The Electroconvulsive therapy (ECT) is a psychiatric treatment in which cerebral convulsions are induced by electricity.
This therapeutic tool, also known as electroconvulsive therapy or electro-shock therapy, is used to treat various psychological disorders. The most common are Major depression , Bipolar disorder Y schizophrenia .
The use of ECT has been in place since the 1930s and is nowadays a highly used therapy in the treatment of severe mental disorders. It is estimated that approximately one million people receive ECT every year, as the World Health Organization points out.
Both its characteristics and their effects give rise to some controversy over society. Many people perceive and label it as a highly harmful technique.
However, by analyzing their qualities in detail, it is soon apparent that ECT is a necessary therapy in several cases. Like any other treatment, its application has advantages and disadvantages.
In fact, the scientific community agrees that TEC is one of the main treatments available and used in psychiatry for serious mental illness.
The characteristics of this therapy will then be reviewed in order to better understand and understand what ECT is. We will review your side effects and relate them to your therapeutic capacity.
What exactly is electroconvulsive therapy?
Electroconvulsive therapy is a treatment designed to relieve acute depression, bipolar disorder, schizophrenia and other severe mental illnesses.
For many patients, this treatment provides significant relief from its pathology. More importantly, in some cases it is the only therapy that provides therapeutic effects.
For its application requires an electrical energy device, which sends electrical impulses directly to the brain . To do this it is necessary to place a series of electrodes in specific regions of the skull.
The electric shock produced on the brain is very brief (a few seconds). The application of the discharge produces a brief and controlled cerebral seizure, which lasts between 30 seconds and 2 minutes, depending on each case.
General anesthesia should be used to apply this therapy. That is, the patient must be completely asleep before its application.
Also, it is necessary to apply a muscle relaxant and a dental protector to avoid possible damages during the seizure.
It should be noted that the intervention of the TEC is remarkably brief. The discharge itself lasts for a few seconds and the total effect of the anesthesia is prolonged for a few minutes.
Thus, although this treatment requires all the care prior to the administration of anesthesia, it does not require hospitalization. In fact, ECT can be applied to both inpatients and outpatients.
Applications of TEC
Electroconvulsive therapy is a highly used treatment in mental health and is indispensable in some cases of serious psychiatric disorders.
Mainly, ECT is used for the treatment of depression, schizophrenia, manias and catatonia, as these are the psychopathologies in which it has been shown to be effective.
However, this therapy is nowadays considered as second line treatment. ECT is used to treat subjects with these pathologies that do not respond to medications or other therapies.
Specifically, the American Psychiatric Association (APA) postulates the use of ECT as a therapeutic option in patients with the following characteristics.
- Pharmacotherapy has not been effective in the treatment of the first episode or in the prevention of relapses of the disorder.
- Pharmacotherapy can not be administered safely or the patient has some characteristic that makes it difficult to apply.
- The patient prefers electroconvulsive therapy to pharmacological treatment.
Thus, ECT is not the first choice treatment for any pathology, since there is now a clear preference for the use of Psychotropic drugs .
However, the low efficacy and the problems of application of medications in some cases of severe mental disorder, make ECT a highly used technique.
Likewise, ECT has demonstrated that it does not present a lower therapeutic efficacy than many of the psychotropic drugs used for the treatment of major depression, schizophrenia or bipolar disorder.
Indications of the TEC
The Food and Drug Administration (FDA) postulates six different pathologies for which the use of ECT is indicated. These are: unipolar and bipolar depression, schizophrenia, manic and mixed bipolar disorder, Schizoaffective disorder , Schizophreniform disorder And mania.
Depression
Major and severe depression is the pathology par excellence of the TEC. In fact, the cure rate of this therapy for each depressive episode is 70%. Thus, especially in subjects with depression who do not respond to either pharmacotherapy or psychotherapy, the use of ECT should be considered.
Also, electroconvulsive therapy is a particularly relevant treatment to intervene Psychotic depressions , Subjects with high suicidal risk and patients who refuse to eat or present a state of high inactivity.
In fact, ECT is much more effective in the treatment of psychotic depression (92-95% effectiveness) than in the intervention of melancholic depression (55-84% efficacy).
Finally, it has been shown how the combination of ECT and drugs promotes a better prognosis. A recent study showed that the combination of both techniques reduced relapses by 45% more than single-drug use.
Schizophrenia
The use of ECT in schizophrenia is subject to a combination of drugs. In fact, there is no evidence that electroconvulsive therapy alone is effective in treating this pathology.
Regarding the combination of drugs and ECT, it is observed that the integration of both techniques presents between 50 and 70% of effectiveness.
These data show that ECT may be a good therapeutic option in the treatment of schizophrenia. Especially in those cases in which treatment with Antipsychotics Is insufficient to ensure a good forecast.
Schizoaffective disorder and schizophreniform disorder
Both schizoaffective disorder and schizophreniform disorder are pathologies very similar to schizophrenia. Thus, the efficacy of ECT for these alterations is very similar to that discussed above.
Specifically, it is argued that ECT may be a particularly indicated option for schizoaffective disorder, since it constitutes a psychotic disorder with altered mood, so that benefits from the effects that ECT produces on both disorders.
Mania
ECT is an excellent treatment option in cases where pharmacological treatment is not fast enough. In patients with elevated levels of agitation or extreme physical exhaustion, electroconvulsive therapy results in rapid and effective intervention.
Likewise, ECT is also indicated in cases in which the pharmacological treatment fails to completely remit the manic episode. Electroconvulsive therapy has a response rate close to 80% in the treatment of mania.
Mechanisms of action of the TEC
The mechanism of action of the TEC continues to be in the research phase. In general, four theories or four possible mechanisms through which electroconvulsive therapy performs its therapeutic effects are posited.
These four mechanisms are: effects on the monoaminergic system, neuroendocrine effects, neurotropic effects and anticonvulsive effects.
Effects on the monoaminergic system
The electrical discharges produced by the TEC cause an alteration and a modification of the functioning of several neurotransmitters.
Specifically, it is postulated that the operation of the Serotonin and the Noradrenaline Would be those that are most influenced by the electric shocks.
A) Increased serotonergic transmission
It has been shown how ECT modifies the postsynaptic functioning of the serotoninergic system. Specifically, serotonin type 1A and 2A receptors increase in the cortical regions and in the hippocampus After the implementation of the TEC.
The relationship between serotonin and depression is well established, so this mechanism of action would explain its therapeutic potential for this pathology. Also, the Antidepressants Tend to decrease postsynaptic receptors, which is why ECT is more effective than drugs in some cases.
B) Inhibition of noradrenergic transmission.
The effects of ECT downloads bear similarities to the effects of antidepressants. Thus, electroconvulsive therapy increases the level of noradrenaline and the sensitivity of alpha 1 adrenergic receptors. It also decreases alpha 2 receptors and sensitivity to beta adrenergic receptors.
Neuroendocrine effects
Discharges from electroconvulsive therapy generate an increase in the release of various hormones and neuropeptides. Specifically, after ECT, prolactin is increased, Cortisol , the Oxytocin And vasopressin.
This increase in hormones occurs due to an acute decrease in dopaminergic Hypothalamus . This factor would contribute to explain the therapeutic effects of ECT in the improvement of the motor manifestations of Parkinson's disease .
Neurotropic effects
The theories suggest that ECT increases the expression of brain-derived neurotrophic factor (BDNF). In this way, the therapy could prevent and reverse BDNF deficits.
The BDNF is a Neurotrophin Whose deficit is implicated in the pathophysiology of stress Y the Depression . Thus, by increasing the expression of this factor, therapeutic effects could be achieved for different mental disorders.
Anticonvulsive effects
ECT per se acts as an anticonvulsant, as its application produces seizures and increases the seizure threshold as more therapy sessions are applied.
Positron emission tomography (PET) studies show that during ECT, cerebral blood flow, the use of glucose and oxygen, and the permeability of the blood-brain barrier increase.
Also, some studies show that ECT also leads to an increase in GABA levels in the brain.
Thus, electroconvulsive therapy would not only be effective in attenuating the symptoms of psychopathologies directly, but also in increasing the effectiveness of pharmacological treatment, which is why in many cases both treatments are combined.
Side effects of ECT
ECT is a therapy that is spectacular. In fact, socially it is interpreted as an extravagant treatment that causes multiple side effects.
However, the side effects of ECT are not shown to be excessively higher than those that may result from antipsychotic drugs or other medicinal products.
Side effects of electroconvulsive therapy may include:
Cardiovascular
At the beginning of the discharge the body responds with Bradycardia (Slowed breathing). Subsequently, tachycardias, hypertension and other tachyarrhythmias occur.
In the long term, some cases of mild ischemia have been described, especially in patients who already had previous carotid vascular pathologies.
Cognitive impairment
This is probably the main side effect of ECT. However, there are individual variations in cognitive impairments. In most cases the subjects experience a period of ictal confusion that lasts about 30 minutes.
Memory loss may appear in the long term, but with the use of unilateral electrodes, the memory .
Spontaneous convulsions
Only between 0.1 and 0.5% of subjects who develop ECT develop spontaneous convulsions, a slightly higher incidence than that of the general population.
Contraindications of the TEC
The conduct of electroconvulsive therapy in subjects suffering from intracranial hypertension is strongly discouraged. Likewise, patients with occupant brain lesions, acute myocardial infarction, Stroke Recent and pheochromocytoma can not perform ECT.
On the other hand, there are other pathologies that may increase the risk of side effects with ECT. These are considered relative contraindications and are:
- Perform an anticoagulant treatment.
- Congestive heart failure.
- Severe lung injury.
- Severe osteoporosis.
- Fracture of long bones.
- Retinal detachment.
References
- Arrufat F, Bernardo M, Navarro V, Salva J. Relationship between the anticonvulsant properties of ECT and its therapeutic action. Neurobiology Archives 1997; 600 (1): 37-54.
- American Psychiatric Association: The Practice of ECT: Recommendations for Treatment, Training, and Privileging. The Task Force Report of the American Psychiatric Association, Washington DC, 1990.
- Bernardo M, Pigem J. Electroconvulsive therapy. In: Gutierrez M, Ezcurra J, Pichot P ed. Advances in Psychopharmacology. Barcelona, Editions in Neuroscience. 1994.
- Calev A, Fink M, Petrides G, Francis A. Phenomenological augmentation of ECS: Neurochemistry. Convulsive Ther 1993; 9:77.
- Drafting Committee of the American Psychiatric Association. The practice of electroconvulsive therapy, recommendations for treatment, training and training. Psiquiatría Editores, SL. 2002.
- Leroy, A; Arredondo Fernández, A; Bleda García, F; Other authors. A guide for the patient treated with electroconvulsive therapy. Goals, number 42, February 2002.