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 latest guide to ECT. It carefully explains where in the course of an illness ECT is best considered, what will take place, the necessity of voluntary consent, and how the treatment works. In this post, Dr. Fink looks at why electroconvulsive therapy is making a comeback.
Soon to celebrate its 75th birthday, electroconvulsive therapy (ECT, electroshock) is undergoing world-wide revival despite its negative image. Its efficacy in treating medication treatment failures, especially in patients with melancholic depression, bipolar disorder, psychosis, and suicide risk encourages its use. It also helps that the present ECT methods are safe and that scientists have developed a better understanding of its mechanism.
Developed in the 1930s, electroshock therapy was widely used and was effective in reducing the thousands of patients hospitalized in the state asylums throughout America. The medications introduced in the 1950s curtailed usage of ECT, but as more and more patients failed to improve and “therapy resistance” became a watchword in clinical practice, interest in ECT revived.
Much has changed in the clinical practice from the treatment without anesthesia, oxygen, and muscle relaxation that mark present practice. Permanent losses of personal memories are no longer a feature of modern practice. Indeed, the treatment is widely endorsed and a review shows that it meets the standards of ethical medical care.
Many have argued that doctors should not be applying a treatment whose mechanism is unknown. The patients who respond best are those with abnormal endocrine physiology. We now understand that ECT liberates brain hormones that regulate the body functions that are abnormal—sleep, appetite, mood, thought, motor activity—and these releases are essential to effective treatment.
The limitations of medication treatments for depression, mania, and schizophrenia demonstrated in recent large scale governmental studies and the reports of efficacy of ECT support this revival. The increased interest is world-wide and has broken some national barriers that restricted the use of ECT in some countries.