Before we go any further, we should make it clear that a small number of people with really severe mental illnesses receive ECT. About 100,000 Americans undergo ECT each year, while nearly 14.8 million Americans report depression annually [sources: Reti, NIMH]. Although the therapy was once used for a variety of mental disorders, it's now employed almost solely for severe depression or some symptoms of mania [source: NAMI].
While the treatment was always controversial, its popularity waned quite a bit with the introduction (as well as the improvement and variety) of antidepressants and other drugs for mental illnesses on the market. For example, in England between 1985 and 2002, ECT's use more than halved [source: Royal College of Psychiatrists]. In fact, one of the main instances when clinicians turn to ECT is after many different medications have been proven ineffective in treating a patient's severe depression.
Until recently, there's never been proof of how exactly the seizure works to improve mental health. Some theories have to do with the physiology of the brain. It's possible that the seizures can change how blood flows through the brain or the metabolism in certain areas [source: Royal College of Psychiatrists]. Because depression is often treated through chemical means, it's also possible that ECT causes a release (or improved functioning) of certain chemicals in the brain. More research also indicates that ECT can stimulate cell growth and nerve pathways, which might link to improved mood [source: Royal College of Psychiatrists].
A study published in 2012 suggested that an over-communicative brain might be an issue in depression. Shocking the brain might work like turning down a stereo, according to one of the study's authors, allowing a severely depressed patient to think a little more clearly [source: Rettner].
There have also been several studies done with placebo treatments, which point out the effectiveness of ECT. Essentially, the patients receive the exact same treatment -- anesthesia and muscle relaxant included -- and are told they had the shock, but don't. The patients with the actual ECT treatment did recover from their illness much faster. However, some patients with the fake treatment recovered as well, perhaps because of the extra clinical attention [source: Royal College of Psychiatrists]. In severe depression, the treatments do appear to be more effective than medication [source: Royal College of Psychiatrists].
As we talked about earlier, the side effects have also improved quite a bit with modern practice. Headaches are reported, as is muscle pain. There are still memory issues, as well: One-quarter to two-thirds of patients report memory problems after ECT [source: NAMI]. Some patients report having trouble forming memories after the treatment, while others say they have a hard time remembering some events before the therapy. Also, there can be initial confusion after the procedure, which isn't uncommon to coming out of sedation in general.
But that doesn't mean it still doesn't court its fair share of controversy. It's not hard to find groups that oppose the practice. Some are adamantly anti-psychiatry in general, while others claim that long-lasting damage is done to cognition and memory, as well as just being generally ineffective [source: Wilson].
Author's Note: How Electroconvulsive Therapy Works
I'll admit that I was, um, shocked to learn how well-regarded ECT is in the psychiatric and medical community. Like most people, I didn't realize how far the procedure had come and how beneficial it had proven to a lot of folks. While I think there's a lot to be understood about its effectiveness and how it works, I certainly think that more study and experimentation is warranted.
- Attkisson, Sharyl. "Shock Therapy: Old treatment, new scrutiny." CBS News. Jan. 31, 2011. (March 14, 2013) http://www.cbsnews.com/8301-31727_162-20030067-10391695.html?tag=mncol;lst;1
- Barnes, Richard. "Information on ECT." Royal College of Psychiatrists. December 2012. (March 14, 2013) http://www.rcpsych.ac.uk/expertadvice/treatments/ect.aspx
- DukeHealth.org. "Electroconvulsive Therapy (ECT): Q&A with Sarah Hollingsworth Lisanby, MD." Duke University. March 6, 2012. (March 14, 2013) http://www.dukehealth.org/health_library/health_articles/electroconvulsive-therapy-ect-q-a-with-sarah-hollingsworth-lisanby-md
- Encyclopædia Britannica Online Library Edition. "Shock therapy." 2013. (March 14, 2013) http://www.library.eb.com/eb/article-9067462
- Good Morning America. "Kitty Dukakis: Shock therapy saved my life." ABC News. Sept. 18, 2006. (March 14, 2013) http://abcnews.go.com/GMA/story?id=2458124&page=1
- Johns Hopkins Medicine. "Electroconvulsive (ECT) Service." Johns Hopkins University. (March 14, 2013) http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/ect
- Johns Hopkins Newsletter. "ECT without the Hollywood." John Hopkins University. 2007. (March 14, 2013) http://www.hopkinsmedicine.org/psychiatry/about/publications/newsletter/archive/07_spring_summer/ect_hollywood.html
- Mayo Clinic. "Electroconvulsive therapy." Mayo Clinic. Oct. 25, 2012. (March 14, 2013) http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129
- National Alliance on Mental Illness. "What is electroconvulsive therapy?" National Alliance on Mental Illness. July 2012. (March 14, 2013) http://www.nami.org/factsheets/ECT_factsheet.pdf
- National Institute of Mental Health. "The Numbers Count." National Institute of Health. Feb. 4, 2013. (March 22, 2013) http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#MajorDepressive
- National Institute of Mental Health. "Brain Stimulation Therapies." National Institute of Health. Nov. 17, 2009. (March 14, 2013) http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml
- Norton, Elizabeth. "Insight into a shocking therapy for depression." ScienceNOW. March 2012. (March 14, 2013) http://news.sciencemag.org/sciencenow/2012/03/insight-into-a-shocking-therapy-.html
- Payne, Nancy A. and Prudic, Joan. "Electroconvulsive Therapy Part I: A perspective on the evolution and current practice of ECT." Journal of Psychiatric Practice. September 2009. (March 14, 2013) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042260/
- Reti, Irving. "Electroconvulsive Therapy Today." John Hopkins Clinic. (March 22, 2013) http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/images/DepBulletin407_ECT_extract.pdf
- Rettner, Rachael. "Depressed brain explained by new electroconvulsive therapy study." Huffington Post. March 19, 2012. (March 14, 2013) http://www.huffingtonpost.com/2012/03/20/shock-therapy-brain-depression-study_n_1367203.html
- United States Food and Drug Administration. "FDA Executive Summary (Meeting to discuss the classification of Electroconvulsive therapy devices.)." United States Food and Drug Administration. January 2011. (March 14, 2013) http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevicesAdvisoryCommittee/neurologicalDevicesPanel/UCM240933.pdf
- United States Food and Drug Administration. "Product Classification, Electroconvulsive therapy device." United States Department of Health and Human Services. March 1, 2013. (March 14, 2013) http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?ID=3278
- Wilson, Duff. "F.D.A. Panel is split on electroshock risks." The New York Times. Jan. 28, 2011. (March 14, 2013) http://www.nytimes.com/2011/01/29/health/29shock.html