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According to Mayo Clinic (2011), electroconvulsive therapy is a procedure that involves the passing of the electric current through the brain. It results into a deliberate trigger of a brief seizure. Mayo Clinic (2011) explains that the therapy works by causing certain changes in the brain chemistry with the major aim of stopping the observed symptoms of certain mental illnesses. Therapeutic practitioners have always recommended that the use of electroconvulsive therapy be limited as the last option when all other forms of relevant treatments have been proved unsuccessful. This method is usually stigmatizing especially because of some past instances in which high doses of electricity were administered without anesthesia leading to certain fatal risks like loss of memory and fracturing of bones. However, the safety and the effectiveness of the therapy have greatly been improved by the current use of perfectly controlled electrical current.
The History of Electroconvulsive Therapy
According to WebMD (2011), electroconvulsive therapy was first used in the treatment of patients with severe mental illness by Ugo Cerletti and Lucio Bini in 1930s. During its early days of in use, the method met a lot of opposition from those who viewed it as too barbaric and crude. However, with increased refinement of its procedures, ECT has widely been accepted among the therapeutic practitioners all over the world. The method is currently widely used in the treatment of several disorders like schizophrenia, depression and bipolar disorder (WebMD, 2011).
Bailine, S et al (2010) notes that although the electroconvulsive therapy was introduced in 1930s, its therapeutic use today is very different from what the authors and the film artists are portraying. According to the hospital’s publication, the electroconvulsive therapy has steadily increased in its effectiveness over time increasing its safety. This increase in effectiveness is evidenced in the way in which the therapy provides relief to patients from various serious psychiatric symptoms compared to other forms of therapies such as medication and psychotherapy.
According to the report by the McLeen hospital, approximately 80 percent of patients treated with electroconvulsive therapy normally respond positively to the treatment getting a total relief from their symptoms. This is why despite the negative report by media, the therapy is endorsed by the American psychiatry Association and is widely used in the United States. It is estimated that approximately 100, 000 patients receives electroconvulsive therapy in the United States annually (Bailine et al, 2010).
Circumstances under which Electroconvulsive Therapy is Necessary
According to the Mayo Clinic report (2011), the therapy has been proved effective for treating symptoms related to a number of mental health conditions. For example, it has been proved effective in treating people who are thinking of committing suicide or those who suffer from severe mania. The therapy can also be used in treating severe depression especially in cases where the depressed is detached from reality. It is thus a good intervention mechanism for those planning to commit suicide. The therapy has also been found to be an effective way of treating treatment-resistant depression. It is normally the preferred intervention in situations where a depressed individual has undergone all the necessary medication without showing improvement.
Mayo Clinic (2011) reported that electroconvulsive therapy is also effective in the treatment schizophrenia especially where the patient also experience psychosis. The symptoms in such situations may include a strong desire by the affected individual to hurt another person or himself by acts such as committing suicide. Another disorder that can be treated using electroconvulsive therapy is severe mania. The disorder is normally indicated by symptoms like intense euphoria, agitation as well as hyperactivity whose occurrence is as a result of the bipolar disorder.
Additionally, electroconvulsive therapy is also effective in treating other symptoms of mania like impaired decision making or where the victim is involving himself in very risky behaviors or substance abuse and psychosis. Another disorder that can effectively be addressed using the therapy is catatonia disorder which is normally characterized by lack of movement, fast or strange movements, and lack of speech (Mayo Clinic, 2011).
According to Mayo Clinic report (2011), the electroconvulsive therapy may also be used as a last resort treatment to treat the disorders which can not be treated using medication and other forms of therapy. Such disorders may include: the treatment resistant obsessive compulsive disorder, diseases like epilepsy and Tourette syndrome. The treatment-resistance obsessive compulsive disorder does not usually improve with any kind of medication or form of treatment. However, according to Mayo Clinic (2011), the disorder can effectively be treated through the administration of the electroconvulsive therapy.
Epilepsy and other conditions like Parkinson’s diseases may also not be effectively addressed by medications and other forms of therapy. They are normally caracterized by symptoms such as the difficulty in movement or even seizures. Research has shown that the disorder can effectively be addressed by electroconvulsive therapy treatment. In the same way, studies have shown that the therapy can to a greater level be used to improve Tourette syndrome, a disorder that does not normally react with any form of medication or treatments (Mayo Clinic, 2011).
According to the Mental Health America (2011), electroconvulsive therapy is an effective treatment option especially whenever medications are not allowed or when other forms of therapy have proved to be ineffective. The organization noted that, the therapy can also be used during pregnancy especially in cases where the doctor has warned against the use of any medication for the safety of the developing fetus. During pregnancy, the mothers are always advised to be vey careful because research has shown that most of the drugs are harmful to the fetus. Electroconvulsive therapy on the other hand has no harmful effect on fetus and is therefore the preferable option for the pregnant women with severe depression. The therapy also provides an effective alternative to the aged who are adversely affected by the drugs side effects.
According to the American Psychiatric Association, electroconvulsive therapy can be administered under the conditions such as whenever a need arises for rapid treatment response such as pregnancy, when a patient refuse to eat leading to nutritional imbalance, when a patient’s has a depression that has proved to be resistance to antidepressant therapy, where the patient can not use antidepressant medications because of other medical ailment, when treating mania or a bipolar disorder and finally in treating those who had in the past positively reacted to electroconvulsive therapy (Kalapatapu, 2011).
The Risks Involved in Electroconvulsive Therapy
Mayo Clinic (2011) noted that even though electroconvulsive therapy is generally safe, it has some risks and side effects including: confusion, memory loss physical side effects, and medical complications. Additionally, in some extremely rare cases, electroconvulsive therapy may cause heart attack, stroke, or even death. Normally, people with certain heart problems are advised never to undergo the therapy.
Studies have shown that, in certain cases, the patients go through some duration of confusion immediately after they have undergone an electroconvulsive therapy treatment. Many patients are not always able to remember where they are and what took them to the place. However, in normal cases the patient is able to return to their normal functioning state after some time usually a few minutes or hours. Though rarely, there have been cases in which the confusion may last for several days or longer. According to the clinic’s report, adults are more prone to this challenge (Mayo Clinic, 2011).
The second risk that may be experienced during electroconvulsive therapy is memory loss which normally happens in several ways. A patient may experience retrograde amnesia rendering them unable to remember any event that precedes the treatment. The trouble with memory may even occur weeks after the treatment. However, it is generally expected that the patient would improve after a few months (Mayo Clinic, 2011).
Another risk involved in electroconvulsive therapy is a group of physically related effects. This may include: nausea, vomiting, headache, pain in the jaw, muscle ache and spasms. Electroconvulsive therapy is also associated with certain medical complications. Studies have established that during the therapy, the heart rates and the pressure of the blood normally increase. Though not normally expected, in certain cases this may lead to serious heart problems which may even increase for those who normally have heart problems.
Additionally, Mankad (2010) noted that certain patients are at high risk of experiencing complications than others. He identified the groups to include those with heart attack, those whose level of blood pressure can not be controlled, those who have developed brain tumors and those who had experience some form of spinal injuries.
Effectiveness of Electroconvulsive Therapy
According to Mankad (2010), studies have shown that electroconvulsive therapy produces dramatic improvement in the signs and symptoms of major depression. This is especially so when it is used by the elderly patients. He reported a study by the American Psychiatric Association that had shown that around 90% of patients who receive electroconvulsive therapy for depression respond positively. According to Mankad’s own analysis, this is a positive result compared to only 70% of those responding well on being treated with antidepressant medications alone.
Mankad also reported a further research which had indicated that mania disorder also responds well to treatment with electroconvulsive therapy in most of the cases. He however admitted that electroconvulsive therapy’s reaction with schizophrenia is not very effective. On the other hand the result of electroconvulsive therapy is said to be abnormal if an ICT induced seizure lasts too long during the procedure.
Precautions before the Proceddure
According to Mankad (2010), anyone who chooses to go through electroconvulsive therapy must go through screening. Mankad and his colleagues note the importance of the reporting of any past medical conditions by the candidates of the therapy before the actual procedure. This is because such conditions may always lead into complications at certain levels of the treatment. He identified a number of the conditions to be analyzed as including: the patient’s complete medical history, a physical examination, routine laboratory test, an electrocardiogram, spinal and chest x rays and the computed tomography.
Mankad (2010) also identified some medications that may not be taken during the therapy. These include medicine such as lithium and monoamine oxidase inhibitors (MAOIs). Mankad cautions that any patient using such medications should stop some period before he/ she can be allowed to go through the therapy. He added that it is advisable for patients not to eat or drink for a minimum of eight hours before the procedure begins. This would reduce the possibility of vomiting and chocking that may further complicate the process.
Contributing on the necessary preparation before the therapy, Mayo clinic (2011) notes that before one is allowed to have his/ her first treatment, he/she must undergo a physical examination in addition of the normal psychiatric evaluation. If need be, one may also be advised to contact an anesthesiology to help in containing anesthesia related risks. The clinic seems to agree with the contributions of Mankad and his colleagues. The Clinic emphasized that a complete pre-ECT evaluation should include an examination of the medical history, physical examination, the basic blood tests and finally an electrocardiogram to check the health condition of the person’s heart (Mayo Clinic, 2011).
According to WebMD (2011), a patient who is to go for the electroconvulsive therapy should first be given a muscle relax and is put to sleep with a general anesthesia. This involves the placing of electrodes on the patients scalp followed by the application of a finely controlled electric current which causes a brief seizure in the brain. WebMD (2011) explains that the relaxation of the muscles usually help limit the visible effects of the seizure. It limits the possible reactions to slight movement of the hands and feet. Throughout the treatment period, the patients are always closely monitored.
The effectiveness of the Electroconvulsive Therapy
Mankad (2010) noted that with the introduction of improved safety procedures and its flexibility to both the inpatient and the outpatient facilities, the effectiveness of electroconvulsive therapy can never be questioned. According to Mankad, provided there are specially equipped rooms with oxygen sanction, and cardiopulmonary resuscitation equipments for any emergency, then the procedure can be effectively carried out. The effectiveness of the procedure also requires the services of a team of health care professionals, including psychiatrist, an anesthesiologist, a respiratory therapist, and other assistants (Mankad, 2010).
How ECT Works
According to Mayo Clinic (2011), electroconvulsive therapy procedure begins by the passing of the electric current through the brain. This is meant to deliberately trigger a brief seizure. The usual amount of electric voltage for electroconvulsive therapy normally ranges between 70 and150 volts and it is recommended that its passage takes between 0.1 to 1.5 seconds.
Mayo Clinic (2011) identifies a number of factors that affects the number of electroconvulsive therapy treatments one can undergo. These include: the age of the patient, the specific diagnosis, the history of illness, the amount of support that one receives from the family, and finally one’s response to therapy. Normally, treatments are two or three times per week and should last until the patient reacts positively. However, it is very rare for the treatment to last for more than six months.
The Mental Health America (2011) took this discussion further by underlining the need for post treatment care. It explains that it is recommended for the patient to be moved to a recovery area immediately after the treatment where his/her progress will closely be monitored. Most of the patients are normally confused after the process though the confusion does not normally last for long. Finally, for the maintenance of the electroconvulsive therapy, the patients are required to return to the hospital at least once in three months for further treatments.
With the advancements that are discussed, it is without any doubt that the electroconvulsive therapy is effective in its effort to contain the symptoms of the disorders. With the expected increase in the level of technological involvement in the procedure, its effectiveness is even expected to increase. Electroconvulsive therapy is already winning the favor of many practitioners and having been endorsed by the American psychiatry Association, the therapy is expected to even improve the more. However, more research needs to be done. Such research should especially aim at improving the safety of the patients during the procedure.