The Neuroscience of "Electroshock" Therapy (ECT) 🧠
Brainwaves of Hope: The Science, History, and Future of Electroconvulsive Therapy (8min Read)
Electroconvulsive therapy (ECT) was first administered in 1938 and was misused and abused during its early years.
However, it has since evolved into a safe and effective treatment for various psychiatric conditions.
ECT works by resetting the HPA axis, modulating brain regions, stimulating neurotransmitters, altering the immune system, up-regulating BDNF, and enhancing neuroplastic changes and neurogenesis.
While ECT has potential side effects, the benefits often outweigh them for those with severe, treatment-resistant mental illnesses.
Few Mental Illness treatments have been as misunderstood and stigmatized as electroconvulsive therapy (ECT), popularly known as electroshock therapy.
The mere mention of the term often conjures up images of a barbaric procedure straight out of a horror movie.
But is ECT really the inhumane therapy many believe it to be? Short answer, no, not at all!
Let's delve deeper into the world of modern ECT to separate fact from fiction.
How It All Started
I don’t know about you, but I was so curious to figure out who on earth came up with the idea that electrocuting a human could be beneficial.
It turns out it was actually two people, Dr. Ugo Cerletti, an Italian neuropsychiatrist, and Lucio Bini, an electrical engineer.
Cerletti and Bini got inspiration from an unlikely source: a Roman slaughterhouse.
They noticed how electric shocks were used to render pigs unconscious before slaughter, preventing pain and suffering.
This observation sparked an audacious idea: could electric shocks have a similar therapeutic effect on the human brain?
Gotta be honest, this wouldn’t be my first thought after seeing this…
Nevertheless, Cerletti and Bini set out to test their hypothesis.
In 1938, they administered the first-ever electroconvulsive therapy (ECT) treatment to a man suffering from severe depression and hallucinations.
To their astonishment, the man's condition improved dramatically, and thus, ECT was born!
The Dark Side
ECT held great promise for treating psychiatric ailments.
However, its rapid adoption and misuse during its early days cast a shadow over ECT that would haunt it for decades.
For example, in the mid-20th century, asylums were bursting at the seams with patients.
Desperate for a quick and easy solution to manage the swelling numbers, some doctors turned to ECT, wielding it like a magic wand to "zap" the unruly into submission.
In this grim setting, ECT became a tool of control rather than a beacon of hope.
One story I found involved a woman named Mary, who was admitted to an asylum for "hysteria" and "rebelliousness."
She was deemed "difficult" by the staff, Mary found herself strapped to a table, electrodes pressed to her temples, and jolts of electricity surging through her brain.
The violent convulsions (a grand mal seizure) that followed left her disoriented and confused, but meek and submissive.
The doctors considered the procedure a success, but this traumatic experience left Mary mentally and emotionally scarred for life.
In these early years, ECT was often administered without the use of anesthesia or muscle relaxants.
Patients were fully conscious and aware, experiencing the terror of the impending shock.
The intense convulsions sometimes led to broken bones and other injuries, further cementing ECT's reputation as a barbaric and inhumane practice.
Welcome to Hollywood
Naturally, these chilling stories spread like wildfire, and Hollywood soon caught wind of the drama.
In the 1975 film "One Flew Over the Cuckoo's Nest," the character Randle McMurphy, played by Jack Nicholson, undergoes a harrowing ECT procedure.
The film's portrayal of ECT as a cruel and punitive measure only served to further stigmatize the treatment in the public's eye.
Despite this stigmatization, a wave of innovation swept through the world of ECT.
Anesthesia and muscle relaxants became standard practice, dramatically reducing the risk of injury.
Meanwhile, researchers tinkered with treatment parameters, such as electrode placement and stimulus intensity, refining the therapy to maximize its benefits while minimizing side effects.
Fast forward to the present day, and ECT has evolved into a safe and effective treatment for various psychiatric conditions, including major depression, bipolar disorder, and even some cases of schizophrenia.
With a growing body of neurobiological evidence supporting its efficacy, ECT has shed its dark past and emerged as a vital tool in the psychiatric arsenal.
Carrie Fisher(Star Wars) & ECT
In fact, today, there are many many more success stories than horror stories!
One of those is Carrie Fisher, the beloved actress known for her iconic role as Princess Leia in the "Star Wars" franchise.
That’s right, Carrie battled bipolar disorder and substance abuse throughout her like and credited ECT with saving her life and providing her with stability during her most tumultuous times.
How Does It Work?
A modern ECT session is always administered by a team of medical professionals at a hospital or clinic.
Here’s a basic outline of the procedure:
The patient lies in a bed and gets general anesthesia, ensuring they're asleep and pain-free during the 5-10 minute procedure.
A muscle relaxant is administered to prevent movement during ECT.
Electrodes are placed on the patient's head, targeting the temporal cortex. They can be on both sides (bilateral) or just the right side (right unilateral) for fewer side effects.
With the patient asleep and muscles relaxed, a 500-900 milliampere current is sent through the electrodes for 1-6 seconds, causing a controlled seizure lasting under 60 seconds.
As the anesthesia and relaxant wear off, the patient is moved to a recovery room. They may be confused for a few minutes to hours but can usually resume daily activities within an hour.
Results vary; some notice improvement after one session, while others need 2-3 weekly sessions for 3-4 weeks to see effects.
What’s the Neuroscience?
So, how on earth does this work?!
Most of us are taught that getting electrocuted would be very bad, so why is it so beneficial in this case?
As always, Neuroscience can help us figure this out.
While this is a continuously expanding field of research, here are some of the reasons we think ECT works.
Resetting the HPA Axis:
The HPA Axis is involved in our stress response, and ECT may help reset our HPA Axis.
This allows us to respond to stress more effectively, and decrease inflammation that chronic stress can produce in our mind, brain & body.
Functional Connectivity of Key Brain Regions:
ECT has been shown to modulate the functional connectivity of different brain regions like the anterior cingulate cortex (ACC), thalamus, prefrontal cortex (PFC), limbic system, and hippocampus.
This improves communication between these areas which are all implicated in mood regulation.
This enhanced connectivity is vital for enabling more balanced emotional responses.
The therapy can also stimulate the release of essential neurotransmitters such as serotonin, dopamine, and norepinephrine.
These chemicals play a pivotal role in mood regulation and are often found to be imbalanced in individuals with psychiatric disorders.
Alterations in the Immune System:
ECT has the ability to modulate the immune system, potentially reducing inflammation and bolstering overall brain health.
A healthy immune system is crucial for optimal cognitive and emotional functioning.
This is something we talk a lot about at Mind, Brain Body Lab, because we find low-grade chronic inflammation to lead to many mental & emotional issues with clients.
Up-Regulation of BDNF:
ECT has been shown to promote the production of brain-derived neurotrophic factor (BDNF).
BDNF, which is like Miracle Grow for your brain, supports neural growth and survival, fostering a more resilient brain.
Neuroplastic Changes & Neurogenesis:
ECT can stimulate the growth of new neurons, contributing to the brain's ability to adapt and recover.
This proliferation is essential for maintaining optimal cognitive and emotional functioning.
It has also been shown to enhance neuroplasticity and adaptive responses inside the brain.
These changes help the brain become more resilient and better equipped to cope with the challenges of psychiatric conditions.
While transformative & evidence-backed, ECT is not without its side effects.
Some patients experience short-term memory loss and disorientation following treatment, but these effects are generally temporary and resolve over time.
Others experience headaches and nausea, but these resolve themselves quick as well.
Some very rare, but more intense side effects include myocardial ischemia, intracranial hemorrhages and herniation injuries.
But again, these are very rare.
Overall, the benefits of ECT often far outweigh the potential side effects for those with severe, treatment-resistant mental illnesses.
So, is ECT the inhumane therapy many believe it to be? Far from it.
While the early days of ECT were tainted by questionable practices, today's ECT is a far cry from its infamous past.
Modern ECT has the potential to transform lives and offers hope to those who have exhausted other treatment options.
ECT has come a long way from its dark past, evolving into a safe and effective therapy for various mental health conditions.
As we continue to develop our understanding of the brain and refine ECT techniques, we open the door to even more targeted and effective treatments.
The key lies in dispelling myths, raising awareness, and continuing to share the success stories of those who have benefited from this life-changing therapy.
See You Next Week!
I hope you found today's blog insightful, I’ll see you right back here next week!
Until then… Live Heroically 🧠
Singh, A., & Kar, S. K. (2017). How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms. Clinical Psychopharmacology and Neuroscience, 15(3), 210-221. https://doi.org/10.9758/cpn.2017.15.3.210
UK ECT Review Group. (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. The Lancet, 361(9360), 799-808. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12705-5/fulltext
Lisanby SH, Luber B, Schlaepfer TE, Sackeim HA. Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology. 2003 Oct;28(10):1852-65. doi: 10.1038/sj.npp.1300229. PMID: 12865903.
Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010 Sep 15;68(6):568-77. doi: 10.1016/j.biopsych.2010.06.009. Epub 2010 Jul 31. PMID: 20673880. https://pubmed.ncbi.nlm.nih.gov/20673880/
Fregni, F., & Pascual-Leone, A. (2007). Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nature Clinical Practice Neurology, 3(7), 383-393. https://www.nature.com/articles/ncpneuro0530
Dukakis, K., & Tye, L. (2006). Shock: The Healing Power of Electroconvulsive Therapy. New York: Penguin Group. https://www.amazon.com/Shock-Healing-Power-Electroconvulsive-Therapy/dp/1583332839
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., ... & Beaulieu, S. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97-170. https://onlinelibrary.wiley.com/doi/full/10.1111/bdi.12609
Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K, Mueller M, Bernstein HJ, O'Connor K, Smith G, Biggs M, Bailine SH, Malur C, Yim E, McClintock S, Sampson S, Fink M. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry. 2006 Dec;63(12):1337-44. doi: 10.1001/archpsyc.63.12.1337. PMID: 17146008; PMCID: PMC3708140. https://pubmed.ncbi.nlm.nih.gov/17146008/
Nordanskog P, Dahlstrand U, Larsson MR, Larsson EM, Knutsson L, Johanson A. Increase in hippocampal volume after electroconvulsive therapy in patients with depression: a volumetric magnetic resonance imaging study. J ECT. 2010 Mar;26(1):62-7. doi: 10.1097/YCT.0b013e3181a95da8. PMID: 20190603. https://pubmed.ncbi.nlm.nih.gov/20190603/