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Electroconvulsive therapy (ECT) is a medical treatment that uses a controlled electrical current to intentionally trigger a seizure event inside the brain. Doctors have used ECT to address the effects of mental illness since the early 20th century. In the past, this treatment gained a well-deserved reputation for its ability to produce unacceptable side effects; however, modern forms of electroconvulsive therapy greatly reduce the chances for these unwanted effects, and the U.S. National Library of Medicine considers the procedure safe for most individuals. People with severe forms of depression may benefit from ECT, even when all other treatment options fail.

Electroconvulsive Therapy Basics

During ECT, a doctor or technician uses electricity-conducting devices called electrodes to send a small dose of current to the outside of a patient’s head. Inside the brain, this current triggers a seizure by sharply altering the rate of communication between nerve cells in the brain called neurons. In most cases, this procedure is performed in a hospital setting after short-term anesthesia renders the patient temporarily unconscious. In addition to this anesthesia, doctors typically use an anticonvulsant medication to control the seizure activity in the brain and limit ECT’s effects on the rest of the body. Most people receive six to 12 rounds of electroconvulsive therapy, with a few days allowed for recovery and assessment between sessions. In some cases, an individual may receive as many as 20 rounds of the therapy.

For a long time, no one knew how electroconvulsive therapy achieves its effects inside the brain. In a study published in 2012 in the Proceedings of the National Academy of Sciences, a multinational team of researchers used a form of live body imaging called functional magnetic resonance imaging (fMRI) to examine the changes made by the therapy. These researchers concluded that ECT reorganizes the ways in which different sections of the brain communicate with each other. This reorganization basically reduces excessive communication between parts of the brain responsible for controlling mood, the flow of emotions, concentration and rational thought.

Severe Depression Basics

Loosely speaking, the term severe depression can be used to refer to major depression, a debilitating illness that drastically alters the normal mood of affected individuals and produces serious disruptions in various aspects of everyday function. However, the term is typically used to refer to specific cases of major depression that produce extreme symptoms such as suicidal thoughts or actions, cases of major depression accompanied by symptoms of another debilitating mental health problem called psychosis, or cases of major depression that don’t improve significantly after the use of other treatments such as antidepressant medications or psychotherapy.

Treatment Effectiveness

Mental health professionals in the United States generally view electroconvulsive therapy as a safe and effective short-term treatment for the various forms of severe depression, the American Academy of Family Physicians and the National Institute of Mental Health report. In a study scheduled for publication in 2013 in the Journal of Affective Disorders, a team of researchers from the Medical College of Georgia examined the long-term effectiveness of ECT in more than 500 severely depressed people who successfully completed an initial course of electroconvulsive treatment. Immediately after treatment, even people with the worst forms of depression saw an improvement in their symptoms. However, six months later, only 64 of the study participants still experienced high levels of relief from their course of ECT.

The authors of the study note that people who receive electroconvulsive therapy in combination with antidepressant medications typically see greater long-term improvements than people who receive only ECT. In line with these findings, most people who currently undergo the procedure either receive an antidepressant prescription or return to their doctors periodically for follow-up ECT procedures.

Side Effects

When doctors first introduced electroconvulsive therapy as a medical treatment, the procedure was noted for its ability to produce short-term, long-term or permanent memory loss. Current ECT treatments use much less electrical current than the treatments used decades ago, and the memory-related risks of the therapy have dropped accordingly. Still, the U.S. National Library of Medicine lists (usually short-term) memory loss as a potential side effect of electroconvulsive therapy. Additional potential side effects include aching muscles, headaches, short-term disorientation or confusion, nausea, an unusual drop in normal blood pressure, an unusual increase in normal blood pressure and an abnormally accelerated heartbeat.

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