As early as the 16th century, agents to produce seizures were used to treat psychiatric conditions.
In 1785, the therapeutic use of seizure induction was documented in the London Medical Journal.
Within three years metrazol convulsive therapy was being used worldwide.
In 1937, the first international meeting on convulsive therapy was held in Switzerland by the Swiss psychiatrist Muller.
The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide.
ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient. Cerletti and Bini were nominated for a Nobel Prize but did not receive one.
By 1940, the procedure was introduced to both England and the US. Through the 1940s and 1950s the use of ECT became widespread.
ECT is the only form of shock treatment still performed by modern medicine.
In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse.
It took many years for brief-pulse equipment to be widely adopted Unilateral ECT has never been popular with psychiatrists and is still only given to a minority of ECT patients.
The New York Times described the public's negative perception of ECT as being caused mainly by one movie, "For Big Nurse in ''One Flew Over the Cuckoo's Nest,'' it was a tool of terror, and in the public mind ''shock therapy'' has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and overused".
Specifically critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT.
The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression".
Due to the backlash noted previously, national institutions reviewed past practices and set new standards.
In 1978, The American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended.
The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances.
The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented.
Finally in 2001 the American Psychiatric Association released its latest task force report. This report emphasizes the importance of informed consent, and the expanded role that the procedure has in modern medicine.
Further Reading
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