SHOULD ELECTROconvulsive therapy EVER BE USED TO TREAT MENTAL DISORDERS? A. Thesis StatementElectroconvulsive therapy (ECT) is a treatment for severe mental illness in which the brain is stimulated with a strong electrical current which induces a seizure. The seizure rearranges the brain’s neuro chemistry and results in an elevation of mood. This essay asks: Is ECT any safer and more effective in treating mood disorders than drug therapies? This treatment has a controversial history ever since it was first introduced in 1938. I intend to argue that electro convulsive therapy is indeed a safe treatment of mental disorders when other treatments have failed. Due to the development of safer and less traumatic ways of administering ECT, the treatment has made a comeback, is greatly used, and proves to be effective.
B. Historical Context The original use of electricity as a cure for “insanity” dates back to the beginning of the 16 th century when electric fish were used to treat headaches. Electroconvulsive therapy on humans originates from research in the 1930’s into the effects of camphor-induced seizures in people with schizophrenia (Guttmacher, 1994).
... . It needs to be understood that ECT is not a cure for depressive disorders, but a treatment that has the means to control ... is used to induce a cerebral seizure under controlled conditions." (Webster's, 1462. ) This type of therapy has evolved over many, many ... establish safe dosages of electricity that they would later use on patients. And on April 15, 1938 the first electroshock therapy was ...
In 1938, two Italian researchers, Ugo Cerletti and Lucio Bini, were the first to use an electric current to induce a seizure in a delusional, hallucinating, schizophrenic man.
The man fully recovered after eleven treatments. This led to a rapid spread of the use of ECT as a way to induce therapeutic convulsions in the mentally ill. Lothar Kalinowsky, Renato Alma nsi, and Victor Gond a are further responsible in spreading ECT from Italy to North America (Endler, 1988).
Although there is some confusion as to who exactly is credited for administering the first ECT in America, it is known that it occurred in the early 1940. When ECT was first introduced, it was a terrifying and hazardous procedure: patients suffered serious side effects, even breaking a bone from convulsions (Nairne, Smith & Lindsay, 2001).
It has been criticized since its beginnings, and only recently it has begun to be seen more positively. The major reason for this is the fact that the treatment went through significant changes over the years – it is now much safer than before. Nowadays, patients are given a general anaesthetic and medications that relax the muscles to prevent injuries from occur. However, most professionals still consider it to be a treatment of last resort. It is used when people have shown little or no response to conventional antidepressant drugs or other “talk” therapies (Breggin, 1997).
C. Central Issue Since its beginning, the issue of the safety and efficacy of ECT has existed, and thus its use has been always remained controversial (Weiner & Krystal, 1994).
Even with the modern development of ECT, some of the same issues are still prevalent. There are two sides here: the advocates that support the use of the treatment, and those who do not. This is explored next. The first argument for the use of ECT is the fact that majority of studies and modern literature show that this treatment is very successful in treating many psychological disorders.
Evidence seems strongest for the efficacy in severely depressed patients, as well as manic patients (Reisner, 2003).
When looking at those with major depression, the likelihood of substantial improvement ranges from 80-90% (Weiner & Krystal, 1994).
In manic patients, Gabbard concludes that 80% of patients show “marked improvement” (2001, p. 1272).
The case of Dr. Lowell and Mrs. Jackson revolves around a conflict between the doctor, who advocates the implementation of a particular treatment and the patient who disagrees with the doctor and wishes to do things her own way. The doctor feels that the suggested course of action is disastrous and threatens to have the patient declared mentally incompetent. The question now is whether or not the ...
The second argument for the use of ECT is that successful treatments induce remission in episodes of illness (Gabbard, 2001).
The evidence supporting this conclusion is compelling and includes a sizable number of well-controlled “sham-ECT” studies. In these studies, patients were randomized to receive real ECT or sham-ECT (which involves anaesthesia but no electrical stimulation), thus providing for precise double-blind tests of efficacy (Gabbard, 2001).
One misconception is that it provides a “cure.” This is not the case – it does not produce a “cure” any more than any other treatment involving antidepressant drugs. (Gabbard, 2001).
Evidence also shows reduction in hospitalization stays within ECT patients (Endler, 1988).
Moreover, as a result, less money needs to be spent on these patients. When researching modern literature, one clearly sees there are still some consequences that sometimes occur with administration of the electro convulsive therapy. This clearly proves that there are many who believe ECT is generally unsafe in nature. One of the arguments here is the high risk of relapse and reoccurrence (Geddes, 2003).
As Vothknecht et al. show, relapse rates range – exceeding 50% (in 6 to 12 months after initial electro convulsive treatment) up to 95% (2004).
With the clearly high indications or relapse, one can understand as to why so many oppose the use of ECT. The second argument against the use of ECT is its adverse effects, such as risk of mortality, cognitive morbidity, and structural brain changes. Although the mortality rate is low, 1 per 10, 000 patients (Reisner, 2003), it must still be taken into account when ECT is being practiced. Because a series of seizures occur when ECT is administered, “encephalopathy and specific amnesic syndrome can occur” (Weiner & Krystal, 1994, p.
“Amnesia is the most common discussed side effect of ECT” (Gabbard, 2001, p. 1276).
The amnesia falls into 2 forms: (1) retrograde amnesia, which involves difficulty in remembering information learned prior to ECT, and (2) amnesia, which involves difficulty in retaining newly learned material (Refiner, 2003).
Treatment Guideline's EffectAbstractWorking with trauma survivors leads to intense counter transference reactions. These are counterproductive to the efficacious treatment environment of survivor empowerment. A theoretical orientation using medical analogies can further frustrate the survivor and clinician with the implicit assumptions of the clinician having a "cure" and the survivor having ...
D. My Position To repeat, when all other treatments have failed, electro convulsive therapy should be used to treat mental disorders.
ECT has clearly been effective for a range of mental disorders ever since it was first introduced more than half-a-century ago (Endler, 1988).
ECT’s positive effects on the mentally ill patients can be seen throughout literature. Thus, electro convulsive therapy should be administered if has previously failed. Reisner shows that ECT is an effective treatment for severe depression, especially the one with psychotic features, and in proves to be just as effective in mania (2003).
All in all, electro convulsive therapy works more rapidly than antidepressant medication in these situations. There is also evidence that ECT decreases suicidal ideation (Reisner, 2003).
Through the use of Computerized Axial Tomography (CAT) and Magnetic Resonance Imaging (MRI), Bergs holm et al. , among others, found that the brains of depressed ECT patients have no acute damaging effects (Reisner, 2003).
Furthermore, researchers report that MRI and CAT studies generally do not find any new brain pathology after ECT treatments. Another way to show how the use of ECT is making a positive comeback is the fact that its effectiveness in treating severe mental illnesses is recognized by the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health and similar organizations in Canada, Great Britain and many other countries (Gabbard, 2001).
The formal acceptance of ECT by noted organizations encourages physicians and hospitals to expand their use of ECT (Coffey, 1993).
This is just what is needed in order to popularize the use of ECT. Electroconvulsive therapy will not be banned as long as people are convinced that it is safe and effective. By seeing its acceptance of these organizations and by conducting more studies, ECT will definitely demonstrate its strength to “survive.” One other way to argue modern ECT’s safety is by the technique involved in administering the treatment. Because of the legal, ethical, and clinical reasons, before one administers the ECT, the psychiatrist must first obtain written consent from the patient.
... elimination of Electro-convulsive therapy as unproven and inhumane." I feel the same way towards this so called "therapy." At the very least, patients should ... through the brains of their unfortunate victims. ECT is one of the front-line treatments used by psychiatrists to treat depression and ...
Likewise, to ensure safety the ECT is monitored well by the treatment team, which includes the psychiatrist, the nurse, and the anesthesiologist. The psychiatrist is in charge of “ventilating the patient and delivering the stimulus” (Guttmacher, 1994, p. 137).
The nurse is there to provide support and reassurance to the patient, as well as he / she is in charge of “inflating a blood pressure cuff” (Guttmacher, 1994, p. 136).
The anesthesiologist is there to “administer a short-acting barbiturate” (Guttmacher, 1994, p. 136).
The treatment nowadays is well controlled by the above professionals. This acts like a security feature.
There are a number of people involved in the actual treatment, which generates a higher efficacy rate as well as makes the patient feel safer. Furthermore, there seems to be some weaknesses associated with the advocates of anti-ECT. Their argument is that ECT is a risky procedure in any situation. Another point is the fact that relapses are often high following the ECT (Geddes, 2003).
One must understand that any medical procedure entails a certain amount of risk. However ECT is no more dangerous than minor surgery under general anaesthesia, and may at times be less dangerous than treatment with antidepressant medications (Reisner, 2003).
Therefore, this does not present enough evidence to suggest its use to be banned. Electroconvulsive therapy is, indeed, very helpful when other treatments have failed to work. ECT does not cause more adverse cognitive effects compared with (Gerard, Furman, Carpenter et al. , 2000).
Some side effects of ECT do include some memory loss, disorientation, confusion, and changes in psychological and physiological function. However, these are not permanent. Most studies show that these temporary side effects diminish within a few weeks after completion of the treatment (Gerard et al. , 2000).
Although these prove to be important points, they are weaker than those that are pro-ECT.
E. Conclusion Over the past 60 years, ECT has evolved into a state-of-the-art medical procedure far removed from its original, rather primitive, form. First introduced in 1938 by go Ugo Cerletti and Lucio Bini for use primarily with schizophrenia, it has been much more successful in treating major depressive disorders (Endler, 1988).
The major Mental Disturbances and Abnormal Behaviours listed in the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders) and their treatments are as follows: 1. Anxiety disorders It is the disorders characterized by anxiety and avoidance behaviour. Anxiety is a vague, general uneasiness or feeling that something bad is about to happen. It can be associated with a particular situation ...
Due to the present methodological improvement, at present time, ECT is generally recognized as a safe and effective modality for treating a clearly delineated group of mental disorders, most notably major depression. However, even now there are still people who are pro-ECT and those who are anti-ECT.
When looking at the literature to see which is argued more, one comes across both sides. However, the literature and majority of studies conducted prove that there are many positive aspects of ECT when other pharmacological treatments have failed. “Modern ECT is a safe treatment.” (Coffey, 1993, p. 6) even in patients who may be intolerant to tricyclic and mono amine oxidase inhibitor (MAOI) antidepressant drugs. After years of decline, the utilization rate of electro convulsive therapy appears to have levelled out. Defenders of ECT say that because of the addition of anaesthesia to make the procedure painless, the horribleness of ECT is entirely a thing of the past.
Moreover, there is no conclusive proof of any permanent brain damage caused by ECT (Endler, 1988).
The results of ECT in treating severe depression are among the most positive treatment effects in all of medicine (Reisner, 2003).
In conclusion, ECT is an effective, safe, and humane method for treating the affective disorders. ReferencesBreggin, P. R.
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