Bringing electro-shock therapy into the modern era

With all muscles contracting at once, the patient’s body would arc back on itself like the death pose seen in dinosaur fossils or a grotesque yoga position. Teeth would clamp down on a piece of pipe as air hissed out of the lungs. Legs and arms might thrash wildly, and faeces, urine, and for men, even semen could be ejected from the body as a result of straining every sinew. Bones could be fractured, especially those in the spine and around the shoulders and hips. (These were hairline fractures often only seen in X-rays and which healed quickly, but obviously still undesirable). Then there were reports of memory loss. After regaining consciousness, some patients wondered where they were, how they got there, even to whom they were married. Although their memories would normally return days or weeks after the treatment, some patients seemed to lose memories forever.

“If the [founders of ECT] were to see what happens in a clinic today,” says Max Fink, a retired psychiatrist who used ECT from the early 1950s, “they would see the patient lying on a table, electrodes applied, current supplied, and some movements of the patient’s foot… And that’s it.”

As early as the 1940s, ECT had been combined with an anaesthetic and a muscle relaxant that stopped the body from convulsing, prevented any fractures or ejections, and ensured that the patient was asleep throughout... The convulsion only occurs in a person’s brain, as revealed by an electro-encephalogram (EEG) that records brain activity.

This ‘modified ECT’, as it became known, was much safer. It reduced the mortality rate to around 1 in 10,000 patients – a probability lower than that of general anaesthetic itself. As one doctor from Chicago Medical School wrote in 1997, “To put the mortal risk with ECT in proper perspective, it is only necessary to note that ECT is about 10 times safer than childbirth.”

“The truth remains [that] it’s an incredibly good treatment,” says Vikram Patel, a professor at Harvard Medical School. “It’s a life-saving treatment, one of the few we have in psychiatry. I actually have never seen any treatment in psychiatry work as phenomenally as ECT has.”

In 2004, a study from the Consortium for Research in ECT (CORE), a programme funded by the National Institute of Mental Health, found that out of 253 patients with severe and psychotic depression, 238 (94%) responded with a significant reduction in their depressive symptoms as gauged by a standard questionnaire. In total, 189 (75%) of patients achieved full remission after an average of seven sessions of ECT spread over three weeks. Ten people (4%) dropped out because of memory problems or confusion.
http://www.bbc.com/future/story/20180502-the-surprising-benefits-of-electroshock-therapy-or-ect