in Articles, Ask the Shrink

Do They Still Use Electroshock Therapy?

Q: Do they still use electroshock therapy? If so, why? Doesn’t it cause brain damage? – Sandy

A: Dear Sandy,

If by “electroshock” you mean electroconvulsive therapy (ECT), then the answer is yes. If by “they” you mean plumbers, then the answer is probably no. But yes, Sandy, psychiatrists still use it. Why? Because it works. Does it cause brain damage? That depends on how you define brain damage, but probably not.

ECT is a fairly straightforward procedure in which electrical cables are connected to the patient’s ears. Once the patient is sufficiently restrained with large leather straps and metal rods, the cables are connected to a small gasoline-powered generator and the switch is thrown. On those rare occasions when a patient was born without a corpus callosum (the massive bundle of nerves that connects the two hemispheres of the brain), the added electrical resistance can generate enough heat to set the patient’s hair on fire.

Sorry. Just kidding. I kid because ECT has gotten some pretty bad press since its it’s introduction in 1938, and it was once a fairly gruesome affair – not necessarily because of the electrical stimulation applied to the brain, but because of the ensuing seizure. Before the finer points of anesthesia were worked out, the seizures could lead to damaged muscles and even broken bones.

From Punishment to Cure

ECT found its popularity when such procedures were used punitively. The technique took hold during that shameful period in which psychiatric patients were “calmed” with lobotomies or were restrained under cold, heavy, wet blankets. Patients calmed down alright, but only because they had been incapacitated or wanted to avoid more punishment, not because of any therapeutic value to such techniques.

The procedure has gotten much more civilized and useful since the bad old days. Nowadays, a person undergoing ECT will be anesthetized so that they don’t recall the seizure, and paralyzed so that they don’t get hurt. Once the patient is sedated, a mild electrical stimulation is given until seizure is induced. The electrical stimulus is usually applied to both sides of the brain through an electrode placed at each temple.

The process is typically repeated three times per week, for up to 20 treatments. It doesn’t have to end there. The Iron Shrink has heard tell of at least one severely depressed patient who insists on receiving maintenance treatments every four months or so because ECT is the only thing that can stave of debilitating depression.

ECT can be a life-saver for patients suffering from intractable depression, mania, and sometimes even psychosis. Patients who are suicidally depressed, for example, can return to a fairly normal level of functioning in a matter of days. It’s not entirely understood how the process works, but it’s thought that the induced seizures alter blood flow and glucose metabolism in the brain, as well as creating some poorly understood changes in neuron receptors.

There are other theories, but I won’t bore you unless I get an overwhelming outcry for Theoretical Approaches to Electrically-Based Psychopharmacology. Long story short, it’s happiness through the magic of electricity.

Does ECT Cause Brain Damage?

The most commonly reported side-effect of ECT is memory loss, usually limited to the time shortly before and after the treatment. Some patients complain of headaches or muscles soreness. But researchers have been unable to pinpoint any long-term damage to the brain. That doesn’t mean it doesn’t exist, but it has yet to be found.

There are some educated folks out there who insist that the electrical storm induced by ECT damages normal impulse patterns in the brain. Some say that the only reason ECT works is because it is so traumatic and disorienting that it leaves the patient with a temporary illusion that everything is OK. That’s not the tightest reasoning, if you ask me. Other risks, rare as they are, are related to increases in blood pressure, adverse reactions to anesthesia, and the like.

For those who believe that ECT isn’t worth the risk of zapping the frontal lobes, I offer one of the Iron Shrink’s cardinal rules: Life Is Full Of Trade-Offs. For a patient who is unbearably depressed and has had no luck with other treatments, a little memory loss might be a small price to pay for an escape from despair. Besides, Sparky, it’s a walk in the park compared to your average appendectomy.