CHENNAI: When one hears ‘shock treatment’ or Electroconvulsive Therapy (ECT), this is the visual most of us are familiar with: a person lying on a hospital bed with two metal plates clamped on either temples, a piece of rubber clenched between the teeth, eyes tightly shut waiting for something terrifying to happen. The person screams and shouts and then falls unconscious when the wailing hits a crescendo.
Contrary to popular perception, ECT can bring several mental health disorders under control with minimum side-effects. “Severe and psychotic depression, repetitive suicidal thoughts, catatonic behaviour, drug resistant cases of bipolar disorder and schizophrenia can be treated with ECT,” says psychiatrist Dr Venkatesh Madan. “What is given to patients today is modified ECT, where they are given anesthesia. The patients are unconscious and do not feel the pain during therapy. So there’s no screaming or shaking violently.”
A small dosage of electricity is supplied carefully to the brain to induce a mild seizure. This seizure is then contained within the brain. In modified ECT, general anesthesia is administered to the patient and in addition to that, smooth muscle relaxants are given to ensure that seizures don’t spread to the body. Only one limb is left without being anesthetized — to gauge the intensity of the treatment given by observing its movement.“The seizure lasts for less than 20 seconds and the entire procedure is completed within 10 minutes,” says Dr Ramesh Kumar from Schizophrenia Research Foundation (SCARF). “We don’t pass high doses of electric current and the threshold of each person is calculated carefully by the clinician.” Patient are administered this therapy only with their consent. In certain cases, consent of the family is taken, if the patient is unable to provide it, but such cases are rare.
“For a person who refuses to eat to end his life or shows catatonic behaviour or has a life-threatening mental condition that requires immediate reversal, ECT is extremely successful,” says Dr Ramesh. “The treatment has very minimal drawbacks although it is used only as a last line of treatment after all drugs have failed on a patient.”
The side-effects of treatment are similar to those you get from anesthesia. But adverse effects of ECT itself, however, are limited. There is a popular belief that a patient suffers from memory loss after treatment but Dr Ramesh contradicts that. “A person will not wake up from treatment and ask ‘Who am I?’ In rare cases, they may forget the events that took place on the day of the treatment,” he says.
Although, ECT is regarded as an effective treatment by psychiatrists, the mechanism by which it reverses the disorder is unclear. One hypothesis is that the seizures restore equilibrium in the brain. However, in most cases, the therapy is acute and works well for short-term recovery. Long term therapy is usually coupled with pharmacological treatment and maybe followed up with ECT only annually or biannually for maintenance. ECT may cost anywhere between `2,000 and `6,000 per treatment depending on
the hospital.
ECT is seen as an extremely effective treatment especially for pregnant women suffering from psychotic conditions, as medication can affect the baby. There are smaller studies around the world that prove that ECT even helps treat autistic individuals with self-destructive behaviour. The positive effects are understudied in India while the infamous image of ‘shock treatment’ still prevails.