Electroconvulsive therapy (ECT) is one of the most controversial treatments used in modern psychiatry.
Methods of inducing seizure or convulsions as a way of treating psychiatric conditions were introduced as early on as the 16th Century. At that time, the conditions were largely untreatable due to medications not being as developed or advanced as they are today. The use convulsive therapy was first documented in the London Medical Journal in 1785.
It was in 1937 that the first international meeting on convulsive therapy took place in Switzerland, under the organization of Swiss psychiatrist Muller. The proceedings from this meeting were published in the American Journal of Psychiatry and within three years, convulsive therapy using cardiazol (metrazol) was being used across the world.
Next, neuropsychiatrist Ugo Cerletti and his colleague Lucio Bini who had been conducting animal experiments using electric shocks, introduced the idea of replacing cardiazol with electroshocks treatment as the method for inducing a convulsion.
The electroshock method was cheaper and more convenient than the metrazol method but it was also less predictable and controllable. Cerletti and Bini were nominated for a Nobel Prize and by the 1940s the use of ECT had become widespread in England and the US. The popularity of the technique also spread throughout the 1950s.
The use of ECT gradually declined over the years, mainly due to poor public perception of the technique, partly as a result of its portrayal in film and media. The therapy became more popular again in the 1980s when the benefits to patients with severe refractory depression became obvious.
In 1978, the first task force report from the The American Psychiatric Association was released introducing new standards for consent and recommending the use of unilateral electrode placement.
In 1985, the NIMH Consensus Conference supported the use of ECT in certain clinical circumstances. In 1990, the American Psychiatric Association released a second report further detailing guidance on the delivery of ECT as well as training and education. The latest task force report from the association in 2001, emphasized the importance of the patient’s informed consent as well as the extended role ECT plays in medicine today.
Reviewed by Sally Robertson, BSc