Should Electroconvulsive Therapy Ever Be Used to Treat

SHOULD ELECTROCONVULSIVE THERAPY EVER BE USED TO TREAT

MENTAL DISORDERS?

A. Thesis Statement

Electroconvulsive therapy (ECT) is a treatment for severe mental illness in which the brain is stimulated with a strong electrical current which induces a seizure. The seizure rearranges the brain's neurochemistry and results in an elevation of mood. This essay asks: Is ECT any safer and more effective in treating mood disorders than drug therapies? This treatment has a controversial history ever since it was first introduced in 1938. I intend to argue that electroconvulsive therapy is indeed a safe treatment of mental disorders when other treatments have failed. Due to the development of safer and less traumatic ways of administering ECT, the treatment has made a comeback, is greatly used, and proves to be effective.

B. Historical Context

The original use of electricity as a cure for "insanity" dates back to the beginning of the 16th century when electric fish were used to treat headaches. Electroconvulsive therapy on humans originates from research in the 1930's into the effects of camphor-induced seizures in people with schizophrenia (Guttmacher, 1994). In 1938, two Italian researchers, Ugo Cerletti and Lucio Bini, were the first to use an electric current to induce a seizure in a delusional, hallucinating, schizophrenic man. The man fully recovered after eleven treatments. This led to a rapid spread of the use of ECT as a way to induce therapeutic convulsions in the mentally ill. Lothar Kalinowsky, Renato Almansi, and Victor Gonda are further responsible in spreading ECT from Italy to North America (Endler, 1988). Although there is some confusion as to who exactly is credited for administering the first ECT in America, it is known that it occurred in the early 1940.

When ECT was first introduced, it was a terrifying and hazardous procedure: patients suffered serious side effects, even breaking a bone from convulsions (Nairne, Smith & Lindsay, 2001). It has been criticized since its beginnings, and only recently it has begun to be seen more positively. The major reason for this is the fact that the treatment went through significant changes over the years - it is now much safer than before. Nowadays, patients are given a general anaesthetic and medications that relax the muscles to prevent injuries from occur. However, most professionals still consider it to be a treatment of last resort. It is used when people have shown little or no response to conventional antidepressant drugs or other "talk" therapies (Breggin, 1997).

C. Central Issue

Since its beginning, the issue of the safety and efficacy of ECT has existed, and thus its use has been always remained controversial (Weiner & Krystal, 1994). Even with the modern development of ECT, some of the same issues are still prevalent. There are two sides here: the advocates that support the use of the treatment, and those who do not. This is explored next.

The first argument for the use of ECT is the fact that majority of studies and modern literature show that this treatment is very successful in treating many psychological disorders. Evidence seems strongest for the efficacy in severely depressed patients, as well as manic patients (Reisner, 2003). When looking at those with major depression, the likelihood of substantial improvement ranges from 80-90% (Weiner & Krystal, 1994). In manic patients, Gabbard concludes that 80% of patients show "marked improvement" (2001, p.1272).

The second argument for the use of ECT is that successful treatments induce remission in episodes of illness (Gabbard, 2001). The evidence supporting this conclusion is compelling and includes a sizable number of well-controlled "sham-ECT" studies. In these studies, patients were randomized to receive real ECT or sham-ECT (which involves anaesthesia but no electrical stimulation), thus providing for precise double-blind tests of efficacy (Gabbard, 2001). One misconception is that it provides a "cure". This is not the case - it does not produce a "cure" any more than any other treatment involving antidepressant drugs. (Gabbard, 2001). Evidence also shows reduction in hospitalization stays within ECT patients (Endler, 1988). Moreover, as a result, less money needs to be spent on these patients.

When researching modern literature, one clearly sees there are still some consequences that sometimes occur with administration of the electroconvulsive therapy. This clearly proves that there are many who believe ECT is generally unsafe in nature. One of the arguments here is the high risk of relapse and recurrence

(Geddes, 2003). As Vothknecht et al. show, relapse rates range - exceeding 50% (in 6 to 12 months after initial electroconvulsive treatment) up to 95% (2004). With the clearly high indications or relapse, one can understand as to why so many oppose the use of ECT.

The second argument against the use of ECT is its adverse effects, such as risk of mortality, cognitive morbidity, and structural brain changes. Although the mortality rate is low, 1 per 10,000 patients (Reisner, 2003), it must still be taken into account when ECT is being practiced. Because a series of seizures occur when ECT is administered, "encephalopathy and specific amnesic syndrome can occur" (Weiner & Krystal, 1994, p. 275). "Amnesia is the most common discussed side effect of ECT" (Gabbard, 2001, p.1276). The amnesia falls into 2 forms: (1) retrograde amnesia, which involves difficulty in remembering information learned prior to ECT, and (2) anterograde amnesia, which involves difficulty in retaining newly learned material (Resiner, 2003).

D. My Position

To repeat, when all other treatments have failed, electroconvulsive therapy should be used to treat mental disorders. ECT has clearly been effective for a range of mental disorders ever since it was first introduced more than half-a-century ago (Endler, 1988). ECT's positive effects on the mentally ill patients can be seen throughout literature. Thus, electroconvulsive therapy should be administered if pharmacotherapy has previously failed. Reisner shows that ECT is an effective treatment for severe depression, especially the one with psychotic features, and in proves to be just as effective in mania (2003). All in all, electroconvulsive therapy works more rapidly than antidepressant medication in these situations. There is also evidence that ECT decreases suicidal ideation (Reisner, 2003).

Through the use of Computerized Axial Tomography