Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is routinely used to treat refractory depression and catatonia, especially in the elderly where pharmacotherapy could result in undesirable side effects. Essentially, it involves jolting the brain to create a controlled clonic seizure – the patient loses consciousness, has convulsions, and cannot recollect the procedure. I had the opportunity to witness ECT first hand this morning with a group of my colleagues.

The attending physician was kind enough to walk us through a typical preparation. After receiving the patient’s informed consent, methohexital (a very short acting barbiturate) induces anesthesia and succinylcholine (a depolarizing neuromuscular junction blocker) globally relaxes muscular tone. These meds minimally affect a patient’s seizure threshold and are consequently good options. Sometimes patients are given caffeine to help them have a “better” seizure too. Electrodes then transmit the electric pulse to generate the seizure. Patients naturally wake themselves up due to the short half-life of the anesthetic. The overall procedure (assuming no complications) takes 5-10 minutes once the patient is prepped.

So how does jolting the brain help with depression? Frankly, scientists aren’t sure what the exact mechanism is, but it may deal with increased hippocampal neurogenesis – an outcome which is documented in murine cohorts receiving electroshock therapy. I guess it’s just another one of those things in medicine that we don’t understand but continue to use because it works. :-)