In the United States, 100,000 patients a year receive electroconvulsive therapy in psychiatric clinics. In fact, according to data from the Health Insurance Review and Assessment Service, 223 patients received 2,388 electroconvulsive therapy sessions in 2013.
Electroconvulsive therapy, devised in 1938, is a treatment for mental illness that involves applying electrical stimulation to the brain to artificially induce convulsions. A famous person known for electroconvulsive therapy is Kitty Ducacus, the wife of 1988 U.S. presidential candidate Michael Ducacus. In 2001, Kitty was depressed enough to attempt suicide, and after electroconvulsive therapy, she overcame her depression and wrote a book about her experience.
However, electroconvulsive therapy is still an unfamiliar concept to the general public. The images of electric experiments and electric chairs can give a negative impression.
Electroconvulsive therapy is done by inducing bilateral generalized convulsions that affect the basal ganglia and thalamus. Although it is not yet clear what mechanism electroconvulsive therapy uses to improve mental illness, it is believed that several factors may be the mechanism of action, including changes in brain waves, increased glucose and oxygen utilization, and decreased blood flow and sugar metabolism after convulsions, and changes in neurotransmitters and G proteins*.
*G protein: A protein that acts as a switch that transmits various extracellular stimuli into the cel
Electroconvulsive therapy is painless and accompanied by anesthesia and is safe enough to be performed on everyone from their late teens to the elderly, and even to new mothers.
In fact, according to a 2001 study by Shiwach et al., the mortality rate associated with electroconvulsive therapy is about 0.0001%, which is about 2 per 100,000 people. A 2004 study by Nuttall et al. examined 17,394 cases of electroconvulsive therapy over a 13-year period and reported that none of the deaths were caused by electroconvulsive therapy. This is even lower than the mortality rate from childbirth.
(1) Before starting treatment, receive basic tests (blood tests, chest X-rays, electrocardiograms, etc.).
(2) Adjust with your doctor in advance the medications you are currently taking that may affect your treatment, and fast after midnight the day before treatment.
(3) On the day of treatment, go to the treatment room and attach electrocardiogram, blood pressure, pulse, respiration, EEG monitor, and electrodes to pass electric current.
(4) The anesthesiologist anesthetizes the patient using an anesthetic with a short half-life and administers a muscle relaxant.
(5) A psychiatrist induces convulsions by passing an electric current. The actual current flow time is only about 1~3 seconds. Confirm the spasms through changes in brain waves.
(6) At the end of treatment, the anesthesiologist will observe the patient until the patient's vital signs stabilize, and the psychiatrist will observe the patient until the patient fully regains consciousness, and if there are no problems, the patient will be discharged.
Electroconvulsive therapy is usually performed 6~12 times every other day, but the specific frequency of treatment depends on the patient's situation and the degree of response to treatment.
The effect of electroconvulsive therapy is not immediate, but after 2~3 treatments, the symptoms often begin to improve. However, the effects of electroconvulsive therapy do not last permanently. Just as the effect of the drug disappears according to the half-life of the drug if the drug is not taken, the therapeutic effect of electroconvulsive therapy also lasts only for a certain period of time.
Therefore, after the symptoms improve with electroconvulsive therapy, it is recommended to start a new medication or receive regular electroconvulsive therapy about 1~4 times a month.
It is said that most patients feel negative about electroconvulsive therapy at first, but it often changes to a positive after receiving electroconvulsive therapy. 70~80% of patients who received treatment experienced improvement in their symptoms, and their satisfaction with the treatment is also very high.
Electroconvulsive therapy is a fairly safe treatment, but it can have some side effects.
First, symptoms such as fatigue, headache, muscle aches, nausea, and drowsiness may occur. These side effects last for a few hours, but usually go back on their own within two days.
Second, short-term memory impairment may occur before and after treatment, where you may not remember things for minutes~hours. However, after 6 months, most of them recover to their original state, and there is no effect on the acquisition or maintenance of new memories or long-term memory.
Third, there are also cases where teeth are bitten tightly during spasms, resulting in tooth breakage. In fact, psychiatry prevents this by checking in advance for loose teeth, using tooth protectors, and administering muscle relaxants.
Fourth, cardiovascular side effects may occur. It is said to lead to increased blood pressure, tachycardia, heart attack, and even death, but it is considered a very rare side effect.
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