History and Indications for Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is not something new. It is used world over for the treatment of various psychiatric disorders.

Doctors use this procedure because it is effective way to treat some of the most resistible conditions to medications. However, many factors have to be assessed very carefully because if the procedure is not carried out perfectly, it may lead to some complications.

ECT Through Ages

In 1500s the roots of ECT can be found when Paracelsus gave camphor to patients by mouth to induce seizures and cure psychiatric ailments.

In 1758, the first report was published which mentioned the use of camphor for the treatment of mania,again by inducing seizures.

The modern age of ECT begins in the year 1934 when Ladislaus Meduna used camphor in the form of an intramuscular injection for the treatment of catatonic schizophrenia.

1938 is very important year for ECT. During this time, the first attempts to cure schizophrenia with electrical current were conducted. Lucio Cerletti along with Ugo Bini were the first one to use electric current to cause seizures and treat psychiatric conditions. Patients showed great improvement after few sessions.

In 1940, electroconvulsive therapy was introduced in America for the first time.

Depression is another psychiatric disorder, which was treated with success with ECT. However, convulsions are typical for ECT. That is why fractures were observed in most of the patients. Doctors introduced neuromuscular blockers and the fracture problems were solved. Patients were still during the procedure.

Strict rules were created to regulate, which patients would undergo this therapy and which patients would not undergo it. One of the indications for ECT is the major depression. However, this major depression disorder has to be resistible to drug therapy. However it may be considered as the initial treatment for severe depression.

Indications of ECT

American Psychiatric Association, named APA, published a list with the conditions, where ECT is needed:

a.catatonic stupor

b.food refusal, which leads to severe nutritional compromise

c.severe suicidality

d.major depression

These guidelines suggest the usage of ECT in any case, where the immediate antidepressant effect is desired. Canadian colleagues agree with these guidelines and they have adopted them.

About 60 to 80 percent of the patients suffering from major depression enter in a remission, when they undergo ECT. It is proven throughout meta-analysis that ECT is much more effective than a drug therapy, which is used to cure depression. Some coexisting conditions may lower the percentage up to 50 percent of the total number of patients, undergoing ECT.

Schizophrenia is one of the main diseases treated with ECT. Clinical trials were carried out to compare the efficiency between antipsychotic therapy alone and antipsychotic therapy with ECT. The results surprised nobody. The patients undergoing antipsychotic therapy and ECT showed greater improvement compared to the patients undergoing the single therapy.

Atypical mania, bipolar disorder and mania could be treated with Electroconvulsive therapy as well. Many other psychiatric disorders yield to this therapy. Other diseases which yield to ECT include: delusional disorder, which is an organic mood disorder, also obsessive- compulsive disorder.

The elderly patients, suffering from depression, are the targeted group for ECT. The reasons for this are numerous. First of all, these patients do not tolerate the medications very well.

They do not have social life and live alone. Many of these patients have co-morbid conditions, which do not allow them to intake some or all drugs, specific for the depression treatment. That is why the only solution for them is the Electroconvulsive therapy.

The studies have showed that patients undergoing this therapy live longer (at least 5 years), compared to patients, which are left untreated. This proves the efficacy of ECT.

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