and Wales were treated without their consent under the Mental Health Act 139 Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments and that there is a worrying lack of independent advocacy 140 In Scotland the Mental Health Care and Treatment Scotland Act 2003 also gives patients with capacity the right to refuse ECT 141 Regulation Edit In the US ECT devices came into existence prior to medical devices being regulated by the Food and Drug Administration In 1976 the Medical Device Regulation Act required the FDA to retrospectively review already existing devices classify them and determine whether clinical trials were needed to prove efficacy and safety The FDA initially classified the devices used to administer ECT as Class III medical devices In 2014 the American Psychiatric Association petitioned the FDA to reclassify ECT devices from Class III high risk to Class II medium risk which would significantly improve access to an effective and potentially lifesaving treatment A similar reclassification proposal in 2010 met significant resistance from anti psychiatry groups and did not pass 142 In 2018 the FDA re classified ECT devices as Class II devices when used to treat catatonia or a severe major depressive episode associated with major depressive disorder or bipolar disorder 7 Public perception Edit A questionnaire survey of 379 members of the general public in Australia indicated that more than 60 of respondents had some knowledge about the main aspects of ECT Participants were generally opposed to the use of ECT on depressed individuals with psychosocial issues on children and on involuntary patients Public perceptions of ECT were found to be mainly negative 128 A sample of the general public medical students and psychiatry trainees in the United Kingdom found that the psychiatry trainees were more knowledgeable and had more favorable opinions of ECT than did the other groups 143 More members of the general public believed that ECT was used for control or punishment purposes than medical students or psychiatry trainees 143 Famous cases Edit Main article List of people who have undergone electroconvulsive therapy Ernest Hemingway an American author died by suicide shortly after ECT at the Mayo Clinic in 1961 144 He is reported to have said to his biographer Well what is the sense of ruining my head and erasing my memory which is my capital and putting me out of business It was a brilliant cure but we lost the patient 145 Robert Pirsig had a nervous breakdown and spent time in and out of psychiatric hospitals between 1961 and 1963 146 He was diagnosed with paranoid schizophrenia and clinical depression as a result of an evaluation conducted by psychoanalysts and was treated with electroconvulsive therapy on numerous occasions 147 a treatment he discusses in his novel Zen and the Art of Motorcycle Maintenance 148 Thomas Eagleton United States Senator from Missouri was dropped from the Democratic ticket in the 1972 United States Presidential Election as the party s vice presidential candidate after it was revealed that he had received electroshock treatment in the past for depression Presidential nominee George McGovern replaced him with Sargent Shriver and later went on to lose by a landslide to Richard Nixon American surgeon and award winning author Sherwin B Nuland is another notable person who has undergone ECT 149 In his 40s this successful surgeon s depression became so severe that he had to be institutionalized After exhausting all treatment options a young resident assigned to his case suggested ECT which ended up being successful 150 Author David Foster Wallace also received ECT for many years beginning as a teenager before his suicide at age 46 151 New Zealand author Janet Frame experienced both insulin coma therapy and ECT but without the use of anesthesia or muscle relaxants 152 She wrote about this in her autobiography An Angel at My Table 1984 152 which was later adapted into a film 1990 153 American actor Carrie Fisher wrote about her experience with memory loss after ECT treatments in her memoir Wishful Drinking 154 Fictional examples Edit Electroconvulsive therapy has been depicted in fiction including fictional works partly based on true experiences These include Sylvia Plath s autobiographical novel The Bell Jar Ken Loach s film Family Life and Ken Kesey s novel One Flew Over the Cuckoo s Nest Kesey s novel is a direct product of his time working the graveyard shift as an orderly at a mental health facility in Menlo Park California 155 156 Special populations EditSex difference Edit Throughout the history of ECT women have received it two to three times as often as men 157 Currently about 70 percent of ECT patients are women 1 This may be because women are more likely to be diagnosed with depression 1 81 A 1974 study of ECT in Massachusetts reported that women made up 69 percent of those given ECT 158 The Ministry of Health in Canada reported that from 1999 until 2000 in the province of Ontario women were 71 percent of those given ECT in provincial psychiatric institutions and 75 percent of the total ECT given was given to women 159 See also Edit Psychiatry portalNeurostimulation Psychosurgery Transcranial magnetic stimulationReferences Edit a b c d e f g h i j k l m n o p q r s t u v w Rudorfer MV Henry ME Sackeim HA 2003 Electroconvulsive therapy Archived 2007 08 10 at the Wayback Machine In A Tasman J Kay JA Lieberman eds Psychiatry Second Edition Chichester John Wiley amp Sons Ltd 1865 1901 Solano Juanjo 2009 04 20 Electroconvulsive Therapy PDF p 4 Archived PDF from the original on 2022 02 18 Retrieved 2022 05 17 Rudorfer M V Henry M E amp Sackheim H A 1997 Electroconvulsive therapy In A Tasman J amp J A Lieberman Eds Psychiatry 1535 1556 a b Beloucif S 2013 Informed consent for special procedures electroconvulsive therapy and psychosurgery Curr Opin Anesthesiol 26 2 182 185 doi 10 1097 ACO 0b013e32835e7380 PMID 23385317 S2CID 36643014 a b c d e f g h i FDA FDA Executive Summary Prepared for the January 27 28 2011 meeting of the Neurological Devices Panel Meeting to Discuss the Classification of Electroconvulsive Therapy Devices ECT Quote p 38 Three major practice guidelines have been published on ECT These guidelines include APA Task Force on ECT 2001 Third report of the Royal College of Psychiatrists Special Committee on ECT 2004 National Institute for Health and Clinical Excellence NICE 2003 NICE 2009 There is significant agreement between the three sets of recommendations CFR Code of Federal Regulations Title 21 a b c US Food and Drug Administration 2018 12 21 FDA In Brief FDA takes action to ensure regulation of electroconvulsive therapy devices better protects patients reflects current understanding of safety and effectiveness Press release a b c d e f Surgeon General 1999 Mental Health A Report of the Surgeon General chapter 4 a b c d e f g American Psychiatric Association Committee on Electroconvulsive Therapy Richard D Weiner chairperson et al 2001 The practice of electroconvulsive therapy recommendations for treatment training and privileging 2nd ed Washington DC American Psychiatric Publishing ISBN 978 0890422069 a b c Pompili M et al Dec 2014 Electroconvulsive treatment during pregnancy a systematic review Expert Rev Neurother 14 12 1377 1390 doi 10 1586 14737175 2014 972373 PMID 25346216 S2CID 31209001 Margarita Tartakovsky 2012 Psych Central 5 Outdated Beliefs About ECT Archived 2013 08 08 at the Wayback Machine Kolshus E Jelovac A McLoughlin DM 2017 Bitemporal v high dose right unilateral electroconvulsive therapy for depression a systematic review and meta analysis of randomized controlled trials PDF Psychol Med 47 3 518 530 doi 10 1017 S0033291716002737 PMID 27780482 S2CID 10711085 Archived PDF from the original on 2021 06 16 a b Abbott CC et al Mar 2014 A review of longitudinal electroconvulsive therapy neuroimaging investigations J Geriatr Psychiatry Neurol 27 1 33 46 doi 10 1177 0891988713516542 PMC 6624835 PMID 24381234 a b World Health Organisation 2005 WHO Resource Book on Mental Health Human Rights and Legislation Archived 2006 12 06 at the Wayback Machine Geneva 64 Benevides Teal W Shore Stephen M Andresen May Lynn Caplan Reid Cook Barb Gassner Dena L Erves Jasmine M Hazlewood Taylor M King M Caroline Morgan Lisa Murphy Lauren E 2020 Interventions to address health outcomes among autistic adults A systematic review Autism 24 6 1345 1359 doi 10 1177 1362361320913664 ISSN 1362 3613 PMC 7787674 PMID 32390461 S2CID 218586379 Lipsman N et al Jan 2014 Neuromodulation for treatment refractory major depressive disorder Canadian Medical Association Journal 186 1 33 39 doi 10 1503 cmaj 121317 PMC 3883821 PMID 23897945 a b c d e Tasman Allan Kay Jerald Lieberman Jeffrey A First Michael B Riba Michelle B eds 2015 Psychiatry Chichester UK John Wiley amp Sons Ltd doi 10 1002 9781118753378 ISBN 978 1118753378 Bolwig Tom G 2005 First line Use of ECT The Journal of ECT Ovid Technologies Wolters Kluwer Health 21 1 51 doi 10 1097 01 yct 0000158271 45828 76 ISSN 1095 0680 PMID 15791182 Fitzgerald P B 2013 Non pharmacological biological treatment approaches to difficult to treat depression The Medical Journal of Australia 199 6 Suppl S48 51 doi 10 5694 mja12 10509 PMID 25370288 S2CID 204073048 a b Depression in adults The treatment and management of depression in adults NICE guidelines CG90 National Institute for Clinical Excellence 2009 Murray ED Buttner N Price BH 2012 Depression and Psychosis in Neurological Practice In Bradley WG Daroff RB Fenichel GM Jankovic J eds Bradley s Neurology in Clinical Practice Expert Consult Vol 1 6th ed Philadelphia Elsevier Saunders pp 114 115 ISBN 978 1437704341 Dierckx Bram Heijnen Willemijn T van den Broek Walter W Birkenhager Tom K 2012 Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression a meta analysis Bipolar Disorders Wiley 14 2 146 150 doi 10 1111 j 1399 5618 2012 00997 x ISSN 1398 5647 PMID 22420590 S2CID 44280002 Pagnin D de Queiroz V Pini S Cassano GB 2004 Efficacy of ECT in depression a meta analytic review The Journal of ECT 20 1 13 20 doi 10 1097 00124509 200403000 00004 PMID 15087991 S2CID 25843283 UK ECT Review Group 2003 Efficacy and safety of electroconvulsive therapy in depressive disorders a systematic review and meta analysis The Lancet 361 9360 799 808 doi 10 1016 S0140 6736 03 12705 5 PMID 12642045 S2CID 28964580 Micallef Trigona B 2014 Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression a systematic review and meta analysis Depress Res Treat 2014 135049 doi 10 1155 2014 135049 PMC 4131106 PMID 25143831 Shelton Richard C Osuntokun Olawale Heinloth Alexandra N Corya Sara A 2010 Therapeutic Options for Treatment Resistant Depression CNS Drugs Springer Science and Business Media LLC 24 2 131 161 doi 10 2165 11530280 000000000 00000 ISSN 1172 7047 PMID 20088620 S2CID 32936223 a b Jelovac A et al Nov 2013 Relapse following successful electroconvulsive therapy for major depression a meta analysis Neuropsychopharmacology 38 12 2467 2474 doi 10 1038 npp 2013 149 PMC 3799066 PMID 23774532 Lambrichts S Detraux J Vansteelandt K Nordenskjold A Obbels J Schrijvers D Sienaert P 2021 Does lithium prevent relapse following successful electroconvulsive therapy for major depression A systematic review and meta analysis Acta Psychiatrica Scandinavica 143 4 294 306 doi 10 1111 acps 13277 ISSN 0001 690X PMID 33506961 S2CID 231759831 a b Sienaert P et al Dec 2014 A clinical review of the treatment of catatonia Front Psychiatry 5 181 doi 10 3389 fpsyt 2014 00181 PMC 4260674 PMID 25538636 Leroy Arnaud Naudet Florian Vaiva Guillaume Francis Andrew Thomas Pierre Amad Ali 2018 Is electroconvulsive therapy an evidence based treatment for catatonia A systematic review and meta analysis European Archives of Psychiatry and Clinical Neuroscience 268 7 675 687 doi 10 1007 s00406 017 0819 5 ISSN 0940 1334 PMID 28639007 S2CID 4013882 DeJong H et al Sep 2014 A systematic review of interventions used to treat catatonic symptoms in people with autistic spectrum disorders J Autism Dev Disord 44 9 2127 2136 doi 10 1007 s10803 014 2085 y PMID 24643578 S2CID 22002956 a b NICE Guidance on the use of electroconvulsive therapy NICE technology appraisals TA59 Published date April 2003 Kanba S Kato T Terao T Yamada K Jul 2013 Guideline for treatment of bipolar disorder by the Japanese Society of Mood Disorders 2012 Psychiatry Clin Neurosci 67 5 285 300 doi 10 1111 pcn 12060 PMID 23773266 S2CID 2058163 Malhi GS et al Dec 2012 Mania diagnosis and treatment recommendations Curr Psychiatry Rep 14 6 676 686 doi 10 1007 s11920 012 0324 5 PMID 22986995 S2CID 37771648 Tharyan P Adams CE 2005 Tharyan P ed Electroconvulsive therapy for schizophrenia The Cochrane Database of Systematic Reviews 2 CD000076 doi 10 1002 14651858 CD000076 pub2 PMID 15846598 Penders TM Gestring RE Vilensky DA November 2012 Intoxication delirium following use of synthetic cathinone derivatives The American Journal of Drug and Alcohol Abuse 38 6 616 617 doi 10 3109 00952990 2012 694535 PMID 22783894 S2CID 207428569 Penders TM et al December 2013 Electroconvulsive Therapy Improves Persistent Psychosis After Repeated Use of Methylenedioxypyrovalerone Bath Salts The Journal of ECT 29 4 59 60 doi 10 1097 YCT 0b013e3182887bc2 PMID 23609518 S2CID 45842375 Torring N Sanghani S N Petrides G Kellner C H Ostergaard S D 2017 The mortality rate of electroconvulsive therapy a systematic review and pooled analysis Acta Psychiatrica Scandinavica 135 5 388 397 doi 10 1111 acps 12721 ISSN 1600 0447 PMID 28332236 S2CID 31879446 Gallegos J Vaidya P D Agati D et al June 2012 Decreasing adverse outcomes of unmodified electroconvulsive therapy suggestions and possibilities J ECT 28 2 77 81 doi 10 1097 YCT 0b013e3182359314 PMID 22531198 S2CID 6423840 Neera Ghaziuddin Garry Walter eds Electroconvulsive Therapy in Children and Adolescents Oxford University Press 2013 ISBN 978 0199937899 pp 161 280 Lima Nadia NR Nascimento Vania B Peixoto Jorge AC Moreira Marcial M Neto Modesto LR Almeida Jose C Vasconcelos Carlos AC Teixeira Saulo A Junior Jucier G Junior Francisco TC Guimaraes Diego DM Brasil Aline Q Cartaxo Jesus S Akerman Marco Reis Alberto OA 2013 Electroconvulsive therapy use in adolescents a systematic review Annals of General Psychiatry 12 1 17 doi 10 1186 1744 859X 12 17 ISSN 1744 859X PMC 3680000 PMID 23718899 Benson NM Seiner SJ 2019 Electroconvulsive Therapy in Children and Adolescents Clinical Indications and Special Considerations Harv Rev Psychiatry 27 6 354 358 doi 10 1097 HRP 0000000000000236 PMID 31714466 S2CID 207934946 Holtzheimer PE 3rd Mayberg HS 2010 Deep brain stimulation for treatment resistant depression Am J Psychiatry 167 12 1437 1444 doi 10 1176 appi ajp 2010 10010141 PMC 4413473 PMID 21131410 McClintock SM Choi J Deng ZD Appelbaum LG Krystal AD Lisanby SH 2014 Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy J ECT 30 2 165 176 doi 10 1097 YCT 0000000000000137 hdl 10161 10644 PMC 4143898 PMID 24820942 Loo CK Katalinic N Smith DJ Ingram A Dowling N Martin D Addison K Hadzi Pavlovic D Simpson B Schweitzer I 2014 A randomized controlled trial of brief and ultrabrief pulse right unilateral electroconvulsive therapy Int J Neuropsychopharmacol 18 1 pyu045 doi 10 1093 ijnp pyu045 PMC 4368876 PMID 25522389 Kellner CH Knapp R Husain MM Rasmussen K Sampson S Cullum M McClintock SM Tobias KG Martino C Mueller M Bailine SH Fink M Petrides G 2010 Bifrontal bitemporal and right unilateral electrode placement in ECT randomised trial Br J Psychiatry 196 3 226 234 doi 10 1192 bjp bp 109 066183 PMC 2830057 PMID 20194546 Read J Bentall R Oct Dec 2010 The effectiveness of electroconvulsive therapy a literature review PDF Epidemiologia e Psichiatria Sociale 19 4 333 347 doi 10 1017 S1121189X00000671 PMID 21322506 S2CID 15118442 Archived from the original PDF on 2012 05 24 Retrieved 2012 01 23 a b Lisanby SH Maddox JH Prudic J Devanand DP Sackeim HA June 2000 The effects of electroconvulsive therapy on memory of autobiographical and public events Arch Gen Psychiatry 57 6 581 590 doi 10 1001 archpsyc 57 6 581 PMID 10839336 Semkovska M McLoughlin DM Jun 2013 Measuring retrograde autobiographical amnesia following electroconvulsive therapy historical perspective and current issues J ECT 29 2 127 133 doi 10 1097 YCT 0b013e318279c2c9 PMID 23303426 S2CID 45019739 a b c Benbow SM 2004 Adverse effects of ECT In AIF Scott ed The ECT Handbook second edition Archived 2012 04 21 at the Wayback Machine London The Royal College of Psychiatrists pp 170 174 Squire LR Slater PC Miller PL January 1981 Retrograde amnesia and bilateral electroconvulsive therapy Long term follow up Arch Gen Psychiatry 38 1 89 95 doi 10 1001 archpsyc 1981 01780260091010 PMID 7458573 Squire LR Slater PC January 1983 Electroconvulsive therapy and complaints of memory dysfunction a prospective three year follow up study Br J Psychiatry 142 1 8 doi 10 1192 bjp 142 1 1 PMID 6831121 S2CID 22600323 Rose D Fleischmann P Wykes T Leese M Bindman J 2003 Patients perspectives on electroconvulsive therapy systematic review British Medical Journal 326 7403 1363 1365 doi 10 1136 bmj 326 7403 1363 PMC 162130 PMID 12816822 a b Chapter 4 Mental Health A Report of the Surgeon General Report Office of the Surgeon General US Retrieved 2007 12 29 Sussman Norman March 2007 In Session with Charles H Kellner MD Current Developments in Electroconvulsive Therapy Primary Psychiatry 14 3 34 37 Archived from the original on 2011 05 16 Retrieved 2009 10 17 Devanand DP Sackeim HA et al July 1991 Absence of cognitive impairment after more than 100 lifetime ECT treatments The American Journal of Psychiatry 148 7 929 932 doi 10 1176 ajp 148 7 929 PMID 2053635 Gbyl K Videbech P September 2018 Electroconvulsive therapy increases brain volume in major depression a systematic review and meta analysis Acta Psychiatrica Scandinavica 138 3 180 195 doi 10 1111 acps 12884 ISSN 1600 0447 PMID 29707778 S2CID 14042369 Wilkinson Samuel T Sanacora Gerard Bloch Michael H May 2017 Hippocampal volume changes following electroconvulsive therapy a systematic review and meta analysis Biological Psychiatry Cognitive Neuroscience and Neuroimaging 2 4 327 335 doi 10 1016 j bpsc 2017 01 011 ISSN 2451 9030 PMC 5627663 PMID 28989984 Richards EM Payne JL Oct 2013 The management of mood disorders in pregnancy alternatives to antidepressants CNS Spectr Submitted manuscript 18 5 261 271 doi 10 1017 S1092852913000151 PMID 23570692 S2CID 24489076 Miller Laura J 1994 Use of Electroconvulsive Therapy During Pregnancy Psychiatric Services 45 5 444 450 doi 10 1176 ps 45 5 444 ISSN 1075 2730 PMID 8045538 Duma A Maleczek M Panjikaran B Herkner H Karrison T Nagele P 2019 Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy A Systematic Review and Meta analysis Anesthesiology 130 1 83 91 doi 10 1097 ALN 0000000000002488 PMC 6300062 PMID 30557212 a b c Prudic J Olfson M Sackeim HA July 2001 Electro convulsive therapy practices in the community Psychol Med 31 5 929 934 doi 10 1017 S0033291701003750 PMID 11459391 S2CID 12210381 Dr Barnes Richard Information on ECT Royal College of Psychiatrists Special Committee on ECT and related treatment Retrieved 3 November 2013 Royal College of Psychiatrists Council Report The ECT Handbook The Third Report of the Royal College of Psychiatrists Special Committee of ECT RCPsych Publications 2005 ISBN 978 1904671220 a b Duffett R Lelliott P 1998 Auditing electroconvulsive therapy The third cycle Br J Psychiatry 172 5 401 405 doi 10 1192 bjp 172 5 401 PMID 9747401 S2CID 23584054 a b Lock T 1995 Stimulus dosing In C Freeman ed The ECT Handbook London Royal College of Psychiatrists 72 87 Motohashi N Awata S Higuchi T 2004 A questionnaire survey of ECT practice in university hospitals and national hospitals in Japan J ECT 20 1 21 23 doi 10 1097 00124509 200403000 00005 PMID 15087992 S2CID 41654261 Chanpattana W Kunigiri G Kramer BA Gangadhar BN 2005 Survey of the practice of electroconvulsive therapy in teaching hospitals in India J ECT 21 2 100 104 doi 10 1097 01 yct 0000166634 73555 e6 PMID 15905751 S2CID 5985564 Ikeji OC Ohaeri JU Osahon RO Agidee RO 1999 Naturalistic comparative study of outcome and cognitive effects of unmodified electro convulsive therapy in schizophrenia mania and severe depression in Nigeria East Afr Med J 76 11 644 50 PMID 10734527 Teena Thacker for Indian Express Mar 23 2011 Electroshocks for mentally ill patients to be banned Kala A 2013 Time to face new realities mental health care bill 2013 Indian Journal of Psychiatry 55 3 216 219 doi 10 4103 0019 5545 117129 PMC 3777341 PMID 24082240 Abusive practice of unmodified electroshock treatment abolished at main psychiatric facility of Turkey Disabled Peoples International Archived from the original on 2007 10 12 Retrieved 2008 03 25 Narang P Swenson A Lippmann S 2019 The Journal of ECT LWW 35 1 e5 e6 doi 10 1097 YCT 0000000000000515 PMID 29944607 S2CID 49432743 Retrieved 2021 07 02 Haskett R F Loo C 2010 Role of Adjunctive Psychotropic Medications during ECT in the Treatment of Depression Mania and Schizophrenia The Journal of ECT 26 3 196 201 doi 10 1097 YCT 0b013e3181eee13f PMC 2952444 PMID 20805728 Madhavan Seshadri Nadeem Z Mazi Kotwal Response Predictors in ECT A discussion about Seizure Threshold British Journal of Medical Practitioners Retrieved 23 March 2016 Corinne Slusher for MedScape Updated Jan 6 2012 Electroconvulsive Therapy Machine Ectron Our story Archived from the original on 2014 10 27 Retrieved 2015 01 07 Tsoukalas Ioannis 2020 How does ECT work A new explanatory model and suggestions for non convulsive applications Medical Hypotheses 145 110337 doi 10 1016 j mehy 2020 110337 PMID 33099256 S2CID 225063736 a b c Leiknes K A Jarosh von Schweder L Hoie B 2012 Contemporary use and practice of electroconvulsive therapy worldwide Brain and Behavior 2 3 283 344 doi 10 1002 brb3 37 PMC 3381633 PMID 22741102 See the Slovenian government website Archived 2007 08 08 at the Wayback Machine for information about ECT in Slovenia a b c d Reid WH Keller S Leatherman M Mason M January 1998 ECT in Texas 19 months of mandatory reporting J Clin Psychiatry 59 1 8 13 doi 10 4088 JCP v59n0103 PMID 9491059 Euba R Saiz A 2006 A comparison of the ethnic distribution in the depressed inpatient population and in the electroconvulsive therapy clinic J ECT 22 4 235 236 doi 10 1097 01 yct 0000235928 39279 52 PMID 17143151 S2CID 28261416 Rise In Electric Shock Therapy In County Archived 2011 05 01 at the Wayback Machine Sarah Hall Norwich Evening News 24 June 4 2008 Accessed June 4 2008 Hermann R Dorwart R Hoover C Brody J 1995 Variation in ECT use in the United States Am J Psychiatry 152 6 869 875 doi 10 1176 ajp 152 6 869 PMID 7755116 Cauchon Dennis 1995 12 06 Patients often aren t informed of full danger USA Today Archived from the original on 2008 01 15 Retrieved 2008 01 01 Electroconvulsive Therapy in Children Psychology Today www psychologytoday com Texas Department of State 2002 Electroconvulsive therapy reports Archived 2007 08 10 at the Wayback Machine Fink M amp Taylor A M 2007 Electroconvulsive therapy Evidence and Challenges JAMA Vol 298 No 3 pp 330 332 Pippard J Ellam L 1981 Electroconvulsion treatment in Great Britain 1980 Lancet 2 8256 1160 1161 doi 10 1016 s0140 6736 81 90602 4 PMID 6118592 S2CID 30499609 a b Electro convulsive therapy survey covering the period from January 2002 to March 2002 Department of Health NICE 2003 Electroconvulsive therapy ECT Archived 2008 09 08 at the Wayback Machine Retrieved on 2007 12 29 Carney S Geddes J 2003 Electroconvulsive therapy recent recommendations are likely to improve standards and uniformity of use British Medical Journal 326 7403 1343 1344 doi 10 1136 bmj 326 7403 1343 PMC 1126234 PMID 12816798 NICE 2003 Appraisal of electroconvulsive therapy decision of the appeal panel Archived 2007 05 21 at the Wayback Machine London NICE Duffett R Lelliott P 1998 Auditing electroconvulsive therapy the third cycle British Journal of Psychiatry 172 5 401 405 doi 10 1192 bjp 172 5 401 PMID 9747401 S2CID 23584054 Royal College of Psychiatrists 2017 1 2016 2017 Additional safeguards for ECT introduced in new s58A Mental Health Law Online a b Tang YL et al Dec 2012 Electroconvulsive therapy in China clinical practice and research on efficacy J ECT 28 4 206 212 doi 10 1097 YCT 0b013e31825957b1 PMID 22801297 S2CID 2743272 Graham Harrison Emma Connaire Shaunagh 8 October 2015 Chinese hospitals still offering gay cure therapy film reveals The Guardian Hannah Beech June 13 2016 This Man Was Sectioned in China for Being Gay Now He s Fighting Back Time Retrieved October 20 2017 Stone R 2009 07 26 China Reins in Wilder Impulses in Treatment of Internet Addiction Science 324 5935 1630 1631 Bibcode 2009Sci 324 1630S doi 10 1126 science 324 1630 PMID 19556477 A History of Mental Institutions in the United States which says electrostatic machines were used in 1773 Lind James 1736 1812 on JSTOR plants jstor org Retrieved 2021 05 08 Parent Andre 2004 Giovanni Aldini from animal electricity to human brain stimulation Can J Neurol Sci 31 4 576 584 doi 10 1017 s0317167100003851 PMID 15595271 Wright Bruce A M D An Historical Review of Electro Convulsive Therapy Jefferson Journal of Psychiatry 66 74 Beveridge A W Renvoize E B 1988 Electricity A History of its use in the Treatment of Mental Illness in Britain During the Second Half of the 19th Century PDF British Journal of Psychiatry 153 2 157 162 doi 10 1192 bjp 153 2 157 PMID 3076490 S2CID 31015334 Archived from the original PDF on 23 September 2015 Retrieved 28 December 2014 Berrios G E 1997 The scientific origins of electroconvulsive therapy History of Psychiatry 8 29 pt 1 105 119 doi 10 1177 0957154X9700802908 PMID 11619203 S2CID 12121233 a b Fink M 1984 The origins of convulsive therapy American Journal of Psychiatry 141 9 1034 1041 doi 10 1176 ajp 141 9 1034 PMID 6147103 Bolwig T 2011 How does electroconvulsive therapy work Theories on its mechanism The Canadian Journal of Psychiatry 56 1 13 18 doi 10 1177 070674371105600104 PMID 21324238 Bangen Hans Geschichte der medikamentosen Therapie der Schizophrenie Berlin 1992 ISBN 3927408824 a b Sabbatini R The history of shock therapy in psychiatry Retrieved 2013 04 24 Cerletti U 1956 Electroshock therapy In AM Sackler et al eds The Great Physiodynamic Therapies in Psychiatry an historical appraisal New York Hoeber Harper 91 120 Sirgiovanni Elisabetta Aruta Alessandro April 23 2020 From the Madhouse to the Docu Museum The Enigma Surrounding the Cerletti Bini ECT Apparatus Prototype Nuncius 35 1 141 doi 10 1163 18253911 03501013 S2CID 218991982 a b Sirgiovanni E Aruta A 2020 The Electroshock Triangle Disputes about the ECT Apparatus Prototype and its Display in the 1960s History of Psychiatry First Published April 20 2020 https doi org 10 1177 0957154X20916147 a b Kiloh LG Smith JS Johnson GF 1988 Physical Treatments in Psychiatry Melbourne Blackwell Scientific Publications 190 208 ISBN 0867931124 a b Goode Erica 1999 10 06 Federal Report Praising Electroshock Stirs Uproar The New York Times Retrieved 2008 01 01 Goleman Daniel 1990 08 02 The Quiet Comeback of Electroshock Therapy The New York Times p B5 Retrieved 2008 01 01 See Friedberg J 1977 Shock treatment brain damage and memory loss a neurological perspective American Journal of Psychiatry American Psychiatric Association Publishing 134 9 1010 1014 doi 10 1176 ajp 134 9 1010 ISSN 0002 953X PMID 900284 Breggin PR 1979 Electroshock its brain disabling effects New York Springer ISBN 082612710X OCLC 5029460 Blaine JD Clark SM 1986 Report of the NIMH NIH consensus development conference on Electroconvulsive therapy Psychopharmacology Bulletin 22 2 445 452 PMID 3774937 Dutton Audrey 2017 02 18 This mental health treatment isn t barbaric it totally changed my life Electroconvulsive therapy How modern techniques improve patient outcomes Hiroaki I Hirohiko H Masanari I 2012 A case of schizophrenia successfully treated by m ECT using long brief pulse International Journal of Case Reports and Images 3 7 30 doi 10 5348 ijcri 2012 07 147 CR 8 Fisher P Dec 2012 Psychological factors related to the experience of and reaction to electroconvulsive therapy J Ment Health 21 6 589 599 doi 10 3109 09638237 2012 734656 PMID 23216225 S2CID 42581352 Philpot M Treloar A Gormley N Gustafson L 2002 Barriers to the use of electroconvulsive therapy in the elderly a European survey European Psychiatry 17 1 41 45 doi 10 1016 S0924 9338 02 00620 X PMID 11918992 S2CID 24740314 Whitaker Robert 2010 Mad in America bad science bad medicine and the enduring mistreatment of the mentally ill Rev pbk ed New York Basic Books pp 102 106 ISBN 978 0465020140 Golenkov A Ungvari G S Gazdag G 21 February 2011 Public attitudes towards electroconvulsive therapy in the Chuvash Republic International Journal of Social Psychiatry 58 3 289 294 doi 10 1177 0020764010394282 PMID 21339235 S2CID 6300979 Committee on Mental Health March 2002 Report on Electroconvulsive Therapy New York State Assembly Archived from the original on 30 April 2011 Retrieved 8 March 2011 Melding P 2006 07 07 Electroconvulsive therapy in New Zealand terrifying or electrifying The New Zealand Medical Journal 119 1237 U2051 PMID 16862197 Archived from the original on 2011 05 01 Retrieved 2011 03 08 a b Teh S P C Helmes E Drake D 2007 A Western Australian Survey On Public Attitudes Toward and Knowledge of Electroconvulsive Therapy International Journal of Social Psychiatry 53 3 247 271 doi 10 1177 0020764006074522 PMID 17569409 S2CID 40147979 Kellner Charles H 2012 07 05 The FDA Advisory Panel on the Reclassification of ECT Devices Unjustified Ambivalence Psychiatric Times UBM Medica Archived from the original on 2012 08 21 Retrieved 2012 10 25 Duff Wilson for the New York Times January 28 2011 F D A Panel Is Split on Electroshock Risks Mechcatie Elizabeth FDA Regulation of ECT Devices in Transition Clinical Psychiatry News Retrieved 8 March 2011 Fergusson G et al eds 2009 The Scottish ECT Accreditation Network SEAN Annual Report 2009 PDF Scottish ECT Accreditation Network Archived PDF from the original on 2011 04 29 Retrieved 2010 05 24 Jones R 1996 Mental Health Act Manual 5th edition London Sweet and Maxwell p 225 a b c Rose D Wykes T Bindman J Fleischmann P 2005 Information consent and perceived coercion patients perspectives on electroconvulsive therapy British Journal of Psychiatry 186 54 59 Lutchman RD et al 2001 Mental health professionals attitudes towards and knowledge of electroconvulsive therapy Journal of Mental Health 10 20 141 150 doi 10 1080 09638230124779 S2CID 218906587 The Mental Health Act 1983 updated version Archived December 26 2011 at the Wayback Machine Part IV Section 58 Care Quality Commission Care Quality Commission 2010 ECT Your rights about consent to treatment The Mental Health Act 1983 updated version Part IV Section 62 Care Quality Commission The Mental Health Act Commission 2005 In Place of Fear eleventh biennial report 2003 2005 236 The Stationery Office CQC says care for people treated under the Mental Health Act still needs to improve Care Quality Commission 8 December 2011 Archived from the original on 21 May 2015 The Mental Health Care and Treatment Scotland Act 2003 Part 16 sections 237 239 Levin Saul M D M P A Binder Renee M D Time Is Now to Support the ECT Reclassification Effort American Psychiatric Association Retrieved 23 April 2017 a b McFarquhar Tara F Thompson James December 2008 Knowledge and Attitudes Regarding Electroconvulsive Therapy Among Medical Students and the General Public The Journal of ECT 24 4 244 253 doi 10 1097 YCT 0b013e318168be4a PMID 18648319 S2CID 11334694 Smith Daniel 2001 02 01 Shock and Disbelief Atlantic Monthly 287 2 79 90 PMID 15997536 Retrieved 2019 12 30 A E Hotchner Papa Hemingway A Personal Memoir ISBN 0786705922 p 280 All About Heaven e allaboutheaven org Retrieved 2019 12 30 Worth Books 2017 Summary and Analysis of Zen and the Art of Motorcycle Maintenance An Inquiry into Values Open Road Media ISBN 978 1504046411 Healy David Charlton Bruce G May 2009 Electroshock in Zen and the Art of Motorcycle Maintenance fictional not factual Medical Hypotheses 72 5 485 486 doi 10 1016 j mehy 2008 12 026 ISSN 1532 2777 PMID 19201545 Sherwin Nuland How electroshock therapy changed me Talk Subtitles and Transcript TED com 30 October 2007 Retrieved 2015 05 19 Gellene Denise 2014 03 04 Sherwin B Nuland Author of How We Die is Dead at 83 The New York Times Lipsky Dave October 30 2008 The Lost Years amp Last Days of David Foster Wallace Rolling Stone Archived from the original on May 3 2009 Retrieved June 5 2017 a b Lim Xinhui Galletly Cherrie 4 April 2019 To suit the occasion I wore my schizophrenic fancy dress the life of Janet Frame Australasian Psychiatry 27 5 469 471 doi 10 1177 1039856219839489 PMID 30945930 S2CID 93000402 Review Film 3 Novels Are Adapted For Angel at My Table The New York Times 21 May 1991 Section C p 15 Retrieved 10 July 2020 Wishful Drinking with Carrie Fisher NPR Kellner C H 2013 Electroconvulsive Therapy ECT in Literature Sylvia Plath s The Bell Jar Prog Brain Res Progress in Brain Research Vol 206 pp 219 228 doi 10 1016 B978 0 444 63364 4 00029 6 ISBN 978 0444633644 PMID 24290484 Mitchell amp Snyder p 174harvnb error no target CITEREFMitchellSnyder help Report of the Electro convulsive Therapy Review Committee Toronto Electro convulsive Therapy Review Committee 1985 Grosser G 1975 The Regulation of Electroshock Treatment in Massachusetts Massachusetts Journal of Mental Health 5 12 25 Weitz D Ontario Electroshock Statistics Figures released under the Freedom of Information Act Toronto Ontario Ministry of Health 2001 External links Edit Wikimedia Commons has media related to Electroconvulsive therapy Position Statement on Electroconvulsive Therapy ECT 2015 from the American Psychiatric Association ECT information from mental health charity The Royal College of Psychiatrists Retrieved from https en wikipedia org w index php title Electroconvulsive therapy amp oldid 1132992847, wikipedia, wiki, book, books, library,

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