How many times have we come across the allusion of One Flew Over the Cuckoo’s Nest when anybody talks or writes about Electroconvulsive Therapy (ECT) or “Shock Therapy”? Jack Nicholson’s brilliance on screen still hovers in the minds of the populace. The picture of him laying in bed, held by two men in white, a rubber piece in his mouth, an unknown amount of current passing into him through a white headed prong and his extraordinary facial expressions of pain send shivers down one’s spine. Fortunately, none of that stands true!
For long, ECT as a treatment modality has faced insinuation from the human right activists and from those who are struck by the lack of cognizance. To fandangle it, the media and mental asylum fascinated TV shows have tarnished the image of one of the most powerful tools in the field of psychiatry. My first hands-on experience in ECT was during my residency training in USA. Like others, I too had notions and some aspersions about ECT before witnessing it live.
Patients and their families are petrified by ECT because of fallacies they have about ECT, such as high voltage electricity passing through the body, one might feel severe pain, their bones would break because of rigorous seizures, and they would experience significant memory loss. It is imperative to acknowledge that ECT is not a new treatment modality with which we have no experience, however, if you search on PubMed (http://www.ncbi.nlm.nih.gov/pubmed/?term=electroconvulsive+therapy) with keyword electroconvulsive therapy, there are more than ten thousand research articles written on it in the past half a decade. It is the fastest and best treatment option available for the psychiatric illnesses like severe psychosis, catatonia, and recurrent suicidal ideations. ECT can be more effective than medications for the treatment of refractory depression. In addition, according to a study recently published in the Journal of ECT by Ray-Griffith et al, “Electroconvulsive therapy is a safe and effective treatment during pregnancy and of particular benefit in the acute treatment of suicidal ideation.”
Like any other procedure, ECT too, has minimal side effects. The common sides effect are confusion immediately after the treatment, which lasts for a few minutes to a few hours, and some memory loss, which generally improves within a few weeks. The entire procedure endures for 5-10 minutes while the seizure lasts for less than 45-120 seconds. During the ECT the patient is given general anesthesia, and muscle relaxants, so that the patient does not feel any pain or has any subjective awareness of the procedure. If one were watching oneself receive ECT, one would see nothing but one’s toes wiggle and a slight movement in the body.
Throughout the treatment, an anesthesiologist inspects the patient and supervises his vitals, heart rhythm, and oxygen level. The patient might feel some side effects post-ECT, like nausea, dizziness and muscle aches, which are temporary and usually relieved by over the counter anti-emetics and analgesics. Prior to the treatment, the ECT specialist fully examines, orders investigations, and might consult other specialties to rule out any medical condition, which might affect the procedure.
After several days of training, I went back to my daily routine- my outpatient clinic. One of the patient’s to whom I recommended ECT, asked me, “Will you advocate the same for your family or for yourself”. My answer was, “Yes! I will choose ECT for my family and myself.”