Is Shock Treatment Still Used

24 July 2013 Last updated at 12:52

Patient undergoing electroshock treatment The employ of electricity to care for mental illness started out as an experiment in the 1930s

The idea of treating a psychiatric illness past passing a jolt of electricity through the brain was 1 of the about controversial in 20th Century medicine. Then why are we even so using a process described by its critics equally barbaric and ineffective?

Sixty-four-year-old John says his breakdown in the late 1990s was triggered by the collapse of his marriage and stress at piece of work.

"We had a nice firm and a nice lifestyle, but it was all just crumbling away. My depression was starting to overwhelm me. I lost command, I became violent," he explains.

John likens the feeling to existence in a hole, a hole he could not go out of despite courses of pills and talking therapies.

Just now, he says, all of that has changed cheers to what is one of the to the lowest degree understood treatments in psychiatry - electroconvulsive therapy (ECT).

"Before ECT I was the walking expressionless. I had no interest in life, I but wanted to disappear. Afterwards ECT I felt similar there was a way out of it. I felt dramatically better."

The use of electricity to treat mental illness started out every bit an experiment. In the 1930s psychiatrists noticed some heavily distressed patients would suddenly improve after an epileptic fit.

John on why he feels he needs ECT to go along severe low at bay

Passing a strong current through the brain could trigger a similar seizure and - they hoped - a similar response.

Past the 1960s information technology was being widely used to treat a diversity of atmospheric condition, notably astringent low.

But as the erstwhile mental asylums closed down and aggressive concrete interventions like lobotomies barbarous out of favour, so likewise did electroshock treatment, equally ECT was previously known.

The infamous ECT scene in One Flew Over the Cuckoo'south Nest cemented the idea in the public'south mind of a brutal treatment, although by the time the film was released in 1975 it was very rarely given without a general anaesthetic.

Perhaps more significantly, new anti-depressant drugs introduced in the 1970-80s gave doctors new ways to treat long-term mental illness.

Just for a group of the nigh severely depressed patients, ECT has remained one of the terminal options on the tabular array when other therapies have failed.

Annually in the UK around 4,000 patients, of which John is i, still undergo ECT.

"It'south non intuitive that causing seizures can be skillful for depression just it's long been determined that ECT is effective," says Professor Ian Reid at the Academy of Aberdeen, who heads upward the team treating John.

ECT process (Alert: Some may find images upsetting) Go on reading the main story

Patient surrounded by medics The patient lies on a bed and is questioned almost their recent well-being while their blood pressure is measured and ECG electrodes monitoring heart activity and an oxygen sensor are attached. A cannula is inserted into one hand for the intravenous administration of anaesthetic and musculus relaxant.

Patient being manually ventilated EEG electrodes monitoring electric action in the brain are attached and a blood pressure cuff placed on the other arm to prevent muscle relaxant flooding information technology and a safety grip placed in hand - leaving this limb untreated allows medics to assess the convulsive response. Anaesthetic and and then muscle relaxant administered as the patient is given transmission ventilation to oxygenate their organisation and hyper inflate lungs.

ECT shock being applied to patient A mouth guard is put between patient's teeth to forbid damage during shock and convulsions, and electrodes are practical to the temples. The electrical shock is administered for about four seconds. Immediately later on the patient convulses for upwardly to 60 seconds. On average patients quake for 20 seconds.

Patient recovering from ECT treatment Once the convulsions cease the patient is moved to a recovery room where they are monitored and given oxygen. After about ten minutes the patient regains consciousness. Bold that the procedure has gone smoothly the patient usually leaves infirmary within ii to 3 hours.

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In the 75 years since ECT was first used scientists have argued nigh why and how information technology might work.

The latest theories build on the thought of hyperconnectivity. This new concept in psychiatry suggests parts of the brain can start to transmit signals in a dysfunctional style, overloading the system and leading to weather condition from depression to autism.

Helen Crane on how she forgot major events including her mother'south death after ECT

Prof Reid and his colleagues used MRI scanners to map the brains of nine patients before and after treatment.

In an academic paper in 2012 they claimed ECT can "turn down" overactive connections as they starting time to build, effectively resetting the brain'southward wiring.

"For the first time we can point to something that ECT does in the encephalon that makes sense in the context of what we think is wrong in people who are depressed," Prof Reid says. "The change that nosotros see in the brain connections after ECT reflects the modify that we run across in the symptom contour of patients who generally run into a big improvement."

Only passing electricity through the near complex organ in the trunk is not without risk. Many doctors think the side-effects of ECT can exist then serious they outweigh any possible benefits.

Helen Crane was given two rounds of ECT in the belatedly 1990s. She now blames the second course for wiping years of her retention, from trips away to dramatic family unit events.

"After ECT, I had this instinct that something was incorrect with my mother. I said to my husband 'What's happened to my mother?' And and then he had to tell me that she'd died almost two years before," she says.

"It was devastating going through bereavement once again. How on Earth could I have forgotten something so of import and cardinal? Getting words incorrect is frustrating, but to have lost really bones stuff in your life is awful."

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"Start Quote

I'1000 convinced that in 10 or 15 years we will take put ECT in same rubbish bin of historical treatments equally lobotomies and surprise baths that have been discarded over time"

End Quote Dr John Read University of Liverpool

Critics of ECT claim effectually a 3rd of patients will notice some sort of permanent change from memory loss to problems with speech communication and bones skills like improver.

"What happens is a little like recharging a car battery," says the psychologist Dr John Read from the Academy of Liverpool, one of the most vocal critics of ECT.

"It's not difficult to get artificial changes in the brain, you lot could exercise it with cocaine, just information technology doesn't final and three or four weeks subsequently the person is either back at the aforementioned level of depression or many studies show worse levels of depression."

Opponents say that ECT patients can enter into an addictive wheel of repeated treatment and that whatsoever improvement across the very brusque term is likely to be lilliputian more than an extreme form of the placebo effect, with patients benefitting psychologically from the extra care and medical attention associated with ECT.

"It'due south non in any mode addressing the cause of their low. Information technology'south systematically and gradually wiping out their memory and cognitive role," says Dr John Read.

"I'm convinced that in 10 or 15 years we will have put ECT in same rubbish bin of historical treatments as lobotomies and surprise baths that have been discarded over time."

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ECT in the UK

Women are twice as likely to be given ECT as men, reflecting the full general pattern of serious depression in society
Around a third of patients are as well ill to give their consent
Across the UK as a whole it is thought around iv,000 people a year are given ECT
Scottish hospitals lone still treat 370 people a year, according to the latest figures.

Simply Prof Reid says when weighing up the risks and benefits of the treatment "it is important to realise that the people who are treated with ECT are suffering from an disease that could kill them".

"Depression is associated with a measurable bloodshed. It can be lethal. Untreated patients tin can die."

The team in Aberdeen now promise their research will allow drug companies to develop new treatments that mimic some of the effects of electroconvulsive therapy.

"One of the exciting things about beingness able to identify a alter in the encephalon related to a psychiatric disorder is that it might make it easier to diagnose that condition over time," Prof Reid says.

"No 1 would be happier than me if we could reproduce the changes that ECT has on the brain in a less invasive and safer style for patients."

Lookout Newsnight'southward total film examining why nosotros are notwithstanding using ECT