Max Fink, M.D., is Professor of Psychiatry and Neurology Emeritus at State University of New York at Stony Brook. He is the author of Electroconvulsive Therapy: A Guide for Professionals and Their Patients. The book tackles such questions as: For whom is electroshock effective? How is it administered? What are its risks? How long does the treatment take? Is it a cure? In this post, Dr. Fink explains what, exactly, electroconvulsive therapy is.
Long a mystery among psychiatric treatments, electroconvulsive therapy (ECT, electroshock) has revealed some of its features to science. Interest in ECT revived after its denigration in the 1970s and 1980s by its continuing success in relieving melancholic depression and bipolar disorder, especially in the large numbers of “medication resistant” patients who suffer chronic debilitation despite extensive courses of medications and psychotherapy. In such patients ECT is effective and safe, especially with present methods of treatment, oxygenation, and muscle relaxation.
The patients successfully treated with ECT are those with severe mood disorder, loss of appetite, weight, and sleep, a preoccupation with death, hopelessness, helplessness, and motor retardation, agitation or catatonia. These symptoms are understood as a failure in the body’s hormone regulatory system, especially in the functions of the thyroid, adrenal, and sex glands. Interestingly, the control of these glands resides the brain’s central glands of hypothalamus and pituitary, structures in the middle of the brain.
ECT stimulates the brain’s central glands directly, either by electricity or chemicals, that produce brain seizures (similar to spontaneous epileptic seizures). Electricity alone, without the seizure, is not clinically useful although occasionally recommended as “brain stimulation” without seizures.
With the seizure the brain’s glands release their hormones into the brain’s own circulating system and into the blood stream, effectively stimulating all the glands of the body. The hormone systems are temporarily normalized. To achieve a long lasting effect, the treatments must be repeated over many weeks, and occasionally over months.