In the legendary movie One Flew Over the Cuckoo’s Nest, there is a scene where the gagged protagonist convulses in a hospital bed. Many believe that in our time, electroshock therapy is carried out in a similar way. Others are surprised that it survived at all. We talk about the past and present of this procedure.
The first associations that come to mind at the word “electric shock” are stories about psychiatric hospitals of the early 2001th century and scary movie scenes. Electroshock in A Beautiful Mind (2008) treats hallucinations of a mathematician played by Russell Crowe, in Changeling (XNUMX) in this way they try to silence the heroine of Angelina Jolie.
This method has a bad reputation. However, it is still used today. When, for whom and is it safe?
When and where
The correct name for the procedure is Electroconvulsive Therapy, abbreviated as ECT. This is a method of psychiatric and neurological treatment using an electric current that is passed through the brain and artificially causes an epileptic seizure. Already in ancient Rome, according to some reports, headaches were treated by applying electric fish to the head: catfish, stingray and eel.
And in the 1930s, the Hungarian psychiatrist and neurologist Laszlo Meduna found that those who had both schizophrenia and epilepsy experienced less psychotic episodes. Then he decided to treat one disease with the help of another and for this he found a medicine that causes convulsions.
Later, under the influence of his ideas, the Italian professor Ugo Cerletti came up with an alternative way to induce a convulsive seizure – an electric current. The apparatus created by him after experiments on animals was first tested in 1938 on a patient with schizophrenia, the therapy, according to historical data, was successful, the patient recovered.
The USSR was one of the first states in which both electroconvulsive and chemoconvulsive therapy began to be used.
ECT has also been actively practiced in Europe and the USA. However, the procedure itself in those days looked really intimidating, it was performed without anesthesia, and patients endured it hard.
“The initial version of the technique provided for a specific composition of the treatment team: a doctor supplying current and several strong assistants who hold the patient’s convulsing body,” says Igor Oleichik, MD, chief researcher at the Department for the Study of Endogenous Mental Disorders and Affective Conditions of the Federal State Budgetary Scientific Institution “ NTSPZ.
But in 1942, the possibility was discovered with the help of curare (specially processed juice of a South American plant) to achieve complete muscle relaxation – muscle relaxation. Muscle damage was eliminated and the procedure became much safer. However, ECT has now been suspended in Russia.
“In our country, only one muscle relaxant is used – suxamethonium chloride (listenone),” explains Igor Oleichik. – Since 2020, it has been discontinued, and foreign analogues are not registered in the Russian Federation, and they cannot be used. I would like to believe that the situation will change, because for many patients this method is the last hope.
To whom and how much
The electroconvulsive therapy procedure lasts only 1 minute and is carried out in the intensive care unit of a psychiatric hospital.
The method has a number of contraindications, including pregnancy, so the patient is first examined by an ophthalmologist, a neurologist and a therapist, an ECG and EEG are performed, blood pressure and pulse are measured. If there are no contraindications, the patient signs an informed consent for medical intervention to use the method, gets acquainted with possible side effects.
“I would not say that the procedure is completely safe,” says psychiatrist and psychotherapist Inna Kazachinskaya. – However, I would not say this about any medicine, not a single surgical intervention: even at the dentist’s appointment, anaphylactic shock can occur after an anesthetic injection. Specialists first use all other resources and methods and apply ECT only when they are convinced that nothing else helps when the patient’s receptors are insensitive to drugs.
The procedure is used to treat patients – only adults! – with severe depression, schizophrenia, manic states and other severe mental disorders. The number of procedures prescribed by the doctor: usually 10-15. ECT sessions are carried out 2-3 times a week.
We tend to be anxious and anxious before almost any medical procedure.
ECT is no exception, therefore, before all manipulations, the anesthesiologist-rheumatologist introduces sedatives. Then anesthesia and a muscle relaxant are used. The latter relaxes all the muscles of the body so that during convulsions caused by current, the body does not receive physical damage. It also relaxes the respiratory muscles, so the patient is artificially ventilated at this time.
How and why
The psychiatrist conducting the procedure applies electrodes to the patient’s temples, through which an electric current pulse is applied. To make the impact on the body more gentle, short pulses are now used, the current strength is carefully controlled. There is a convulsive attack, expressed outwardly as a twitching of various muscle groups.
And the mechanism of internal action is as follows: an electric wave causes the release of neurotransmitters (serotonin, dopamine, norepinephrine), compensating for their deficiency or excess, and thus eliminating the cause of a mental disorder. In addition, the electrical current increases the sensitivity of neurons – this is how ECT helps to overcome the body’s resistance to drugs.
“For clarity, we can compare the effect of ECT on the brain with rebooting the computer,” explains Igor Oleichik, “after which failures in its work disappear.”
“Fear is gone”
Polina, 36 years
“I suffered from depression for 6 years, I tried all antidepressants – without result, even lay in a psychiatric hospital, nothing helped. There was a last hope for ECT, and it was justified. After ten treatments, I finally feel healthy. At first it was very scary, but after the first procedure, the fear went away thanks to the careful and attentive attitude of the staff of the intensive care unit.
The condition changed after the end of the course of procedures. Passed apathy and a sense of hopelessness, I wanted to live again, there were plans for the future. I did not like that there were problems with memory. For example, I did not remember what I ate the day before, with whom I talked (although the events of only those days when the procedures were performed fell out of my memory). Everything that happened to me before entering the hospital, I remembered and remember perfectly.