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About 9 years ago, my cousin in California confided in me that she was still undergoing electric-shock-therapy for her severe depression. I was sure this form of treatment was on it's way out of the medical practice, but she said she still had regular appointments for it. Almost a decade has past, is this form of treatment still occurring in the USA?

Although she (and others) are under anesthesia when the ECT occurs, how do they prevent electrocution from happening? How does it work exactly?

  • ECT is a very effective treatment for chronic major depression that has not responded adequately to other treatment approaches. Psychologists are not medical doctors and do not provide ECT. Psychiatrists are medical doctors and are the primary physicians to provide this treatment, along with anesthesiologists and nurses. Answers to your questions are abundantly available on the Internet. I do not mean this as a criticism as it is a very good question. – Mark D Worthen PsyD Jul 19 '17 at 0:32
  • Reading over your last two questions again, I see they are specific. I will answer later this week if your query remains unanswered. – Mark D Worthen PsyD Jul 19 '17 at 2:22
  • @MarkDWorthenPsyD do you want to come and answer the question as promised? – Graham Chiu Mar 12 '18 at 23:45
  • What do I get? ... ;^] // Just kidding. I’ll put it my to-do list. • – Mark D Worthen PsyD Mar 14 '18 at 19:08
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Also provided at the Medscape webpage linked by @GrahamChiu,

Electroconvulsive therapy (ECT) has been demonstrated by the American Psychiatric Association to be an effective and safe treatment for many psychiatric disorders. (Jaffe, 2001) The use of ECT still generates significant controversy, however. One review concluded that ECT is only marginally more effective than placebo (ie, sham ECT). (Ross, 2006) ECT has been viewed as harmful by the general public, (Lauber, et al., 2005a) psychiatric patients, (Arshad, et al., 2007) and mental health professionals. (Lauber, et al., 2005b)

ECT has also been perceived as a form of violence against women. (Burstow, 2006) It has been negatively portrayed in movies such as One Flew Over the Cuckoo's Nest, House on Haunted Hill, and Requiem for a Dream. (McDonald & Walter, 2001)

Despite such debate, ECT is used in the United States and endorsed by the American Psychiatric Association. (APA, 2015)

References

APA (2015). Electroconvulsive Therapy (ECT) Position Statement.
Available at: https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2015-Electroconvulsive-Therapy.pdf

Arshad, M., Arham, A. Z., Arif, M., Bano, M., Bashir, A., Bokutz, M., ... & Khan, M. M. (2007). Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan. BMC psychiatry, 7(1), 27.
DOI: 10.1186/1471-244X-7-27

Burstow, B. (2006). Electroshock as a form of violence against women. Violence against women, 12(4), 372-392.
DOI: 10.1177/1077801206286404

Jaffe, R. (2001). The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. A Task Force Report of the American Psychiatric Association. 2nd ed. Washington, D.C.: American Journal of Psychiatry.
DOI: 10.1176/appi.ajp.159.2.331

Lauber, C., Nordt, C., Falcato, L., & Rössler, W. (2005a). Can a seizure help? The public's attitude toward electroconvulsive therapy. Psychiatry research, 134(2), 205-209.
DOI: 10.1016/j.psychres.2004.07.010

Lauber, C., Nordt, C., & Rössler, W. (2005b). Recommendations of mental health professionals and the general population on how to treat mental disorders. Social psychiatry and psychiatric epidemiology, 40(10), 835-843.
DOI: 10.1007/s00127-005-0953-7

McDonald, A., & Walter, G. (2001). The portrayal of ECT in American movies. The journal of ECT, 17(4), 264-274.
Available from: [https://journals.lww.com/ectjournal/Fulltext/2001/12000/The_Portrayal_of_ECT_in_American_Movies.6.aspx]

Ross, C. A. (2006). The sham ECT literature: implications for consent to ECT. Ethical Human Psychology and Psychiatry, 8(1), 17.
[Medline]

  • Wasn't the ECT in the movie used against a male? It was a long time ago that I saw that movie. – Graham Chiu Mar 12 '18 at 23:09
  • @GrahamChiu In "One flew…" it was a male. at-Chris: A little heavy on refs and a little light on actual answer ;) (Your usage of fullstops is confusing for me. Would it violate your learned guidelines to set the point after the inline quote that belongs to a statement?) // But Graham points at an interesting thing: Why just as "violence against females"? – LаngLаngС Mar 13 '18 at 0:22
  • New article: Ross EL, Zivin K, Maixner DF. Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States. JAMA Psychiatry. 2018;75(7):713–722. doi:10.1001/jamapsychiatry.2018.0768 – Mark D Worthen PsyD Jul 6 '18 at 7:46
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Approximately 100,000 patients annually receive ECT in the United States.

and

In the United States, ECT is most commonly performed 3 times per week regardless of electrode placement. [1] More frequent regimens are not justified. [1] Treatments 2 times per week may result in less memory impairment than treatments 3 times per week. [1, 9] Compared with treatments administered 3 times per week, twice-weekly treatments result in the same degree of final clinical improvement, although possibly at a slower rate of response. [1]

https://emedicine.medscape.com/article/1525957-overview

Electrocution requires a voltage of over 500 V, and ECT is kept below this.

ECT used to defined by the voltage used but now

The dose is measured in millicoulombs of charge delivered

Mechanism of action

The mechanism of action of ECT is not fully known. ECT affects multiple central nervous system components, including hormones, neuropeptides, neurotrophic factors, and neurotransmitters. [13]

The induction of a bilateral generalized seizure is required for both the beneficial and adverse effects of ECT. [9] An increase in gamma-aminobutyric acid (GABA) transmission and receptor antagonism has been observed, which raises the seizure threshold during ECT. [14] ECT may also lead to an increase of endogenous opioids, which may also have anticonvulsant properties. [12]

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