Is electroconvulsive therapy dangerous?

Is there reason to be concerned that electroconvulsive therapy is dangerous?

Since 1938, when the Italian neurologist Ugo Cerletti introduced electroconvulsive therapy as a treatment for various mental disorders, this technique has been the subject of strong criticism, sometimes based on incorrect information.

Today, after more than 80 years of use, this therapeutic method continues to raise doubts about its efficacy and safety. But what is the reason for this controversy? Is electroconvulsive therapy dangerous? First of all, let's see what this type of intervention consists of.

What does electroconvulsive therapy consist of?

Electroconvulsive therapy (ECT) is a procedure carried out under general anesthesia that consists in introducing small electrical currents through the brain to intentionally trigger a in order to trigger a brief seizure intentionally.

This technique consists of placing several electrodes on the patient's forehead and a rubber band around them through which wires are connected to the machine that controls and executes the electrical mechanism.

During the procedure, the electric current passes from the electrodes to the brain in just a few seconds. This is what triggers the seizure, which usually lasts less than 1 minute. Because the patient is anesthetized and his muscles are relaxed, there is little or no sign that he is convulsing and his body is usually completely immobile.

The ultimate goal of this therapeutic technique is to bring about changes in brain neurochemistry so that some of the symptoms can be quickly reversed. of the serious mental disorders and illnesses it seeks to alleviate.

For what types of disorders is therapy indicated?

The main indication for electroconvulsive therapy (ECT) is major depression that is life-threatening or significantly impairs the individual's functioning. Because of its rapidity of action and efficacy, it may be the treatment of choice in severe psychiatric disorders. in severe psychiatric disorders such as catatonia, depression, bipolar disorder and psychosis..

This technique is considered to be the most effective and fastest acute treatment for treating major depression. According to randomized trials, remission occurs in 70-90% of patients receiving the therapy.

Another specific indication for ECT is psychotic unipolar depression, people with suicidal tendencies and malnutrition secondary to refusal of food, severe catatonia, as well as people with recurrent depressive episodes and treated with this therapy after numerous drug failures.

It is considered that there are no absolute contraindications for ECT, irrespective of the type of population and the type of treatment.irrespective of the type of population and their clinical situation, except for at-risk populations that should be monitored more closely.

Main side effects

As any therapeutic procedure, ECT is not exempt from possible side effects.. These are the most common:

• Memory loss or amnesia
• Muscle discomfort
• Nausea
• Headache
• Confusion

Headaches, nausea and muscle discomfort are usually mild and can be prevented or attenuated with medication. The most unpleasant side effect is usually memory lossThe most unpleasant side effect is usually memory loss, although it reverses and disappears within a few weeks.

It should be clarified, however, that this type of side effect depends on the patient's preconditions, such as age, susceptibility to this type of treatment, the technique used or the frequency of administration.

Is electroconvulsive therapy really dangerous?

There is evidence that electroconvulsive therapy is one of the most dangerous is one of the psychiatric treatments with the highest efficacy and safety rates for the treatment of some mental disorders. for the treatment of some serious mental disorders.

Research has concluded that the most common side effect is memory loss or amnesia. However, this therapy appears to have fewer side effects than those produced by some Antidepressant and antipsychotic drugs in frail elderly patients.

The effects of this technique on the developing brain are not yet known.. In pregnant and lactating women who are concerned about possible teratogenic sequelae (birth defects during gestation of the fetus) and other side effects of medication, it may also be effective, and they can be safely treated with this therapy.

A review of 300 cases of ECT during pregnancy found five cases of congenital anomalies (hypertelorism, clubfoot, optic atrophy, anencephaly and pulmonary cysts). The review concluded that these malformations were not the result of the therapy, and that there was no evidence of postnatal developmental effects.

Clinical research also supports the efficacy and safety of electroconvulsive therapy as a therapeutic tool for relapse prevention in major depressive disorder, including in adolescents. as a therapeutic tool for relapse prevention in major depressive disorder, even in adolescents.

It seems therefore that, in view of the studies and research conducted, the question of whether electroconvulsive therapy is dangerous should be answered with an unequivocal no, at least until proven otherwise.

Efficacy in intervention on disorders

Research indicates that electroconvulsive therapy (ECT) is effective in the short term for the treatment of depression, and is probably more effective than pharmacotherapy for the treatment of psychiatric disorders. probably more effective than pharmacological therapyBilateral ECT (with electrodes on both sides of the head) is moderately more effective than unilateral ECT.

Studies further conclude that high doses of ECT appear to be more effective than low doses in the treatment of severe mental illnesses such as depression and bipolar disorder. In addition, ECT is also shown to be effective in severe bipolar depression.

ECT would also be indicated in children and adolescents with severe and persistent major depression, with symptoms that put them at risk of depression.with life-threatening symptoms or unresponsive to other treatments. However, in this type of younger population, ECT should be used exceptionally and always carried out by a qualified professional.

All in all, ECT is a therapy reserved only and mainly for patients with severe and persistent symptomatology, especially when they have not responded to other types of treatment or when there is a real serious threat to their life.

Bibliographic references:

• Gallegos J.; Vaidya P.; D'Agati D.; et al. (2012). Decreasing adverse outcomes of unmodified electroconvulsive therapy: suggestions and possibilities. The Journal of Electroconvulsive Therapy. 28 (2): 77 - 81.
• Fitzgerald, P.B. (2013). Non-pharmacological biological treatment approaches to difficult-to-treat depression. The Medical Journal of Australia. 199(6): 48 - 51.