A strange electroconvulsive therapy fact sheet from NAMI

Electroconvulsive therapy (ECT) is a very simple treatment. You give someone an electric shock and they have a seizure. If you have ECT nowadays in many parts of the world, including the United States, the procedure is always done under anaesthetic and you are injected with a muscle paralysing drug to prevent the convulsions that would otherwise accompany the seizure. But you still have the seizure. In fact, the seizure is thought to be the main therapeutic ingredient of ECT. There is one psychiatrist in the United States, William T. Regenold, associate professor of psychiatry at the University of Maryland in the US, who is experimenting with deliberately giving people electric shocks below their seizure threshold (something I wrote about in a previous post) but if you are being treated by anyone else the aim of ECT is definitely to produce a seizure.

So it is rather odd that NAMI (National Alliance on Mental Illness) Minnesota have produced a three-page fact sheet on ECT (updated 11 December 2011) which doesn’t once mention the seizure. Here is NAMI’s description of what happens during ECT:

“ECT is performed under general anesthesia, which puts
the person to sleep. People also receive muscle relaxant medication, which keeps them still…. Electrode pads are placed on the person’s head at precise locations. They are either placed on both sides of the brain, called bilateral ECT, or on one side, called unilateral ECT. Once the anesthetic and muscle relaxant take effect, the doctor presses a button on the ECT machine. This causes a short, controlled set of electrical currents to pass through the electrodes into the person’s brain. This lasts only a few seconds. An electroencephalogram (EEG) records the person’s brain activity. The EEG will show a sudden increase in activity as soon as the treatment begins.”

The alert reader may wonder why they need to kept still if they are under general anaesthetic, or what the increase in EEG activity is all about, but there is no mention of a seizure.

Most patient information leaflets of course talk about an electric current rather than an electric shock, but it is bizarre how NAMI talks about “currents” in the plural, or indeed how they talk about electrodes at “precise locations”, or how in the fact sheet’s first sentence they define ECT as a “type of brain stimulation therapy”. It sounds almost as if they are trying to align ECT with deep brain stimulation, where electrodes are inserted into the brain.

The leaflet continues with a section entitled “How has ECT changed over time” which makes the usual misleading claims.

“Today, electricity is administered as an extremely quick pulse instead of a steady stream.

Less electricity is used in ECT therapy today.

People receive far fewer ECT treatments today.”

In fact, the amount of electricity used in ECT today is much the same (volts, amps and millicoulombs) as it was in the olden days. Don’t forget that while today the electric shock, or “short, controlled set of electrical currents” (as the leaflet puts it) in ECT last “only a few seconds”, the forebears of today’s psychiatrists gave people an electric shock lasting a fraction of a second. Brief-pulse (as opposed to sine-wave) refers to the waveform and, although it is now preferred, doesn’t make ECT into a whole different treatment, which is probably why some hospitals in the United States were still using sine-wave in the late 1990s (and may, for all I know, still be doing so – there are certainly hospitals in other parts of the world still using sine-wave). Brief-pulse, and ultra-brief pulse, waveforms were incidentally first used in the 1940s.

Do people today really receive far fewer treatments today than they used to? In the early days of ECT some people received large numbers of treatments and others received only a few treatments. The same is true today; someone can still have large numbers of treatments by having long courses of ECT, multiple courses of ECT and/or maintenance ECT.

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