UC HEALTH LINE: Electroconvulsive Therapy Effective, but Often Misunderstood

CINCINNATI—In its depictions in popular culture, electroconvulsive therapy (ECT) evokes images of cruelty, as in the 1975 film "One Flew Over the Cuckoo’s Nest,” or cartoonish comedy, with characters shown hooked up to an elaborate device with their hair standing on end.

That’s unfortunate, a UC Health psychiatrist says, because ECT is vastly different from such depictions and has helped numerous patients cope with psychiatric disorders such as depression and mania. Used correctly and with proper follow-up, it offers the potential for improved quality of life.

"It’s the best mood stabilizer that we know of,” says James Curell, MD, an associate professor in the University of Cincinnati (UC) Department of Psychiatry and Behavioral Neuroscience who administers ECT at UC Health University Hospital. (ECT is also available at the Lindner Center of HOPE, a mental health clinic and UC Health affiliate in Mason, Ohio.)

Curell says ECT’s negative image goes back to the 1940s and 1950s, when there weren’t many treatments available for depression or bipolar disorder.  "It was really overused, and in some cases even abused,” he says.

Later, in "One Flew Over the Cuckoo’s Nest,” the main character—a patient at a mental institution—is subjected to ECT as a means of controlling him. He’s also incorrectly depicted as fully conscious during the procedure—which, incidentally, does not produce the desired effect.

"ECT was portrayed as a punishment rather than a therapeutic procedure,” says Curell. "But the data on it has always been that it’s the most effective treatment for severe depression.”

According to the National Institutes of Health, scientists are unsure of the exact mechanism of ECT. However, it appears to produce changes in the chemistry and functioning of the brain that act to reset the regulation of the patient’s mood. Studies have shown that it increases chemicals such as dopamine which play an important role in mood regulation.

Because it’s technically a surgical procedure and involves the use of anesthesia, ECT carries risks and is therefore not the first course of treatment for depression, Curell says.
A patient will usually be placed on antidepressants or a combination of medication and psychotherapy, but ECT is usually the next course of treatment if there is no improvement in mood.

Curell, who has 20 years of experience administering ECT, performs it on an outpatient basis at UC Health University Hospital. It’s a three- to four-week course of treatment, three times a week. Patients are given a short-acting anesthetic and are asleep for the procedure, and are also given a muscle relaxer to keep them from having contractions.

Electrodes are placed on the head and an electric current is passed through the brain, producing a seizure that lasts about a minute. The entire procedure lasts about five to 10 minutes, and the patient spends time in a recovery room until he or she is fully alert.

Risks associated with ECT, in addition to any risks associated with anesthesia, include headache, upset stomach, muscle aches, memory loss and short-term confusion. Because heart rate and blood pressure increase during ECT, there is a risk of heart attack or stroke.

With successful ECT treatment, the patient continues to make progress in mood stabilization with the help of proper medication and psychotherapy. Research shows that there is about a 50 percent chance of relapse into depression if a proper course of treatment is not followed after ECT.

"ECT alone isn’t enough,” cautions Curell. "You also need to get adequate follow-up treatment.”