As evidence supporting the use of
electroconvulsive therapy (ECT)
to treat patients with depression
and other psychiatric illnesses continues
to grow, myths about this treatment
persist. In light of these myths, patients
might be reluctant to receive ECT. As clinicians,
we need to educate patients about
the safety and effectiveness of this treatment.
Here are 10 of the most commonly
held myths about ECT, and why each is a
misconception.
1. It is a barbaric treatment. ECT is conducted
in a controlled medical environment,
either during a hospitalization or as
an outpatient procedure, by a team, consisting
of a psychiatrist, anesthesiologist,
and nurse. Patients receive a short-acting
intravenous anesthetic to ensure that they
are unaware of the procedure, and a muscle
relaxant to help prevent physical injury.
Vital signs and brain waves are monitored
throughout the procedure, which typically
lasts 15 to 20 minutes. Patients remain
relaxed, are unaware that they are having a
seizure, and experience no pain. Following
ECT, the patient is taken to a recovery area,
where he or she is closely monitored as the
medications wear off.
2. It causes brain damage. Studies using
MRI to look at the brain before and after
ECT have found no evidence that ECT
causes negative changes in the brain’s
structural anatomy.1
To the contrary, there
is evidence that there is neuroplasticity in
the brain in response to ECT, and the neurotrophin
brain-derived neurotrophic factor
also may be increased.2,3
3. It causes permanent memory loss.
ECT can result in both anterograde and
retrograde memory impairment; however,
anterograde amnesia typically lasts only
days to weeks. Retrograde amnesia is much
less common, but when it occurs, it tends
to be a loss of memory of events that took
place in the weeks leading up to and during
treatment. Using an ultra-brief (as opposed
to standard brief,) pulse, as well as right
unilateral (as opposed to bilateral) electrode
placement substantially reduces the risk of
cognitive and memory adverse effects.4
4. It is a treatment of last resort. Typically,
ECT is used for patients who have not
responded to other interventions. However,
ECT can be used as a first-line treatment
for patients if a rapid or higher likelihood
of response is necessary, such as when a
a patient is suicidal, catatonic, or malnourished
as a result of severe depression.5
5. It only works for depression. Evidence
shows ECT is efficacious for several psychiatric
conditions, not just unipolar depressive
disorder. It can effectively treat bipolar
depression, mania, catatonia, and acute
psychosis associated with schizophrenia
6. It is not safe. Death associated with
ECT is extremely rare. A recent analysis
estimated that the rate of ECT-related
mortality is 2.1 deaths per 100,000 treatments.
In comparison, the mortality rate
of general anesthesia used during surgery
has been reported as 3.4 deaths per
100,000 procedures.8
Evidence also suggests
ECT can be safely administered to
patients who are pregnant.9
7. It cannot be given to patients with epilepsy.
There are no absolute contraindications
to using ECT for these patients. Most
patients with epilepsy can be successfully
treated with ECT without requiring an
adjustment to the dose of their antiepileptic
medications.10
8. It will change one’s personality. ECT
has not been found to cause any alterations
in personality. Patients who are treated
with ECT may describe feeling more like
themselves once their chronic symptoms of
depression has improved. However, ECT
has not been shown to effectively treat the
symptoms or underlying illness of personality
disorders and it may not be an effective
treatment for depression associated with
borderline personality disorder.11
9. Its success rate is low. ECT has the highest
response and remission rates of any
a form of treatment used for depression.
An estimated 70% to 90% of patients with
depression who are treated with ECT show
improvement.12
10. It is a permanent cure. ECT is not likely
a permanent solution for severe depression.
The likelihood of relapse in patients with
severe depression who are helped by ECT
can be reduced by receiving ongoing antidepressant
treatment and some patients may
require continuation or maintenance ECT.13
References
1. Scott AI, Turnbull LW. Do repeated courses of ECT cause
brain damage detectable by MRI? Am J Psychiatry. 1990;
147(3):371-372.
2. Sartorius A, Demirakca T, Böhringer A, et al.
Electroconvulsive therapy increases temporal gray matter
volume and cortical thickness. Eur Neuropsychopharmacol.
2016;26(3)506-517.
3. Bocchio-Chiavetto L, Zanardini R, Bortolomasi M et al.
Electroconvulsive therapy (ECT) increases serum brain-derived
neurotrophic factor (BDNF) in drug resistant
depressed patients. Eur Neuropsychopharmacol. 2006;16(8):
620-624.
4. Sackeim HA, Prudic J, Nobler MS, et al. Effects of pulse
width and electrode placement on the efficacy and
cognitive effects of electroconvulsive therapy. Brain
Stimul. 2008;1(2):71-83.
5. American Psychiatric Association. The practice of
electroconvulsive therapy: recommendations for treatment,
training, and privileging: a task force report of the American
Psychiatric Association, 2nd edition. Washington, DC:
American Psychiatric Association; 2001.
6. Fontenelle LF, Coutinho ES, Lins-Martins NM, et al.
Electroconvulsive therapy for obsessive-compulsive
disorder: a systematic review. J Clin Psychiatry. 2015;76(7):
949-957.
7. Narang P, Glowacki A, Lippmann S. Electroconvulsive
therapy intervention for Parkinson’s disease. Innov Clin
Neurosci. 2015;12(9-10):25-28.
8. Tørring N, Sanghani SN, Petrides G, et al. The mortality
rate of electroconvulsive therapy: a systematic review and
pooled analysis. Acta Psychiatr Scand. 2017;135(5):388-397.
9. Sinha P, Goyal P, Andrade C. A meta-review of the safety
of electroconvulsive therapy in pregnancy. J ECT. 2017;33(2):
81-88.
10. Lunde ME, Lee EK, Rasmussen KG. Electroconvulsive
therapy in patients with epilepsy. Epilepsy Behav. 2006;
9(2):355-359.
11. Feske U, Mulsant BH, Pilkonis PA, et al. Clinical outcome
of ECT in patients with major depression and comorbid
borderline personality disorder. Am J Psychiatry. 2004;
161(11):2073-2080.
12. Kellner CH, McClintock SM, McCall WV, et al; CORE/
PRIDE Group. Brief pulse and ultrabrief pulse right
unilateral electroconvulsive therapy (ECT) for major
depression: efficacy, effectiveness, and cognitive effects. J
Clin Psychiatry. 2014;75(7):777.
13. Jelovac A, Kolshus E, McLoughlin DM. Relapse following
successful electroconvulsive therapy for major depression:
a meta-analysis. Neuropsychopharmacology. 2013;38(12):
2467-2474.
An estimated
70% to 90% of
patients with
depression who
are treated
with ECT show
improvement
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