There are several excellent reviews of the history, clinical indications, and likely harms and benefits of ECT (Abrams; American Psychiatric Association Task Force on Electroconvulsive Therapy (APA Task Force); Crowe; Ottosson). The essential feature of the treatment is the induction of a cerebral seizure (which is easily measured via concomitant electroencephalography) by means of electrodes attached to the scalp. Current is applied through the electrodes for a fraction of a second. The two electrodes may be attached to the right and left temples (bilateral ECT), inducing a seizure in both hemispheres of the brain, or to anterior and posterior placements on only one side (unilateral ECT), limiting the seizure to that side. Patients are premedicated with a muscle relaxant and anesthetized with a short-acting barbiturate general anesthetic. Patients remain unconscious after the treatment for about five minutes and are usually mildly confused for an hour or so after they awaken. They have no memory of the treatment itself. Treatments are usually given two or three times weekly for two to four weeks.
ECT was used originally as a treatment for schizophrenia on the basis of the now-discredited belief that epilepsy, which ECT was thought to mimic, and schizophrenia did not occur in the same persons. It is used chiefly with patients suffering from severe depression; most psychiatrists suggest its use to patients only when drug treatment and/or psychotherapy have not helped. ECT is also used occasionally with bipolar patients suffering from a life-threatening degree of manic excitement, or to schizophrenic patients suffering from a catatonic stupor, when these conditions do not improve with drug therapy.
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