Childhood trauma can lead us to become severely clinically depressed as adults, and this happened to me. Electroshock therapy or electro-convulsive therapy (ECT) is only used as a last resort on people who are at high risk of suicide and/or are unable to function in even the most basic areas of life.
ECT is, in fact, misunderstood by the vast majority of people – many see it as barbaric and frightening. Such views, in large part, are derived from the popular media (e.g. from films such as ‘One Flew Over the Cuckoo’s Nest’). However, most controlled research suggests that ECT is helpful as a treatment for severe depression (e.g. Pagnia et al., 2004; Ekstrand et al., 2021).
The procedure involves small electrical currents being passed through the brain (whilst the client is under general anaesthetic) which is thought to alter the brain’s chemistry.
It is normally only used for moderate or severe depression when other interventions, such as psychotherapy and drug treatment, have failed and/or the mental illness of the individual is so severe that it is life-threatening. And, according to The National Institute for Health and Care Excellence (NICE) it may also be useful in some cases of catatonia or severe and long-lasting episodes of mania.
There are, though, some risks. Approximately 2-10 patients per 100,000 treatments (i.e. less than 0.01%) die during the procedure – however, this is no higher than the risk of dying from anaesthesia alone (patients have a general anaesthetic before undergoing ECT). Some patients also report memory problems as a result of the treatment.
After the treatment patients might have headaches, aching muscles or nausea. Also, some patients experience some memory loss (but, generally, only mildly) which can last up to six months (Sackeim et al. 2007).
Patients who undergo ECT, however, tend to view it positively. In one study, 98% of patients who received it said they’d undergo it again if their depression recurred (Pettinati et al., 1994).
MY OWN PERSONAL EXPERIENCE OF ELECTRO-CONVULSIVE THERAPY (ECT).
My own depression was so severe and protracted that I underwent ECT sessions (an ECT treatment session normally comprises blocks of 6 individual treatments) on more than one occasion. I was suicidal and almost completely unable to function (not even able to carry out the most basic self-care, such as shaving, brushing my teeth or taking a bath or shower). As I say, these periods went on for several months, or years, at a time.
Frankly, I did not care whether I lived or died (actually, that’s not quite true, I wanted to be dead), nor what happened to me. Thus, when I was hospitalized, my psychiatrist strongly advised me to undergo ECT. I put up no resistance, nor would I have had the energy or will to do so.
Over the years, each time I underwent ECT sessions, the results were pretty much the same, so I’ll just describe the effect of one set of treatments:
The best thing about it was being given the general anaesthetic – such was the extreme nature of my mental anguish that I constantly longed to be unconscious (or dead). Unfortunately, however, the treatment is quick so one is only unconscious for a few minutes!
When I awoke, I’d have very bad, pounding headaches and many of my muscle groups would be painful. Sometimes, I’d need to walk with a stick for a few days after the treatment until the muscles in my legs recovered.
Also, and this was frightening, for about the first five or ten minutes after the treatment I would be so disoriented and confused that I did not know where I was, or even WHO I was. It is impossible for one to imagine how disturbing this is until one has experienced the sensation for oneself. Fortunately, as I said, this did not last long.
On the topic of memory, it felt to me that my memory was impaired for a couple of years after the final treatment session (though not severely). I would make the point, however, that severe clinical depression in itself can impair memory so I cannot attribute it to ECT without some equivocation.
Finally, and most importantly, my own ECT did not have any beneficial effect on me whatsoever; my depression was not even slightly ameliorated.
Obviously, overall, my experience of ECT was fairly negative. However, it is necessary to stress that I am, of course, just one patient out of thousands who have received ECT, so not very much can be concluded from my personal experience. The research I have already quoted suggests that, for the majority, it is beneficial. Indeed, there are many who believe it has saved their life.
A more recent treatment, alternative therapy involving the application of magnetic waves to the brain is known as Transcranial Magnetic Stimulation (TMS).
Ekstrand J, Fattah C, Persson M, Cheng T, Nordanskog P, Åkeson J, Tingström A, Lindström MB, Nordenskjöld A, Movahed Rad P. Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT). Int J Neuropsychopharmacol. 2021 Dec 4:pyab088. doi: 10.1093/ijnp/pyab088. Epub ahead of print. PMID: 35020871.
Pagnin D, de Queiroz V, Pini S, Cassano GB. Efficacy of ECT in depression: a meta-analytic review. J ECT. 2004 Mar;20(1):13-20. doi: 10.1097/00124509-200403000-00004. PMID: 15087991.
Pettinati, Helen M. et al. “Patient attitudes toward electroconvulsive therapy.” Psychopharmacology bulletin 30 3 (1994): 471-5 .
Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007 Jan;32(1):244-54. doi: 10.1038/sj.npp.1301180. Epub 2006 Aug 23. PMID: 16936712.
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David Hosier. BSc Hons; MSc; PGDE(FAHE).