Is Electroconvulsive Therapy Still In?
Centuries-old treatment survives controversy over its use
By Miles Dumalagan
First used in the 18th century, electroconvulsive therapy or ECT remains an effective treatment for patients with depression, mania and, in some circumstances, schizophrenia. Because ECT requires using electricity to induce seizure, it understandably sends chills down the spine of many laypersons, patients, and their families.
The idea that all a doctor has to do is "push the button" instills fear that going through ECT would be a horrific experience that can cause brain damage and severe side effects. It is often perceived as a form of punishment.
Thus, ECT is more often employed as a last resort in only the most severe cases of suicidal depression when medication is no longer effective and has even become dangerous.
However, its use remains controversial because some patients experience more negative than positive effects. Side effects and relapse are often observed. Death is also a possibility. On the other hand, its antidepressant effects are immediate.
Some argue that there is no question about the indications for ECT and its efficacy in alleviating severe mood disorders as long as it is properly done. While some say that ECT is brain-damaging or brain-disabling, research has not been able to find tangible evidence of long-term brain changes when ECT is properly administered. Also doctors are now more familiar and careful with the equipment.
Because patients and their families are often apprehensive about ECT, they must be told of its beneficial and adverse effects. Other treatment options must also be explained. Informed consent must be obtained and noted on the patient's medical record.
Many agree that ECT should be reserved for patients requiring urgent treatment with the full consent of a legally appointed guardian. And it should not be performed on patients with increased risk of morbidity such as those with space-occupying cerebral lesions or other conditions that increase intracranial pressure, recent myocardial infarction associated with unstable cardiac function, recent intracerebral hemorrhage, unstable vascular aneurysm or malformation, retinal detachment, and pheochromocytoma. The prevalence of these conditions increases with age. Records show that ECT-related medical complications are more likely in the elderly (particularly the oldest age groups), in those with preexisting medical conditions (particularly cardiac illness), and in those receiving concurrent medication.
What remains unknown is why electroconvulsive therapy is effective. A plethora of studies show the neurochemical correlates of this treatment and its relation to antidepressant effect. But they have not been conclusive.
Psychiatrist Aida L. Muncada of the National Center for Mental Health says ECT is still being done at the NCMH. Said Muncada: "And just maybe to correct the notion-the stigma and myths attached to it-ECT still has value in NCMH as an adjunct, fast-acting treatment, especially for those who are suicidal ... because if we don't put a stop to their suicidal thoughts, we might end up with a dead patient."
She stressed though that it is used only for specific indications and is generally not administered to children. "Yung talagang highly-resistant to any form of pharmacotherapy, behavior therapy, and all other therapies; cases
na hindi talaga ma-control ang behavior," she said. "We have to evaluate the patient medically and physically; we have to obtain medical clearance and family consent before initiating it."
Muncada said ECT is not routinely used for schizophrenia patients. Although sometimes, "we get really very aggressive, hostile, and destructive patients in whom no amount of pharmacotherapy works, so ECT is resorted to."
Dr. Toribio V. Jovellanos, chair of the department of psychiatry at the University of Perpetual Help, concurs: "ECT is administered to patients with catatonic stupor, and for emergency procedures for severely agitated schizophrenic patients, or
yung mga nanggugulo."
Modified ECT requires general anesthesia, muscular relaxation or paralysis, and oxygenation. Patients are usually given oxygen from the onset of anesthesia to the resumption of adequate spontaneous respiration, except for the brief interval of electrical stimulation. Modified ECT can be administered in hospitals with complete facilities and the presence of an anesthesiologist
But just like any other treatment recommendations, the decision to suggest ECT to a patient should be based on effectiveness of treatment options and risk-benefit considerations.
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