Electroconvulsive therapy (ECT) is effective in treating major depression and is as safe as a large new study concludes.
This procedure, formerly known as electroconvulsive therapy, has a controversial, largely unfavorable history. This was the result of inaccurate depictions in popular books and movies such as “One Flew Over the Cuckoo’s Nest” and the actual problems of the early steps that used strong currents and did not use anesthesia. ..
Currently, ECT is performed under general anesthesia, and doctors work with anesthesiologists and nurses to apply a weak electric current to the brain (usually about 0.8 amps at 120 volts) for 1 to 6 seconds. This causes seizures in the brain, but due to anesthesia, the patient does not experience muscle contraction. Seizures cause changes in the brain that relieve the symptoms of depression and certain other mental illnesses. Doctors usually give a series of ECT treatments over days or weeks.
The only painful part of the procedure is the insertion of a venous line before anesthesia. Later, side effects such as temporary memory loss, confusion, temporary headaches, and muscle aches may occur. Doctors are discussing whether ECT can cause long-term memory problems that are different from those caused by depression itself.
For this reason New study published in Lancet Psychiatry, Canadian researchers used records of 10,016 adults who were so severe that depression was hospitalized for more than 3 days. Half of them had ECT, while the other half were treated with drugs and psychotherapy. The average age was 57, and about two-thirds were women. Researchers tracked how each group progressed 30 days after discharge.
In this study, patients and controls were carefully matched to adjust for more than 75 factors, including sociodemographic characteristics, drug use, other medical disorders, behavioral and cognitive status, use of psychiatry and other medical services. Did. This thorough methodology helped overcome some of the limitations of previous studies.
ECT did not appear to increase the risk of serious medical problems, such as cardiovascular, respiratory, genitourinary problems requiring hospitalization, or death not due to suicide. Thirty days after discharge, 105 ECT patients had serious medical problems, compared with 135 in the control group, showing no statistically significant difference. Researchers did not track minor medical problems treated outpatiently. Suicide was rare in both groups, but significantly lower in the ECT-treated group.
Dr. Martin Balslev Jørgensen, a professor of psychiatry at the University of Copenhagen who has made a widespread presentation on ECT but was not involved in the study, said: “ECT is surrounded by many negative opinions and needs all the support that can be gained from actual research.”
Dr. Jacob P. Fagal, medical director of Duke’s ECT program and not involved in the study, talks to people who are afraid of complications, although ECT is the best treatment. Said it could be useful. “As a clinician,” he said. “This helps me build a discussion. This brings a very important factor in the discussion about the risk of having ECT compared to the risk of not having ECT in people with severe depression. “
Dr. Jorgensen said the study shows that patients can focus on the real problems of ECT without having to worry about medical complications: how many must be anesthetized. After any treatment, you may experience some memory loss in time until and during ECT.
Dr. Irving M. Letty, a professor of psychiatry at Johns Hopkins and director of the brain stimulation program, who was not involved in the report, is an “important and substantive study” that adds to the literature showing that ECT is safe. Said. .. “This puts it in a medical context — thousands of patients without serious medical complications.”
Dr. Tyler S. Custer, a brain stimulation fellow at the University of Toronto, the lead author of the study, agreed that ECT is at risk, but major depression is also at risk and can cause serious problems. I have. Cardiovascular disease, dementia, substance use and suicide. He said that deciding to undergo ECT is a “complex and serious decision.” “The hope of this study is to provide important information to help patients, their loved ones, and their doctors understand the risks and make safe decisions.”
ECT can be a good treatment option for severe depression
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