why is ECT so controversial till now?

Depression, anxiety, mania, and schizophrenia are known as the common mental disorders that every alternate one is suffering through. Although there are various kinds of medications like antidepressants and mood stabilizers, ECT (electroconvulsive therapy) has its own therapeutic effects. So, how much it is beneficial, and what does it affect? let’s know below.

 

What is ECT?

 

ECT stands for electroconvulsive therapy. It is also known as electroshock or electroplexy therapy. In April 1938, the Italian psychiatrist Ugo Cerletti and Lucio Bini introduced this therapy.

 

This therapy is very fruitful as compared to insulin coma therapy and pharmacy convulsive therapy. Also, it is a very important and controversial psychiatric treatment. Because of this, the APA task force reported on clear guidelines for its use.

 

Why is ECT considered controversial?

It is mainly considered as psychiatric therapy. But, it turns controversial due to the electrical induction of seizure. it is given to the anesthetized patient for therapeutic purposes.

 

Definition of ECT?

 

It is physical or somatic therapy. With the help of two electrodes, the current is passed through the temporal region in between two hemispheres of the brain, to produce a grand mal type of seizure.

 

Parameters of this therapy

 

The voltage used in ECT is 70-120 volts. The usual amount of current passed in ect is about 200-1600 mA. The total duration of this therapy is 0.7- 1.5 sec.

 

What are the benefits of ECT?

 

When all the measures taken for the treatment of psychiatric patients became failed, ECT is only the best alternative for them. It helps you to come out from the severe depressive illness. It works as a lifesaver.

 

Indirectly it saves the life of 15% of people who are suffering from severe illness and will do suicide. It works faster than any psychiatric drugs like antidepressants.

 

Indications

 

The main indications for this therapy are;

• Major depression with or without psychotic symptoms 
• Bipolar disorder
• schizophrenia( acute or catatonic)
• Obsessive-compulsive disorder
• Delirium
• Chronic pain syndrome
• Intractable seizure disorder

 

Contraindications

The contraindications of ECT are of two types;

• Absolute 

The increased intracranial pressure is the absolute contraindication for this therapy.

• Relative 

Cardiovascular diseases like CAD, HTN, Aneurysms, Arrhythmias.

The cerebrospinal vascular effects like strokes, space-occupying veins, aneurysms.

Pulmonary diseases like tuberculosis, pneumonia, and asthma.

 

What is its mechanism of action?

 

The mechanism of action of this electroconvulsive therapy is not known clearly. But, hypothetically it affects the catecholamine pathways. The pathways are situated in between the diencephalon and limbic system.

Here diencephalon is the point where the seizure starts and the limbic system is the point responsible for mood disorders. It is also associated with the hypothalamus.

 

What are the types?

 

There are two types  ;

• Direct ECT
• Modified ECT

 

• Direct ECT

 

It is not a common method .it is mainly given without anesthesia and muscle relaxant.

 

• Modified ECT

 

In this type, the electrodes are placed on the side of the head. After that, a specific amount of electric current is passed through the brain.

 

To stop muscle contraction and the probability of broken bone, anesthesia and muscle relaxant are given to the patient.

 

Placement of electrodes during therapy?

 

Bilateral placement

 

It is one of the most common and most effective placements of electrodes. This type of placement is mainly used for the patient with severe cognitive dysfunction.

 

Here each electrode is placed 2.5-4 cm on the midpoint on the line joining the tragus of the ear and the lateral canthus of the eyes.

 

Unilateral placement

 

 This type of placement of electrodes is less effective. It is mainly used for the patient with less cognitive dysfunction. here the electrodes are placed only on one side of the head, usually on the non-dominant side. 

 

The course of electroconvulsive therapy?

 

It is given three times a week to limit cognitive problems. When the symptoms begin to respond the time of ECT is reduced to twice a week or once a week.

Also, the depression needs 6-12 treatments. Psychosis and mania require 20 treatments. Like the catatonia needs 3-5 treatments.

 

Who are the team members?

• Psychiatrist
• Anesthetist
• Trained nurses
• Nursing aids
• Ect assistant

 

Medicines used in electroconvulsive therapy

 

The pre-treatment medication such as atropine sulfate and glycopyrrolate is administered in intramuscular ( 30 mm). It is mainly used to decrease the secretion and inhibit the effect of vagal stimulation. It is mainly induced by ECT.

Some injections like atropine(0.6mg to 1mg)m, succinylcholine(1 mg/kg/b.wt) and sodium thiopental(3-5 mg/kg/b.wt) is given during this therapy.

 

Like that short-acting, anesthesia is given before it is started. Then the muscle relaxant is given to prevent muscle contraction and during the seizure to reduce the possibility of fracture of the bone. Oxygenation is also required before and after the procedure.