ECT - Depression

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  • Created by: Amy
  • Created on: 12-06-13 20:57

ECT - Electro-convulsive shock therapy

The original rationale for ECT was as a treatment for schizophrenia and depression based on research by Sakel in the 1930s.   He found that when he injected insulin into schizophrenics, it lead to convulsions and a coma, mood improved.

ECT was first introduced in the 1930’s and was frequently misused causing physical and emotional damage.  Patients are first given a muscle relaxant and sedative then electrodes are placed on their temple/s and an electric current of 70-150 volts is passed through the brain for 0.04-1 second.  This causes a convulsion that lasts around a minute.  Typically 2-3 treatments are given a week for 3-4 weeks.

There are two forms of ECT: BILATERAL AND UNILATERAL.

There is no one accepted explanation of how ECT works, but the most popular is that it increases the availability of serotonin in the brain.

The use of ECT began to decline with the introduction of anti-depressants in the 50s and 60s.  However it is still used today but in much safer and controlled conditions. In England and Wales in 1999 11,340 patients were treated with the technique.  These days it is no longer seen as an effective treatment for schizophrenia but is successfully used for those with severe depression (Sackheim and Rush 1995).

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Effectiveness

  • FINK (1985) reviewed a range of studies on ECT and concluded that it is effective in over  60% of severe depressives. 
  • It seems to be more likely to work than drug treatment. Janicak (1985) found 80 % of his patients responded well to ECT whereas only  64% responded to drug treatment.
  • One of the positive aspects of ECT is that its effect is immediate so for someone contemplating suicide it will be more effective than giving anti-depressants that take several weeks to work.
  • However, Sackheim (1993) found that there was a high relapse rate within a year; Only a short term treatment
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Appropriateness

One of the major criticisms is that it is used without any real knowledge of why it works. 

There are 3 MAIN HYPOTHESES as to how it works: -

1. Patients see it as a punishment for their behaviour and so the use of ECT encourages them to reduce the depressed behaviour. However, the use of sub-convulsive shocks (do not produce convulsions) are equally unpleasant but do not produce the same positive effects.

This suggests that for ECT to work, there must be convulsions.

2. That it works because of the amnesia that accompanies it as a side effect. However, unilateral ECT (a shock to just one side of the brain) doesn’t cause much memory loss and is as effective as bilateral ECT.

This suggests that memory loss is irrelevant – it is the convulsion that is important.

3. That it causes biochemical changes i.e. it increases levels of noradrenaline and serotonin. This is probably the most likely reason.

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More evaulation

  • A main criticism is that it is inappropriate to put a person through such unpleasant therapy.  However, the way it is administered these days is much less traumatic than it used to be – people used to sometimes break bones when they had a convulsion!  Nowadays, the treatment is more humane with an anaesthetic and a  muscle relaxant used before the shock is administered so the patient is unconscious and doesn’t hurt themselves. 
  • Despite these improvements many people still see ECT as a form of abuse which a patient is encouraged to go through at a time when they are very vulnerable and can’t stand up for themselves. 
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Issues and Debates - Applies to bio too

ACCORDING TO BIOLOGICAL THERAPIES WHAT IS MORE IMPORTANT NATURE OR NURTURE?

Nature-> genetics and hormones etc all play a large role in how depression is caused

MOST DRUG THERAPIES WERE DEVELOPED USING ANIMALS. WHY IS THIS A PROBLEM?

Ethical issues

WHY ARE THESE TREATMENTS REDUCTIONIST?

Reduce complex illness to genetics, what if biology is a symptom

WHY ARE THESE TREATMENTS DETERMINISTIC?

No free will.. you don’t make a choice about getting better .. CBT on the other hand helps them learn the skills to get better

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