Shock Therapy Safe, Effective for Tough-to-Treat Depression

By Amy Norton HealthDay Reporter

MONDAY, July 19, 2021 (HealthDay Information)

“Shock” remedy typically helps raise extreme despair, however concern and stigma can deter sufferers from getting it. Now a big new research is confirming the remedy’s security.

Electroconvulsive remedy (ECT), because it’s medically identified, has been round for many years. For nearly as lengthy, it has been seen in a foul mild — fueled by disturbing media portrayals like these within the 1975 movie “One Flew Over the Cuckoo’s Nest.”

However right this moment’s method to ECT is way totally different from many years in the past, and it is now a advisable remedy for extreme despair that doesn’t reply to straightforward antidepressants.

The brand new research — just lately printed within the journal Lancet Psychiatry — provides to proof that ECT doesn’t increase the danger of great medical issues.

Of greater than 10,000 sufferers hospitalized with a critical depressive episode, those that acquired ECT have been no extra probably than different sufferers to die over the subsequent month or find yourself within the hospital for a medical drawback.

If something, ECT might need saved some lives, the research discovered: Sufferers who acquired the remedy have been much less prone to die by suicide after their hospital discharge.

“I feel this reinforces what we have identified from less-systematic research and from our personal medical expertise,” mentioned Dr. Joshua Berman, an assistant professor of psychiatry at Columbia College Medical Heart in New York Metropolis.

“ECT is a really efficient remedy,” mentioned Berman, who was not concerned within the research. “And although it isn’t risk-free, it’s usually secure.”

ECT can have unwanted effects, together with short-term issues with reminiscence and studying. Some sufferers find yourself with everlasting reminiscence gaps about previous occasions.

However individuals typically see the process as extra harmful. In a single survey, 20% of respondents cited “concern of loss of life” as a serious concern with ECT, mentioned research creator Dr. Tyler Kaster, from the College of Toronto.

Each he and Berman mentioned damaging media portrayals are one purpose. In different instances, Berman mentioned, individuals could have heard a few unhealthy expertise an older relative had with the remedy.

Throughout ECT, electrodes are positioned on the pinnacle to ship small electrical pulses to the mind — deliberately inflicting a quick seizure. Years in the past, that is perhaps executed with none remedy, and a few sufferers suffered accidents, together with bone fractures, in the course of the seizure.

However lately, ECT is carried out beneath common anesthesia, and sufferers obtain muscle relaxants to stop seizure-related accidents.

Plenty of research have indicated that ECT is much like different “low-risk” medical procedures with regards to issues.

The brand new analysis is extra complete — evaluating ECT sufferers with different sufferers who have been equally depressed however didn’t have the process.

Kaster and his colleagues on the Centre for Dependancy and Psychological Well being in Toronto analyzed medical data from greater than 10,000 sufferers. All had been admitted to psychiatric hospitals in Ontario, Canada, between 2007 and 2017 with critical depressive episodes.

Half of the sufferers had acquired ECT, they usually have been in contrast with comparable sufferers who had not undergone the process.

Of 5,008 ECT sufferers, the research discovered, 105 had a “critical medical occasion” inside 30 days. That in contrast with 135 of 5,008 sufferers who didn’t obtain ECT. These occasions included non-suicide deaths or hospital admission for a medical complication.

Few sufferers died by suicide after leaving the hospital. However the threat was even decrease after ECT: Not more than 5 deaths have been attributed to suicide in that group, versus 11 within the comparability group.

This research didn’t gauge the effectiveness of ECT, Kaster mentioned. Nevertheless it’s estimated that as much as 80% of sufferers with extreme despair see their signs considerably enhance after ECT, in accordance with the American Psychiatric Affiliation.


Study to Spot Despair: Signs, Warning Indicators, Treatment
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That doesn’t imply they’re cured. With out ongoing care — comparable to remedy and “discuss remedy” — relapse is probably going, Kaster mentioned. Some sufferers obtain “upkeep” ECT periods over an extended interval.

Researchers usually are not fully sure why ECT works. Nevertheless it appears to function by a number of mechanisms, Berman mentioned.

Research have discovered {the electrical} stimulation can enhance communication amongst cells in mind areas identified to answer antidepressants. Berman mentioned ECT additionally appears to set off the discharge of “neurotrophic” components, which may help mind cells develop.

Extra data

The American Psychiatric Affiliation has extra on electroconvulsive remedy.

SOURCES: Tyler Kaster, MD, Temerty Centre for Therapeutic Mind Stimulation, Centre for Dependancy and Psychological Well being, College of Toronto, Ontario, Canada; Joshua Berman, MD, assistant professor, psychiatry, Columbia College Medical Heart, New York Metropolis; Lancet Psychiatry, July 12, 2021, on-line


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