Electroconvulsive Therapy for Depression

Recent new practice guidelines for the treatment of patients with major depressive disorder from the American Psychiatric Association states that electroconvulsive therapy (ECT) or electroshock therapy is the most effective form of therapy for patients whose symptoms have not responded adequately to medication. Another recent report from the Center for Disease Control and Prevention emphasizes the prevalence of depression in the United States--about 9 percent of adults surveyed in 2006 and 2008 had current symptoms of depression and 3.4 percent had symptoms of major depression. Let's look at what ECT therapy is about and who should consider it.

Understanding ECT

Before an ECT procedure, patients are given a muscle relaxant and put to sleep with a general anesthetic. An electric current is then applied through electrodes placed on the scalp in order to trigger a brief seizure. A course of ECT therapy most often involves 6 to 12 treatment given 2 to 3 times a week.

Even though ECT has been used for about 70 years, the procedure is greatly misunderstood by the general public because it seems barbaric and invokes images of a mad scientist at work to create Dracula-like creatures. People are also concerned by tales of memory loss caused by ECT, but if memory loss occurs it is usually short-lived.   

Who should consider ECT

ECT is especially recommended as the treatment of choice patients who have:

• not responded to numerous trials of medications
• significant functional impairment
• associated psychotic features
• a need for urgent response because they are suicidal or poorly nourished due to unwillingness to take food
• had a previous positive response to ECT
• a preference for ECT

One of the problems in determining that a patient will not respond to anti-depressive medications is that it generally takes 4 to 8 weeks to tell whether that patient is unresponsive or only partially responsive to a specific treatment. Nonetheless, ECT might be considered when severe depressive symptoms have shown no improvement after about a month.

Other non-drug treatments

The guidelines state that effectiveness of  ECT is better established than other stimulation treatments such as vagus nerve stimulation, deep brain stimulation, and transcranial nerve stimulation. The guidelines do indicate that bright light therapy, which has been successful in the treatment of seasonal depression (depression occurring during the darker days of the winter months), may also be effective for nonseasonal depression.

According to the experts preparing the guidelines, data generally support that regular aerobic exercise or resistance training provides at least modest improvement in mood symptoms for patients with major depression and may reduce depressive symptoms in members of the general population, especially in older adults and individuals with other medical problems.