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Depression Tough-To-Treat: Shock Therapy Safe And Effective

In the past, “shock” therapy has helped to lift severe depression. However, fear and stigma can keep patients from seeking this service. Another large study now confirms the safety of the treatment.

It has been around for ages, as it is known medically as electroconvulsive therapy (ECT). It’s been portrayed in a bad light – fuelled by disturbing media portrayals such as the 1975 film “One Flew Over the Cuckoo’s Nest.” Today, we use ECT in treating severe depression when standard antidepressants fail to provide relief.

Depression Tough-To-Treat: Shock Therapy Safe And Effective

Recent research in The Lancet Psychiatry journal confirms that ECT does not carry serious medical risks. The chances of dying over the next month or getting into the hospital for any medical problem were not higher among ECT patients than other patients with a serious depressive episode who received ECT. 

Depression Tough-To-Treat Shock Therapy Safe And Effective

The study found that patients receiving ECT were less likely to die by suicide after hospital discharge if the treatment had saved some lives. Psychiatrist and assistant professor Joshua Berman of Columbia University Medical Center, New York: This supports what we’ve seen in less systematic studies and from our own experience. The study does not involve Berman, but he believes that ECT is very effective. However, it’s generally safe, as long as you don’t do anything risky.

ECT can have short-term side effects, such as memory impairment and learning difficulties. The memory of past events may be permanently damaged for some patients. The procedure, however, is often viewed as more dangerous. During the study, researchers led by Dr. Tyler Kaster of the University of Toronto reported that 20% of respondents said that ECT prompted fear of death.

Positive media portrayals, he and Berman said, are among the reasons. People may have heard other cases where an older relative did not have a good experience with the treatment, Berman said. Electrical pulses are delivered to the brain using electrodes on the head in an attempt to cause a brief seizure. When that was first done, patients suffered severe injuries, including bone fractures, and were likely to die.

To prevent seizure-related injuries, most patients nowadays undergo general anesthesia during ECT and take muscle relaxants before the procedure. According to several studies, ECT has the same risk of complications as other “low-risk” procedures.

Compared to other depression patients who did not undergo ECT, the new study is more comprehensive in that it assesses depression patients who had ECT with others who did not. The data is based on the analysis of over 10,000 medical records collected by Kaster’s colleagues at the Centre for Addiction and Mental Health. The patients had been hospitalized during the period 2007-2017 with severe depression in Ontario, Canada.

Compared with similar patients who had not received ECT, half of the patients had received ECT. One-tenth of those receiving ECT for 30 days experienced a major medical event, the study found. The number of patients who received ECT was 137 compared to 135 who did not receive it. Deaths that were not suicide or hospital admissions due to medical complications were included.

In hospitals, suicide is uncommon after patients leave. Even so, the risk of suicide was substantially lower after ECT: Just five suicides occurred in that group compared to 11 cases in the comparison group. According to Kaster, the study did not measure the effectiveness of ECT. According to the American Psychiatric Association, ECT is estimated to significantly improve symptoms of severe depression for up to 80% of patients. Then they have not been cured. Kaster said relapse is possible without ongoing treatment, such as medication and counseling. ECT treatment sessions are sometimes needed for “maintenance”.

ECT’s mechanism of action is not entirely clear. In reality, Berman said that the system appears to employ several mechanisms. The stimulation of specific brain regions known to respond to antidepressants has been found to improve cell communication. ECT generates neurotrophic factors, which can promote the growth of brain cells, according to Berman.

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