Electroconvulsive shock

Electroconvulsive therapy
ECT device produced by Siemens and used at the Eg Asyl psychiatric hospital in Kristiansand, Norway from the 1960s to the 1980s.
Synonyms	Electroshock therapy, shock treatment
ICD-10-PCS	[1]
ICD-9-CM	94.27
MeSH	D004565
OPS-301 code	8-630
MedlinePlus	007474
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Electroconvulsive therapy (ECT), formerly known as electroshock therapy, and often referred to as shock treatment, is a psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders. The ECT procedure was first conducted in 1938 and is the only currently used form of shock therapy in psychiatry. ECT is often used with informed consent as a last line of intervention for major depressive disorder, mania, and catatonia. ECT machines have been placed in the Class III category (high risk) by the United States Food and Drug Administration (FDA) since 1976.

A round of ECT is effective for about 50% of people with treatment-resistant major depressive disorder, whether it is unipolar or bipolar. Follow-up treatment is still poorly studied, but about half of people who respond relapse within 12 months. Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment, the most common adverse effects are confusion and memory loss. ECT is considered one of the least harmful treatment options available for severely depressed pregnant women.

A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient is no longer suffering symptoms. ECT is administered under anesthetic with a muscle relaxant. Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission. Placement can be bilateral, in which the electric current is passed across the whole brain, or unilateral, in which the current is passed across one hemisphere of the brain. Bilateral placement seems to have greater efficacy than unilateral, but also carries greater risk of memory loss. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT.