Is Shock Therapy Safe And Beneficial?

Updated June 17, 2021
Medically Reviewed By: Wendy Galyen, LCSW, BC-TMH

Source: pexels.com

Thanks in part to a gripping scene from a well-respected movie about the state of the mental health system in years gone by, many people see shock therapy as a barbaric and dangerous practice. Indeed, there was a time when it was just that.

However, times have changed. Medical science has advanced. If you or your loved one is presented with this option, you need an accurate picture of this type of treatment and its use under modern conditions. If so, it might be time to take a new look at shock therapy to find out if it is the right choice for you or a loved one.

What Is Shock Therapy?

Shock therapy is a type of treatment for chronic mental conditions. This treatment involves passing electrical currents through the brain to trigger a seizure.

Is Shock Therapy Still Used To Treat Mental Illness?

Doctors still use shock therapy to treat mental conditions, but now they call this electroconvulsive therapy or ECT. The treatments have changed dramatically. Where once large currents were used, the new technique uses only small currents. Also, the seizure is extremely brief.

ECT is no longer administered without general anesthesia. One other area that has changed recently is the type and use of equipment. Scientists have now discovered better ways to place the leads to produce the best results with fewer risks and side effects.

When Do Doctors Prescribe ECT?

Doctors typically use ECT only in extreme cases now. Either the condition is very severe and resistant to other treatments, or there's an urgent need to relieve the condition immediately. Some of the reasons a doctor might suggest or prescribe ECT are:

  • Severe depression, if it's accompanied by psychosis, suicidal actions, or a refusal to eat.
  • Treatment-resistant depression
  • Severe mania
  • Catatonia, if not caused by a medical condition that can be treated in other ways.
  • For people with dementia who become extremely agitated and aggressive
  • For women who can't take needed psychiatric medications because they're pregnant or nursing
  • For older adults who suffer extreme difficulty with side effects of needed psychiatric meds
  • For people who would rather have ECT than taking medications
  • For people who have benefitted from ECT in the past

How Does ECT Work?

As the small electrical currents pass through the brain and trigger the brief seizure, they quickly change the brain's chemistry. As a result, the size of certain brain structures can be changed as well.

The hippocampus is the center of emotion, memory, and the autonomic nervous system. People with a smaller hippocampus volume tend to benefit the most from ECT because the treatment increases the size of this structure. The result is that they respond more positively to cues in their environment.

The amygdala, the structure in the brain involved with experiencing emotions, also changes structurally following ECT. These changes are currently being studied to understand better why ECT helps certain people and not others. The goal is to find out who are the best candidates for ECT.

What Is The Procedure For Getting ECT?

If you walked into a clinic where ECT was being done, you might be surprised to see how calm the environment is. Because ECT is usually done with the patient's consent and is scheduled in advance, treatment runs smoothly.

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Preparing For The Treatment

Before making the final decision to give you ECT, your doctor will take your medical history, give you a physical exam, do a psychiatric assessment, take basic blood tests, and do an ECG to check your heart.

Your doctor or the clinic staff may give you instructions on what you need to do the night before the treatment. For example, you might be asked not to smoke, drink caffeine, or eat after a certain time.

When you arrive for your treatment, usually done in the morning, a nurse sets up an IV for the anesthesia. Then, they place electrode pads at specific places on your head. For example, if you have bilateral ECT, the leads will be on both sides of your head. For unilateral ECT, they'll only be on one side of your head.

They also put a blood pressure cuff around your ankle. Finally, you are hooked up to monitors so your doctor can check your brain, heart, blood pressure, and oxygen to make sure you are doing well throughout the procedure. You may also be given an oxygen mask and a mouthguard.

The anesthesiologist administers the anesthetic and a muscle relaxer to minimize the seizure and keep you from injuring yourself. The rest of the procedure happens while you are under general anesthesia and unaware of what is happening.

The Treatment Process

Because of the muscle relaxant, you might show few or no signs of seizure activity in your body. The blood pressure cuff on your ankle keeps the muscle relaxant from entering your foot. The doctor watches this foot to know when you're seizing.

Watching the foot and the monitors for signs of a seizure, the doctor then presses a button on the ECT machine to pass the electrical current through your brain. With the muscle relaxant in your system, you remain visibly relaxed, although the EEG monitoring your brain waves should show a dramatic spike in activity at the start of the seizure. The seizure typically lasts less than one minute.

Aftercare

After the doctor finishes the ECT treatment, you either go to a recovery room or stay in recovery. A nurse may come and cover you with a heated blanket and offer you something to drink. When the anesthetic and muscle relaxant are out of your system enough so that you can walk safely, you can go home. However, you must have someone else to transport you home.

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Once home, you may take a nap. Although doctors usually do not recommend taking more than a half-hour nap during the day, they often suggest a long nap after ECT. After that, you can go back to eating and drinking fluids as you normally do. Talk to your doctor about when you can go back to work and drive. Usually, between 24 hours and two weeks after your last treatment, you can go back to life as usual.

How Many ECT Treatments Will I Need?

In the U.S., the usual course of ECT is two to three times per week for three to four weeks. However, a new technique called right unilateral ultra-brief pulse ECT is a slightly different procedure every weekday. In either case, the number of treatments will vary depending on your individual needs and preferences.

If you want to change your mind about having ECT, you can talk to your doctor about stopping the treatments. Likewise, if you feel significantly better and believe that the shock treatments have reached maximum effectiveness for you, you can approach your doctor about discontinuing treatments.

Risks And Side Effects Of Shock Therapy

Modern ECT is a very safe procedure, but there are a few risks and side effects. Because this is a medical procedure that uses general anesthesia, you may suffer medical complications. In addition, the treatment always causes increases in heart rate and blood pressure. Rarely, these changes lead to severe heart problems. However, it happens so rarely that even people with preexisting heart conditions can have ECT safely. If you're concerned, talk to your doctor about whether ECT is right for you.

After the treatment, you may have nausea, headache, jaw pain, and muscle aches. One benefit of taking a nap after treatment is that it will often help relieve these side effects. If not, you can take medications for these side effects.

Memory loss is what many people fear most about ECT. The procedure can cause some memory problems. What you have trouble remembering is usually what happened just before treatment, either on that day or in the weeks, months, or years before the treatment started.

Forgetting what happened on the day of treatment is common. However, forgetting what happened years before is a condition called retrograde amnesia, and it's very rare, even in people who have had ECT. Most often, your memory problems clear up within a few months of treatment.

It's also common to feel confused in the moments after you wake up from treatment. The confusion can last up to a few hours for some people. Only rarely do people remain confused for days. Older adults are more susceptible to confusion after ECT than younger people.

ECT can be fatal, but it's extremely rare. Only about 1 in 10,000 (or 10 per 100,000) people who have ECT die from it. The U.S. suicide rate, at 12 per 100,000 people, is higher. At least 133 in 100,000 people die of a heart attack. Surgery always carries a risk; even liposuction has a mortality rate of 20 in every 100,000 people. So, although the risk of death is there, it is lower than for many other conditions and medical procedures.

Possible Benefits Of ECT

Researchers are still studying ECT to find out who can benefit from it most. However, for the people that are helped by it, it offers several benefits.

One benefit is that it works much faster than medical therapy alone. Usually, there are dramatic improvements within six treatments, about two weeks after beginning ECT. In fact, people with depression or mania may recover completely after only one to two treatments.

It's very effective for many people, too. For example, about 78% of people who receive ECT for depression improve, and of all the people who receive ECT, 70% to 90% go into remission from their condition. Unfortunately, with medications, the remission rate is only 20% to 30%!

Making The Decision To Have Electroconvulsive Therapy

If your doctor has suggested ECT as a possible treatment for you or a loved one, you need to make sure you understand what your specific treatment will be done and what results in you can achieve. However, you may be worried that you'll be given shock treatment against your will if you seek treatment for psychiatric problems. That's why it's important to find out all you can see as soon as possible.

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Questions To Ask Your Doctor

Here are a few questions you can ask your doctor to find out more about how ECT will work for you:

  • Will I have unilateral or bilateral ECT?
  • What are the steps of the procedure?
  • What will I feel like physically after treatments?
  • When can I expect my symptoms to decrease?
  • How many treatments might I need?
  • How will you decide when I've had enough treatments?
  • Will I need other types of treatments along with or aftershock therapy?

Could A Doctor Give Me Shock Treatments Without My Consent?

Doctors these days are much more hesitant to use ECT than passed, if for no other reason than because people are typically opposed. In addition, ECT is required by law to be used only by your consent or under the most severe conditions, such as:

  • To save your life
  • If urgently needed to prevent a rapid worsening of your condition

You could be given ECT against your will if you cannot understand the information you give informed consent to and have not made an advance decision. Another doctor gives a second opinion that you need to receive the treatment.

You still do not need to worry about getting unwanted ECT because you can opt out of ECT ahead of time if you choose. You do this by making an advanced formal decision to refuse ECT treatments or by giving a Lasting Power of Attorney to your lawyer along with instructions to refuse ECT.

Why Would I Choose To Get ECT Voluntarily?

Although you can prevent doctors from giving you ECT, you might want to consider it before making that formal decision. Many people choose to have ECT voluntarily, and some even bring it up to their doctors.

When you are suffering from severe depression, every day can be like torture. People who face this extreme condition will often do anything to relieve their suffering. When people who are suffering such emotional pain are introduced to the possibility of feeling better very quickly after using ECT, they may choose to do it to get back to feeling like themselves again. The same thing happens to many people with other psychiatric disorders.

Once you understand how safe and effective ECT is now, you might feel less afraid of it. Then, if other treatments do not work, you may choose to follow your doctor's suggestion and get it to overcome your mental problems. Sometimes, even if you do not get ECT, just knowing that another option can make you feel less hopeless.

Is ECT the Complete Solution for My Mental Health Issues?

ECT can help certain people quickly and dramatically. However, you may still need other treatments as well. For example, some people need to continue to have infrequent follow-up treatments. Others also take medications for routine maintenance.

In any case, you will probably need psychotherapy of some kind to help you develop healthier habits and ways of coping with stress.

A therapist can help you deal with depression and other mental conditions before, during, and after you complete shock therapy. They can also help you work on your problems before they become so severe that you need ECT. In addition, if your family member has ECT, you may also benefit from therapy to help you understand how to help them thrive.

You can talk to a licensed therapist on your schedule for online therapy through Regain.us. Whether or not you or a family member is considering ECT, talking to a therapist can help you make the important decisions that can change the course of your life and your relationships.

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