The Future of ECT: Efficacy vs Ethics
Electroshock Therapy, formally known as Electroconvulsive Therapy (ECT), has been around for over 60 years, yet most people are unaware of how it works, when it works, and its current role in the field of psychiatry (Kellner & Li, 2016). ECT is administered in a hospital setting; patients are given a muscle relaxant and have electrodes placed on their temples. In their completely sedated state, electric currents are administered to induce a brief seizure; patients then wake up in recovery with no memory of the procedure (McDonald & Walter, 2004). This often occurs over multiple sessions for maximum effect and is most notably used for severe/treatment-resistant depression, psychosis, and catatonia (Loo, 2012)
Stigma has been the most detrimental factor when trying to successfully implement ECT. Charles Kellner (2016), a doctor performing ECT since 1978, concluded that throughout his career, where doctors are most limited is in regard to lack of training in medical schools as well as lack of experience. In his opinion, these issues are fuelled by stigma, despite a growing consensus that it is both safe and effective. Another area this affects is research, willingness as well as access and funding — a common issue in the history of psychiatry for this very reason (Kellner & Li, 2016). This creates a cycle in which improvements and widespread implementation become very difficult. In Canada, for example, there are no uniform standards for ECT in terms of data collection, hospital protocol, report requirements, or guidelines on administration (ie. frequency of sessions). So while all 17 Canadian medical schools have ECT in their psychiatry departments, any data that is reported is deemed useless (Martin, et al. 2015). In the US specifically, other medical limitations like private insurance plans and FDA device labelling, play a huge roll in gaining access to treatment (McDonald, 2016).
So where’s all this stigma coming from? Another common issue of the field — the portrayal of mental illness in media. In this case, the 1975 film One Flew Over the Cuckoo’s Nest defined the public’s perception of Electroshock Therapy (McDonald & Walter, 2004). Jack Nicholson’s oscar-winning performance terrified the masses by portraying treatment against one’s will, medical manipulation, and administering ECT to a fully conscious, restrained individual. On the other hand, the scientific community opposing the treatment held concerns primarily about the risks of cognitive impairment and destruction, longterm memory loss, as well as the neuro-ethics (ie. patient’s ability to consent) surrounding such a treatment (Coffey & Coffey, 2016).
Taking these sources into consideration, what is most important to the future of Electroconvulsive Therapy is a focus on 1) patient comfort and 2) limited cognitive impairment. Two very recent advancements have been patient-centred ECT and ultrabrief pulse ECT. In patient-centred care, every aspect of their experience is evaluated, assisting in changes to increase patient comfort. For example, the type of music played prior, or allowing a family member accompany the patient during the procedure. The latter is shown to significantly reduce patient/family anxiety, and improve relationships between them and their medical team (Coffey & Coffey, 2016). Ultrabrief pulse ECT has been glorified for similarly effective results to traditional ECT with far less side-effects (particularly memory related). By shortening pulses from every 1.0 milliseconds to 0.3 milliseconds, seizures can be induced at lower energy levels, a big step for both efficacy and ethics (Loo, 2012). ECT has been described as one of the most “miraculous” therapies by psychiatrists, but without a major shift in thinking, the future of psychiatry may not reach it’s full potential (Kellner & Li, 2016). In order to fuel this future of ECT, however, education and discussion need to improve and key factors in accessibility and research are a substantial part of that.
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Sources:
Coffey, M.J., & Coffey, C.E. (2016) Patient-centred Electroconvulsive Therapy Care. Journal of ECT, vol 32(2), 78–79.
Kellner, Charles H., & Li, Erin H. (2016) Electroconvulsive Therapy from Both Sides Now. Journal of ECT, vol 32(1), 1–2.
Martin, B.A., et al. (2015) Delivery of Electroconvulsive Therapy in Canada. Journal of ECT, vol 31(2), 119–124.
McDonald, Andrew, & Walter, Gary. (2004) About to Have ECT? Fine, but Don’t Watch it in the Movies: The Sorry Portrayal of ECT in Film.
Retrieved from: www.psychiatrictimes.com
McDonald, William M. (2016) The FDA and ECT. Jornal of ECT, vol 32(2), 75–77.
Loo, Colleen K., et al. (2012) A Review of Ultrabrief Pulse Width Electroconvulsive Therapy. Therapeutic Advances in Chronic Disease, vol 3(2), 69–85.
