Another biological treatment for depression and other mood disorders is electroconvulsive therapy (ECT). The patient is put under a temporary general anaesthetic and given a nerve blocker before being given the treatment. This involves an electric current being passed from one electrode (placed over the left temple) to another (placed either on the right temple [bilateral] or above the left eye [unilateral]).
This causes a controlled seizure lasting up to one minute which supposedly ‘resets’ the neurochemicals and temporarily relieves the depression for up to three months when undergone as a course of treatment lasting up to three weeks. This treatment is usually a last resort for treatment-resistant depression and is the fastest acting treatment for depression therefore it is used most often in cases where there is a high risk of suicide. Rapoport et al carried out a case study on a severely depressed woman who had repeatedly attempted suicide including an overdose of anti-depressive and anxiolytic drugs.
The woman was then finally given an eight session course of ECT and although she did not show improvement immediately, by the end of her treatment she was free from suicidal thoughts and at a four month check up still showed normal social functioning and no further signs of depression. This suggests in cases of treatment resistant depression or in high risk cases, ECT is more effect than drug treatment. However, Hussain also found that there was no improvement in some treatment resistant cases when using ECT.
Similarly Paguin et al carried out a meta-analysis of studies which investigated the effectiveness of ECT, placebo drugs and antidepressant drugs and found that ECT was significantly more effective in treating both severe and treatment-resistant forms of depression than drugs/placebos. This may be because unlike placebos in drug therapy, there has been very little evidence that ‘sham ECT2’ is effective . For instance, Gregory et al (1985) found significant evidence in favour of real ECT vs. Sham ECT in treatment resistant depression.
The most common side effects are ECT are memory loss and headaches which can last months after treatment. However there can also be cardiovascular changes in patients. Rose et al (2003) found that around one third of ECT patients suffer from memory loss following treatment. The Department Of Health report in 2007, found that 30% of recent ECT patients complained of permanent fears and anxieties since having it. In an earlier DOH report from 1999, they found that out of seven hundred mental health patients who had been sectioned and consequently been given ECT, 59% of them had not given consent for the treatment.
Further concerns about consent are that even where patients do submit to the treatment willingly, it is difficult, particularly when they have been sectioned, to fully inform them about the treatment especially since those who are sectioned are not considered mentally capable of giving informed consent. Finally, one major concern is that even the leading psychologists do not know exactly how ECT works. Since it is supported by the evidence that depression is less common in people who suffer from epileptic fits, it is assumed that it is the seizure and not the current which causes the improvement in condition.
Since ECT is far more invasive and has a far worse reputation than drug treatment, it is the less frequently used therapy. However, as stated earlier, in cases where patients do not seem to respond to drug treatments, ECT is usually significantly more effective. 1 Unless participants are taken from psychiatric patients sectioned under the Mental Health Act in which case, consent may be given by their doctor or family but not them. 2 Where the patient is anaesthetised and is not aware that they are not given the ECT.