hm..

[Dudde]

you know, I've got this huge paper due on electroshock therapy coming up at the end of the month, and since everyone here is so smart I decided to ask anyone if they know anything about it? I could probably find enough material to fill in space...I just wanted to get as much as I could on the subject before I try to present it;)

[fafalone]

It was used on people who were really really insane.

[Glider]

Electro convulsive therapy (ECT) is still used. Although due to misuse and bad press in the 1950s, (due to overuse and abuse...a bit like prozac today), it is much more controlled and there are laws defining its use. These days it is used almost exclusively to treat people with depression. Usually, these people fall into 3 main classes: 1) Those with suicidal tendencies (considered at risk), because ECT shows results in about a week, whereas antidepressant drugs usually take 2 - 3 weeks to begin to show effects, and in such cases, a delay can be fatal. 2) Those who have not responded to drug interventions (ECT is often very effective in such cases). 3) ECT is particularly effective in depressed patients who also suffer from delusions.

 

These days a much lower voltage is used, and it is applied under anaesthetic or in conjunction with muscle relaxants to minimise the discomfort and possibility of injury. Sometimes ECT is administered only to the right hemisphere of the brain. Right hemisphere ECT can be as effective as bilateral ECT, if it is intense enough to induce a seizure. It is the seizure that seems to exert the main effect, not the current used to induce it. Hence, the current used these days is much lower than was used in the 50s.

[fafalone]

What is the physiological basis for its effectiveness?

[Glider]

From what I remember, I believe that in common with antidepressant drug therapy, ECT causes a delayed downregulation of beta-adrenergic autoreceptors (only faster than with drug intervention) which usually inhibit the release of noradrenaline. Inhibiting these receptors also elevates noradrenaline release. This is significant as noradrenergic and serotonergic systems interact, e.g. the destruction of 5-HT systems prevents the down-regulation of noradrenergic systems by antidepressant drugs. In short, the effect is similar to that produced by drug intervention except that it is faster acting, and is an endogenous effect (due to the seizure) rather than exogenous (due to the administration of drugs).

[Dudde]

dang...awsome^_^ thanks!

 

but wouldn't that leave some sort of permanent damage on the persons brain?O_o low voltage or not...

[Glider]

No, not now anyway. Passing a (very low) current across one or both hemispheres simply causes all the neurons to fire at once, and in no particular order (hence the seizure). It's much the same as an epileptic fit, only not limited to a particular area (NB it is the brain seizure that's the important thing. The motor function, i.e. thrashing about, is not necessary, which is why it can be used under anaesthetic).

 

I think earlier use of ECT (1930s - 1950s) resulted in problems with short-term memory, but I believe the problems were temporary (or is it cumulative?...I can't remember now), but I'm sure that doesn't happen any more. Back in the 50s, ECT was hugely over used (some poor sods used to get it hundreds of times a year), and at much greater currents than are used today.

 

 

I should add that although ECT (or more specifically, the generalized brain-seizure it causes) is very effective on cases of depression, and does cause a downregulation of beta-adrenergic autoreceptors, it's exact mechanism of function is not fully understood. It actually induces many short-term changes to brain function, including possibly changes to aminergic receptor sensitivity (I just looked up my old notes).

[daisy]

On a little side note I know someone whose wife suffers from severe depression that is resistant to drugs and her only available treatment now is ECT - nothing else has any effect.

[Dudde]

hmm....

interesting....

 

and thanks for the info guys^_^