Electroconvulsive Therapy (ECT) is an evidence-based, approved and effective treatment for various psychiatric conditions. This treatment is prescribed by psychiatrists and used in clinical practice all over the world.
In early 20th century, some physicians noticed that fits or seizures occurring in certain conditions improved their behaviour, which led them to try and induce intentional fits by using camphor, and later insulin.
The use of electric current to induce brief intentional fits was first done by Italian professor Ugo Cerlette and colleague Lucio Bini in 1938. ECT has evolved to so-called modified form, which includes use of short acting anaesthesia following a set protocol. An estimated 50 patients receive ECT in different hospitals in Bengaluru on a given working day. It is known to people as shock treatment or electric current treatment.
The procedure
ECT involves three main steps. In the first step, an anaesthetic agent and a muscle relaxant is administered by a qualified anaesthetist, aimed to put the patient to sleep for a short duration and relax the muscles.
Second step involves a small amount of electric current delivered from a specifically designed machine through electrodes placed on either side of the patient’s head. In the last step, the person has fits induced by the electric current stimulation. Such a fit will not involve violent body movements because of the action of the muscle relaxant.
The length of time of the observed fit or as recorded by EEG is noted. This is done in a dedicated operation theatre-like room. Each procedure lasts 5-10 minutes, following which the person is transferred to a recovery room. Soon, most are ready to get on with the day’s routine.
A few patients can even go to work after the procedure. Some may have confusion for a few hours or headache. Pre-checks as per protocol involves physical examination, lab tests, fitness by physician and also a check for loose teeth. Risks due to procedure and from anaesthesia are informed and written consent is sought before the treatment.
The depiction of ECT procedures in movies may have contributed to negative perception and stigma. In some movies, it is shown as punishment for aggression, especially to the protagonist aimed to make viewers feel sorry. Similar to any surgery, this treatment should have been shown as a respectable procedure that promoted recovery.
The filmmakers could do some homework by talking to specialists. Stigma has been a barrier to some needy patients and families in agreeing to get the treatment, or undue delay in starting it. Videos to educate about procedure prepared by the NIMHANS psychiatry team is now available on YouTube (https://youtu.be/4X75S7yJvjA).
Mental Healthcare Act
The Mental Healthcare Act of 2017, which came into force in May 2018, prohibits the use of unmodified ECT, which means ECT can only be administered after administering anaesthesia. The Act also emphasises the requirement for patient’s consent for administering ECTs, and not just the family’s consent.
If the patient is not able to understand the treatment, due to a mental illness, and is deemed to need support in making decisions, the treating psychiatrist may seek the family’s consent for treatment. The clinician’s decision to prescribe ECT or not will depend on the circumstance and consent, as there are many provisions in the Act that safeguard the interest of the patient’s rights and preference.
ECT is a safe and well-studied treatment that is believed to enhance brain cell connections. It has been used to successfully treat conditions such as depression, mania, violence in mental illness and another complex condition called catatonia where a person becomes immobile and cannot speaking.
It is a useful treatment for elderly patients and in pregnancy where medications cause side effects. It has helped patients with life-threatening conditions such as severe depression who have stopped eating and drinking, and those at imminent threat or high risk of suicide.
Sometimes, it may be a good alternative treatment when medications have not worked or caused side effects in persons with less severe depression. There are only a few physical health conditions where a person needing ECT is found unfit for the therapy.
It is given up to three times a week and the usual course is six to eight treatments, though some may require more. It is best to meet a psychiatrist for clarifications and the community should consider it like any another treatment.
(The author is a Consultant Psychiatrist practising in Padmashree Diagnostics, Vijayanagar, Bengaluru)