We are constantly being told that electroconvulsive therapy (ECT) involves “small” or even “very small” electric currents, even though these currents are in the region of 800 milliamps – something which most accounts of ECT avoid mentioning. Long gone are the days when an article in the the Journal of Mental Science (the old name for the British Journal of Psychiatry) could refer to “high voltages and seemingly enormous amperages” although the voltages and amperages of ECT nowadays are about the same as they were in 1949 when that article was written and, as the duration of the electric shock has increased from a fraction of a second to a second or several seconds, the total electrical charge measured in millicoulombs is bigger than it used to be.
So it was refreshing to see a medical student who observed ECT as part of their training actually saying how much electricity was being used – 1200 millicoulombs. On their blog Another Student Doctor (a medical student at Barts and The London School of Medicine and Dentistry) describes what happened when the ECT machine was turned up to full power. The first treatment they observed was uneventful. Then:
The next lady came in soon enough and we debated about whether to stay or not. The psych suggested we did; this lady was having a much bigger dose. Each time you have ECT, you raise the threshold required to trigger a seizure. So after several sessions, or indeed several separate times of doing it, you need to get a bigger zap. This lady required a dose of 1200mC, which is as high as the machine goes.
After the rigmarole that the other lady went through, we waited again for the seizure. Except this time her whole body spasmed like in the movies, and when she relaxed she went into a violent fit that required a couple of us to help hold her down. And this was after her muscles had been “paralysed”. This was the more extreme end of the spectrum and the registrar told me later that it was the first time he’d given that big a dose.
The first edition of the Royal College of Psychiatrists Handbook on ECT, published in 1995, had this to say about such large electric shocks:
The International (IEC 601-1) standard limits the output of an ECT machine to about 500mC, the reasons for which are unclear and the subject of international debate. Administering an output dose in excess of this figure voids IEC and TUV safety approval. We, nevertheless, recommend that ECT machines should be capable of putting out a charge of at least 1000mC, as we are of the opinion that stimulating patients in the 500-1200mC range is justified in approximately 5% to 10% of cases, when patients fail to have adequate seizures at output levels under 500mC despite hyperventilation with oxygen.
The British collateral safety standard for electroconvulsive therapy machines was withdrawn some years ago, at the request of psychiatrists, and there are I believe no plans to replace it. It appears that the international one (IEC 60601-2-14) has gone the same way.