Is Electroshock Therapy Still Used Today

24 July 2013 Concluding updated at 12:52

Patient undergoing electroshock treatment The use of electricity to care for mental illness started out as an experiment in the 1930s

The idea of treating a psychiatric illness past passing a jolt of electricity through the brain was one of the most controversial in 20th Century medicine. So why are nosotros still using a procedure described past its critics as barbaric and ineffective?

Threescore-four-year-sometime John says his breakdown in the late 1990s was triggered by the collapse of his marriage and stress at work.

"We had a squeamish house and a nice lifestyle, but it was all just crumbling abroad. My depression was starting to overwhelm me. I lost command, I became fierce," he explains.

John likens the feeling to being in a hole, a hole he could not leave of despite courses of pills and talking therapies.

But at present, he says, all of that has inverse thanks to what is one of the least understood treatments in psychiatry - electroconvulsive therapy (ECT).

"Before ECT I was the walking dead. I had no interest in life, I simply wanted to disappear. Later on ECT I felt similar there was a style out of it. I felt dramatically better."

The use of electricity to treat mental illness started out as an experiment. In the 1930s psychiatrists noticed some heavily distressed patients would all of a sudden improve later on an epileptic fit.

John on why he feels he needs ECT to keep severe depression at bay

Passing a stiff electric current through the brain could trigger a similar seizure and - they hoped - a like response.

By the 1960s information technology was existence widely used to treat a variety of conditions, notably severe low.

But as the old mental asylums closed down and aggressive physical interventions similar lobotomies brutal out of favour, and then too did electroshock treatment, as ECT was previously known.

The infamous ECT scene in One Flew Over the Cuckoo'southward Nest cemented the idea in the public's mind of a fell treatment, although by the time the flick was released in 1975 it was very rarely given without a general anaesthetic.

Perhaps more significantly, new anti-depressant drugs introduced in the 1970-80s gave doctors new ways to treat long-term mental illness.

Merely for a group of the most severely depressed patients, ECT has remained i of the last options on the table when other therapies have failed.

Annually in the UK around 4,000 patients, of which John is one, still undergo ECT.

"Information technology's not intuitive that causing seizures can be practiced for depression but information technology'southward long been determined that ECT is effective," says Professor Ian Reid at the University of Aberdeen, who heads upwardly the team treating John.

ECT process (Alarm: Some may find images upsetting) Continue reading the main story

Patient surrounded by medics The patient lies on a bed and is questioned virtually their recent well-being while their blood pressure is measured and ECG electrodes monitoring heart activity and an oxygen sensor are attached. A cannula is inserted into 1 manus for the intravenous assistants of anaesthetic and muscle relaxant.

Patient being manually ventilated EEG electrodes monitoring electrical activity in the brain are attached and a blood force per unit area cuff placed on the other arm to prevent muscle relaxant flooding it and a safety grip placed in hand - leaving this limb untreated allows medics to assess the convulsive response. Anaesthetic and so muscle relaxant administered as the patient is given transmission ventilation to oxygenate their system and hyper inflate lungs.

ECT shock being applied to patient A oral fissure guard is put between patient's teeth to forbid damage during daze and convulsions, and electrodes are applied to the temples. The electrical shock is administered for about iv seconds. Immediately afterwards the patient convulses for upwardly to 60 seconds. On average patients quake for xx seconds.

Patient recovering from ECT treatment Once the convulsions cease the patient is moved to a recovery room where they are monitored and given oxygen. Later on virtually 10 minutes the patient regains consciousness. Assuming that the procedure has gone smoothly the patient usually leaves infirmary within two to iii hours.

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In the 75 years since ECT was offset used scientists have argued about why and how it might work.

The latest theories build on the thought of hyperconnectivity. This new concept in psychiatry suggests parts of the encephalon can first to transmit signals in a dysfunctional manner, overloading the system and leading to atmospheric condition from depression to autism.

Helen Crane on how she forgot major events including her female parent'due south expiry later on ECT

Prof Reid and his colleagues used MRI scanners to map the brains of 9 patients earlier and later on treatment.

In an academic newspaper in 2012 they claimed ECT can "plow downwards" overactive connections every bit they offset to build, effectively resetting the brain's wiring.

"For the first time we can signal to something that ECT does in the brain that makes sense in the context of what we think is wrong in people who are depressed," Prof Reid says. "The change that we run into in the brain connections after ECT reflects the change that nosotros encounter in the symptom profile of patients who generally see a large improvement."

But passing electricity through the most complex organ in the body is non without risk. Many doctors think the side-effects of ECT can be so serious they outweigh any possible benefits.

Helen Crane was given two rounds of ECT in the late 1990s. She at present blames the 2nd course for wiping years of her memory, from trips away to dramatic family unit events.

"Later on ECT, I had this instinct that something was wrong with my mother. I said to my hubby 'What's happened to my mother?' And then he had to tell me that she'd died nearly ii years earlier," she says.

"It was devastating going through bereavement once again. How on Globe could I take forgotten something so important and fundamental? Getting words incorrect is frustrating, but to have lost really basic stuff in your life is awful."

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"Start Quote

I'm convinced that in 10 or 15 years we will have put ECT in same rubbish bin of historical treatments as lobotomies and surprise baths that have been discarded over time"

End Quote Dr John Read Academy of Liverpool

Critics of ECT claim around a third of patients will notice some sort of permanent alter from retentiveness loss to problems with voice communication and basic skills like improver.

"What happens is a little like recharging a machine bombardment," says the psychologist Dr John Read from the University of Liverpool, i of the most vocal critics of ECT.

"It'south not difficult to get bogus changes in the encephalon, you could do it with cocaine, simply it doesn't last and iii or four weeks later on the person is either back at the aforementioned level of depression or many studies show worse levels of low."

Opponents say that ECT patients can enter into an addictive bicycle of repeated treatment and that whatever improvement beyond the very short term is likely to be little more than an extreme class of the placebo effect, with patients benefitting psychologically from the extra care and medical attention associated with ECT.

"It's not in any style addressing the cause of their depression. It'due south systematically and gradually wiping out their memory and cognitive office," says Dr John Read.

"I'thousand convinced that in 10 or 15 years nosotros volition take put ECT in same rubbish bin of historical treatments as lobotomies and surprise baths that take been discarded over time."

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ECT in the UK

Women are twice equally likely to exist given ECT as men, reflecting the general pattern of serious depression in society
Around a tertiary of patients are too ill to give their consent
Beyond the Great britain as a whole it is thought effectually iv,000 people a twelvemonth are given ECT
Scottish hospitals lone withal treat 370 people a year, according to the latest figures.

Simply Prof Reid says when weighing up the risks and benefits of the treatment "information technology is important to realise that the people who are treated with ECT are suffering from an illness that could kill them".

"Depression is associated with a measurable bloodshed. It can exist lethal. Untreated patients can die."

The team in Aberdeen now hope their research will allow drug companies to develop new treatments that mimic some of the effects of electroconvulsive therapy.

"1 of the exciting things nigh beingness able to identify a change in the brain related to a psychiatric disorder is that it might make it easier to diagnose that status over time," Prof Reid says.

"No one would exist happier than me if we could reproduce the changes that ECT has on the brain in a less invasive and safer way for patients."

Watch Newsnight's total flick examining why we are still using ECT