Perhaps you have a loved one who struggles with depression. Hopefully, they are seeking the treatment they rightfully deserve. However, what happens if the “typical” forms of treatment are not effective enough? What if they have already tried multiple forms of therapy, cocktails of medications, all with little to no success?
Typical forms of treatment for depression include psychotherapy, specifically cognitive behavioral therapy (CBT), and/or antidepressants. However, a study was conducted where 100 clinically depressed patients were given antidepressants, and only about 40 to 60 of the individuals reported an improvement in their symptoms within six to eight weeks. CBT has been found to effectively help eliminate symptoms in around 55 to 75% of depressed patients, which may seem pretty effective. But what about the people who are not relieved by these treatments? Severe depression can feel suffocating, and when no treatments seem to provide enough relief, individuals may begin to feel even more hopeless. When this happens, and all other forms of treatment have failed, a procedure called electroconvulsive therapy (ECT) may be suggested.
Focusing just on it’s name, electroconvulsive therapy sounds like an intimidating experience. Nevertheless, it’s important to understand how ECT works, who it treats, when it is used, and how successful it can truly be. Electroconvulsive therapy is a medical treatment most commonly used in patients with severe major depression or bipolar disorder who have not responded to other typical treatments (“What is ECT”, 2018). When the therapy is taking place, the patient will be under general anesthesia. Small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry, which may ease symptoms of mental health disorders such as depression and bipolar disorder (“Electroconvulsive”, 2018). Although doctors are not exactly sure how inducing a seizure helps relieve depressive symptoms, researchers at Johns Hopkins have recently found that new brain cells develop in the brain’s hippocampus after ECT, which is likely to contribute to the treatment’s success (“How ECT Relieves”, 2018).
Hearing that ECT causes the brain to have a seizure may sound terrifying to some, and deter them from seeking this treatment. However, the entire procedure only lasts around 10 minutes. The patient is given the anesthesia and a muscle relaxant to dull the physical convulsions of the seizure. A blood pressure cuff is placed around the patient’s ankle, blocking the muscle relaxant from entering the foot. Rhythmic movement of the limb is the only visible sign that the seizure has occurred. Even though the outward signs of ECT are minimal, the procedure causes brain activity to skyrocket. A test called an electroencephalogram (EEG) records the electrical signals in the patient’s brain. Sudden increases in activity indicate a seizure. When they level off, the seizure has ended and that treatment session is over (“Electroconvulsive”, 2018).
The amount of ECT sessions a patient will need completely depends on the severity of their depression or other mental disorder. Doctor’s base treatment length on how the patient reports feeling, and the number of depressive symptoms that still linger. Generally, the patient should expect to receive treatment two to three times weekly for three to four weeks for optimal results (“Electroconvulsive”, 2018).
With this all being said, it is still important to understand and recognize that ECT is not a cure, but a treatment. To prolong its effect, it is common for patients to continue psychotherapy or to continue taking antidepressants after ECT is over. Again, ECT is only recommended for those who have already tried medication and therapy and failed to see improvement in depressive symptoms. A combination of psychotherapy and antidepressants are successful in treating around 75% of cases of mild to moderate depression. ECT is seen as an option for the remaining 25% of individuals who are not helped with the traditional treatments. Clinical evidence indicates that for individuals with severe major depression not treated by antidepressants, ECT will produce substantial improvement in approximately 80% of patients (“What is ECT”, 2018).
American novelist and poet, Sylvia Plath, suffered from severe depression for the majority of her life and actually received ECT treatment in the 1950’s when the procedure was still experimental; without anesthesia, she was completely awake and aware the entire time. Ernest Hemingway, another American writer, also suffered from depression and other mental conditions. Hemingway also tried ECT in hopes for some relief. Modern day ECT has promising results with sessions improving depression in 70 to 90 percent of patients. Perhaps Plath and Hemingway could have had a happier ending if they had the procedure today and continued treatment with a combination of psychotherapy and medication.
CH;, K. (n.d.). Electroconvulsive therapy (ect) IN literature: Sylvia Plath’s the Bell Jar. Retrieved February 20, 2021, from https://pubmed.ncbi.nlm.nih.gov/24290484/
Electroconvulsive therapy (ect). (2018, October 12). Retrieved February 20, 2021, from https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894
What is electroconvulsive therapy (ect)? (n.d.). Retrieved February 20, 2021, from https://www.psychiatry.org/patients-families/ect
How ect relieves depression. Retrieved March 01, 2021, from https://www.hopkinsmedicine.org/news/articles/how-ect-relieves-depression