Electroconvulsive therapy for severe depression: efficacy and clinical applications

¶ … Electroconvulsive Work?

Electroconvulsive therapy is one of the oldest surviving biological treatments in the psychiatric field that entered the new millennium. Actually, this treatment approach has existed for more than 60 years and is still commonly used. The increased use of this therapy is influenced by the lack of medication that equals it with regards to antidepressant potency even after the introduction of the first antidepressant drug, imipramine. However, in the past few years, electroconvulsive therapy has attracted considerable attention with regards to its potency and efficacy. This attention has emerged because of the numerous advances in drug development that necessitates the improvement of existing therapies and medication. Despite these attempts, it is increasingly evident this therapy cannot be improved except through improvements in patient selection, knowledge dissemination, and prediction of response. Electroconvulsive therapy has usually appeared as a barbaric treatment but it's the most effective treatment for severe depression.

Overview of Electroconvulsive Treatment

Electroconvulsive therapy has a long history that dates back to more than 60 years ago when it was introduced as a treatment approach in psychiatry. The first use of this treatment approach was on a patient who was delusional, gesticulating, and hallucinating (Abrams, p.6). The patient fully recovered following electroconvulsive therapy, which indicated that this treatment approach could be utilized in patients with psychiatric conditions. Generally, electroconvulsive therapy emerged during a period of unprecedented therapeutic optimism in the psychiatric field. This was following numerous efforts made towards discovering and developing malarial fever therapy and other treatments. While other treatments flourished during this period, electroconvulsive therapy is the only one that is widely used today largely because of its safety, efficacy, and ease of administration. Electroconvulsive therapy will continue being used in psychiatric treatment because of its numerous advantages over other treatments. The increased use of this therapy will also be influenced by the fact that economic realities make it difficult to enhance instrumentation and stimulation.

Electroconvulsive therapy is a treatment for a minimal number of severe psychiatric or mental illnesses. While this therapy was developed for a variety of conditions, it is currently used for fewer, more severe conditions. Currently, the therapy entails passing an electrical current through the brain in order to generate an epileptic fit (Weiner & Krystal, p.275). The use of an electric current in this treatment has contributed to the term "electro-convulsive." The nature of the therapeutic process in this treatment sounds odd given that it was developed a time before effective medication was discovered. The therapy was developed after doctors noticed that some patients diagnosed with schizophrenia or depression and epilepsy show better response and outcomes after having an epileptic fit.

In today's healthcare setting, the therapy is administered under general anesthesia in a healthcare facility attended by a psychiatrist, a nurse, and an anesthesiologist (Dukakis & Tye, p.15). During this process, the patient is given a muscle relaxant in order for contortions and spasms associated with generalized convulsions not to occur. The anesthesiologist then gives the patient oxygen and help in controlling his/her breathing. The administration of the electric current in electroconvulsive therapy is quite different in today's healthcare setting as compared to the initial years of the treatment's discovery. In the early days of the treatment, the electrical current was administered while the patient was awake and was largely unregulated. This process was characterized by several side effects such as broken bones and teeth. Currently, the electrical current is administered using a machine that is calibrated to release the lowest effective dose via electrodes placed on the patient in areas that lessen side effects (Dukakis & Tye, p.17).

Given its effectiveness, electroconvulsive treatment is the only treatment in mainstream medicine that is receiving increased attention and research, increased use, and providing hope to psychiatric patients. Despite its controversial history, electroconvulsive therapy currently represents the only feasible treatment for severe psychiatric illnesses (Fink, p.3). While numerous efforts have been made to improve the therapy, especially patient selection and treatment measures, electroconvulsive therapy is still not perfect. This is primarily because of its side effects such as loss of some past memories and difficulties in retaining new or current memories in some cases. As research on this treatment method continues, more emphasis should be given to creating techniques of brain electrical stimulation and treatment of some severe psychiatric illnesses like depression with minimal side effects.

How Electroconvulsive Therapy Works

Electroconvulsive therapy has always been regarded as a barbaric treatment approach because it involves the use of an electrical current to stimulate the brain. Actually, while the treatment procedure may be painless for patients, it entails literally shocking brain systems using an electrical current in order to generate seizures. The barbaric nature of this therapy emerges from the fact that the treatment procedure may generate painful muscle spasms and some memory difficulties. Despite these factors, electroconvulsive treatment is still the most effective treatment approach for psychiatric illnesses because of how it works. Some of the major ways through which electroconvulsive therapy works includes

I. Release of Brain Chemicals

Electroconvulsive releases important brain chemicals that help in recovery from severe psychiatric illnesses like depression. The therapy releases vital brain chemicals since the electrical current stimulates the brain for these chemicals in order to trigger an epileptic fit. While these chemicals do not emerge from the treatment procedure itself, electroconvulsive therapy helps in triggering the brain to release vital chemicals for an epileptic fit. The release of brain chemicals in this treatment procedure is linked to the fact that it is administered under general anesthetic and utilizes muscle relaxants. One of the most important aspects of release of brain chemicals is the fact that the therapy changes blood flow patterns via the brain as well as changes metabolism areas that could be affected by the psychiatric illness (Barnes par, 7).

Psychiatric illnesses are usually brought by problems with some brain chemicals, which contribute to ineffective or abnormal functioning of the brain. Electroconvulsive therapy provokes the release of these chemicals or makes them more likely to function properly and help in the recovery process. The role of electroconvulsive therapy in releasing important brain chemicals for normal functioning is supported by several subordinate ideas including

B. Increases Hyperconnectivity

Electroconvulsive therapy works to release important brain chemicals through increasing hyperconnectivity in brain processes, particularly in depressed subjects. According to researchers, the pathology of depression is considered to involve many connections in certain areas of the brain (Szalavitz par, 7). However, it is also assumed that depression may involve too little connectivity or wiring in the brain, which is characterized by low mood and low energy. In situations where there is too little connectivity in certain areas of the brain, electroconvulsive treatment increases connectivity. On the contrary, depressive symptoms that are characterized by hyperconnectivity are handled by electroconvulsive therapy, which modulates connectivity in certain areas of the brain.

First, electroconvulsive therapy increases connectivity in the brain, especially in autism spectrum disorders, which are commonly linked to depression. In this case, these disorders generate reduced connectivity in the brain and hinder normal functioning. The electrical current used in this therapy induces the brain into releasing chemicals that help in enhancing connectivity in certain areas. For example, this therapy may entail the use of antidepressants that increase connectivity in the brain and help restore normal functioning. Electrodes placed on the scalp during electroconvulsive therapy generate significant connectivity in several brain regions.

Secondly, electroconvulsive therapy reduces connectivity between frontal regions of the brain that are associated with severe depression. The reduced connectivity largely occurs in frontal brain regions that are engaged in emotional control as well as lower brain regions that help in controlling emotions (Szalavitz par, 10). This is achieved when the therapy involves the use of antidepressants or attaching its electrodes to the right side of the head. A good example of reduced connectivity in frontal regions of the brain during electroconvulsive therapy is in relation to regions that generate emotions or those engaged in emotional control.

II. Improving Levels of Nerve Growth Factors in the Brain

Electroconvulsive also works by improving the levels of the nerve growth factors in the brain, which is crucial in the treatment of psychiatric illnesses. Similar to antidepressants, this therapy has been found to enhance levels of nerve growth factors in the brain. While there may too many connections in certain areas of the depressed brain, there could be few connections in other areas. Regardless of the number of connections in the depressed brain, electroconvulsive therapy increases levels of nerve growth factors in the depressed brain.

A. Inducing the Birth of New Brain Cells

Once electroconvulsive therapy increases the levels of nerve growth factors in the brain, it contributes to the birth of new brain cells that would be crucial in treatment of psychiatric illnesses. Actually, nerve growth factors whose levels are increased by this treatment procedure are those that provoke the birth of new brain cells. Therefore, electroconvulsive therapy helps in the birth of new brain cells through increasing the levels of nerve growth factors relating to this process or activity. A peripheral nerve stimulator can be utilized to supplement ordinary means of achieving maximal muscle relaxation (American Psychiatric Association, p.40).

The first way through which electroconvulsive therapy provokes the birth of new brain cells by increasing the levels of nerve growth factors is through its stimuli. Stimuli from electroconvulsive therapy change the regional concentration of nerve growth factors, which results in birth of new brain cells. For example, the treatment procedure enhances the plasma levels of nerve growth factor in psychiatric patients and induces birth of new brain cells.

Secondly, electroconvulsive therapy provokes the birth of new brain cells is by increasing serum levels. Based on findings of recent studies, the therapy has been found to have positive impacts on serum BDNF and NGF levels in patients with major depression (Bilgen et al., p.82). In essence, electroconvulsive therapy increases serum levels on neurotrophic factor derived from the brain, especially for patients with psychiatric illnesses.

B. Revival of Hippocampus

Electroconvulsive therapy revives damaged connections in hippocampus i.e. an area of the brain linked to depression. The treatment procedure accomplishes this by increasing levels of nerve growth factors that revive damaged connections in hippocampus. Hippocampus is an area of the brain that is commonly linked to depression or other psychiatric illnesses, especially when it is damaged.

The first way through which damaged connections in hippocampus are revitalized is through reducing hyperconnectivity in the brain. As previously mentioned, some cases of psychiatric illnesses like severe depression are associated with too many connections in the brain. In these cases, the treatment reduces the hyperconnectivity in the depressed brain, which helps in revitalizing the damaged areas.

Secondly, electroconvulsive therapy revitalizes damaged connections in hippocampus by increasing connectivity in the brain. As previously indicated, some cases of psychiatric illnesses like depression are linked to reduced connectivity in the depressed brain. In these instances, electroconvulsive therapy enhances connectivity in the depressed brain.

Conclusion

In conclusion, electroconvulsive therapy is one of the oldest yet widely used treatment measures in psychiatry. It primarily involves passing a carefully-controlled electrical current through the brain in order to create an epileptic fit that helps in recovery from psychiatric illness. The electrical current affects electrical and chemical activities in the brain and produces significant improvements in psychotic and depressive symptoms. This treatment procedure works through provoking the release of important brain chemicals in the depressed brain and enhancing the levels of nerve growth factors in the brain. Consequently, while electroconvulsive therapy has usually appeared as a barbaric treatment but it's the most effective treatment for severe depression.