#Health,#TrueNews : Electroshock therapy can treat the depression (?) ( all you need to know about this !)

Electroshock therapy can treat the depression (?)

A recent study has discovered that — contrary to expectation — electroconvulsive therapy may be a better treatment option for many people whose depression has not been eased by other interventions.

Electroconvulsive therapy (ECT), which is usually referred to as shock treatment, involves passing a current through a person's brain to alleviate depressive and other psychiatric symptoms.

First used in the 1930s, it has since been all but replaced by medications and talking therapies.

Although the earliest forms of ECT were as brutal as their name suggests, the modern version is a significantly safer procedure.

Today, a much smaller current is sent to the brain in pulses while the individual is under short-acting anesthesia.

Normally, the individual has a number of sessions over the first few weeks, followed by occasional treatments over the longer-term.

It sounds like a fairly blunt tool, but ECT does work for many people, with more than half of people finding relief after completing the course.

Due to the specialist care needed for ECT treatment, its cost, and stigma, it is often the last port of call when treating depression.

However, according to a study published in JAMA Psychiatry, for people who have had no success on two first-line antidepressants, ECT might be the best and most cost-effective solution.

Re-evaluating ECT use

Researchers from the University of Michigan Department of Psychiatry in Ann Arbor took data from large, already published clinical trials. They used modeling to simulate a patient's journey through treatments to assess which routes produced the best outcomes.

The team discovered that in patients being treated for depression for the first time, medication, psychotherapy, or a combination of both would be most cost-effective.

This was also true for people whose first attempt to treat depression had not been successful — trying another medication with or without psychotherapy was the best route to take.

But for those with treatment-resistant depression — where two different treatment options had failed — ECT was shown to be the most cost-effective course of action. And, importantly, the scientists showed that patients would spend less time dealing with the symptoms of depression.

The researchers found that around half of patients who tried ECT would enter remission (immediate and full relief), and one third of those would relapse after 1 year.

In contrast, a third of the subjects experienced remission after their first antidepressant and only 25 percent of the people who tried a second antidepressant had remission. For those who found no relief in the first two antidepressants, a third only helped around 15 percent, and a fourth drug helped only 7–10 percent of individuals.

So, as a third-line treatment, ECT could significantly benefit patients. But, as it stands, ECT is much further down the list of interventions; it is generally considered the last port of call.

In fact, the researchers themselves had expected ECT to come in fifth or sixth position.
ECT rarely used

In earlier work by the same group of researchers, they found that only 0.16 percent of patients with depression received ECT. And, according to the authors, other studies have shown that ECT is generally used only after five to seven medications have been tried.

Lead study author doc Eric L. Ross said :

"Although choosing a depression treatment is a very personal choice that each patient must make with their physician based on their preferences and experience, our study suggests that ECT should be on the table as a realistic option as early as the third round of care."

These results mean that, currently, not all people with depression are receiving the most effective treatment for them.

"Unfortunately," notes senior study author Dr. Daniel Maixner, "research shows that with multiple medication failures and long duration of illness — sometimes many years — the chance that patients can achieve remission drops quickly to very low numbers."

He goes on, "ECT is the best treatment to produce remission. So, in addition to the clinical idea that ECT should be used sooner, our study adds another perspective highlighting that ECT is also cost-effective earlier in the treatment course of depression."

As for the future, the researchers hope that these findings will help to convince clinicians, patients, and insurance companies alike that ECT is not only cost-effective as a third-line treatment, but it is also in the patient's best interest.

Researcher Kara Zivin, Ph.D. — an associate professor of psychiatry — outlines what they hope their findings will achieve.

"We shouldn't allow the stigma attached to the past incarnations of this approach to prevent its modern form from being seriously considered for appropriate patients," she says.

"Increased coverage could also help address the widespread ECT service-area gaps that we've found in other research."

What's to know about electroconvulsive therapy?

Electroconvulsive therapy is a safe, controlled procedure for depression and other psychological disorders that have not responded to other treatments.

A small amount of electric current is passed through the brain in order to cause a brief seizure.

Depression affects around 15 million Americans, making it the leading cause of disability in the United States (U.S.), but it can be hard to treat.

Between 60 and 70 percent of people with major depressive disorder respond to antidepressant medications. Electroconvulsive therapy (ECT) may help people for whom these and other treatments have not been effective.

ECT is given under anesthesia in both outpatient and inpatient hospital settings. Between 70 and 90 percent of patients experience a rapid improvement in symptoms.

It may also help people who are acutely ill with mania, psychosis, catatonia, agitated dementia, post-traumatic stress disorder (PTSD), and suicidal thoughts.

Fast facts on ECT

Here are some key points about ECT. 

More detail is in the main article.
The American Psychiatric Society (APA) has established clear guidelines for ECT use.
ECT is considered safe for pregnant women, adolescents, and older people.

  • Positive results can be seen in as few as one to two ECT treatments.
  • Around 100,000 people a year receive ECT in the U.S.
  • Symptoms improve in 70 to 90 percent of patients.
  • There is no reliable evidence of long-term harmful effects.

What is ECT?

ECT, formerly called electroshock therapy, has been used to treat several psychiatric conditions since 1938.
In its early use, people undergoing the treatment often experienced damage to teeth and bones and significant pre-treatment anxiety.
In the 1960s, the use of ECT fell significantly, as antidepressants and antipsychotic medications became available.

However, not everyone responds well to drug therapy, and with improved treatment procedures and better management of side effects, ECT can now be an effective treatment with a high safety record.

Nevertheless, continued opposition to its use and the portrayal of ECT as harmful have made the public wary of the procedure. The stigma remains.

Today's evidence shows ECT as a valuable, often underused treatment that could help manage and reduce symptoms in people with serious and persistent psychiatric illnesses.

LISTEN LIVE : http://66.radiopratica.com

How does it work?

ECT delivers a small electric pulse to the brain for 1 to 2 seconds, while an individual is under general anesthesia.

This causes brain cells to fire in unison, resulting in a brief seizure. As the individual is asleep and their muscles are relaxed, the only evidence of the seizure is through the brain's wave activity as seen on a monitor.

The reason for the effectiveness of ECT is unknown.

The electric pulse is thought to trigger an immediate increase in dopamine and serotonin, the body's main neurotransmitters associated with depression.

ECT also causes a release of important hormones and of natural mood-elevating chemicals, known as endorphins.

Antidepressants stimulate a similar reaction, but it can take several weeks and different drug combinations to receive the same effect.

What to expect

A trained physician performs ECT treatments on either an inpatient or outpatient basis.

In the U.S., treatment usually happens three times a week, and a treatment cycle can last from 6 to 12 treatments.

A psychologist or psychiatrist refers a patient to ECT. The ECT provider then meets with the patient to check that the treatment is necessary.

The specialist evaluates the patient's overall health and commences the informed consent process. The consultation also provides a chance to address any concerns about ECT. The individual also meets with an anesthesiologist.

Family involvement is encouraged throughout, to help the patient and their family understand ECT. Families also learn how to care for and monitor their loved one while treatment lasts.

For convenience, these procedures are often completed on the same day as the first ECT treatment.

Depending on pre-existing medical conditions, other screening tests, such as ECG, and some blood tests, may be completed before starting treatment.

The individual receiving therapy is involved in all decision-making regarding any changes in or termination of the treatment. The informed consent process for ECT is more detailed than most in medical and dental procedures.

The patient receives a muscle relaxant and anesthesia through an intravenous drip (IV). Once these take effect, the electric pulse is administered through electrode pads placed on either temple.

The session lasts less than 5 minutes. During this time, the heart rate and rhythm, blood pressure, temperature, and blood oxygen levels are all closely monitored.

The patient spends up to an hour in recovery, and when fully awake they can leave the facility.

No driving is allowed for the next 24 hours.

Those whose symptoms do not improve may need to follow up with medication-based management or further maintenance ECT sessions.

ECT can cost between $300 and $800 per session, and as the average number of sessions is 8, treatment costs can range from $2,400 to $6400.

If an insurer covers treatment for mental health problems, they will likely fund ECT, provided it is clinically indicated.

Side effects

ECT is well tolerated, meaning that many side effects are rare. It is safe to used during pregnancy, in adolescence, and in older age.

The main adverse effect is a possible loss of memories relating to the time before and immediately after treatment. This affects each person differently. It can sometimes last for several months following treatment.

It happens because the part of the brain that retrieves memories is largely affected by the electrical stimulation.

However, experienced practitioners can lessen this side effect by individualizing treatment and modifying certain factors such as lead placement, type of anesthesia, and the time interval between treatments.

Other side effects, especially after the earlier sessions, may include:

  1. headache
  2. jaw ache
  3. temporary anxiety, confusion, disoriented feelings, and fear
  4. nausea
  5. shakiness
  6. muscle stiffness
  7. fatigue and intense sleepiness
  8. possible hallucinations

Older people may be more unsteady and falls more often. Pain relief and anti-nausea medication can help reduce these unwanted effects.

Complications of ECT are rare, and unlikely to be life threatening. As with any procedure performed under anesthesia, there is a risk of serious heart problems or other reactions to anesthesia.

The examining doctor should grant specialist medical clearance and precautions in patients with certain or unstable medical conditions.

These include a recent heart attack, brain surgery or head injury, chronic obstructive pulmonary disease, asthma, stroke, or pneumonia.

ECT is not a first-line treatment. Most practitioners do not consider referral for ECT until many months or years of medication and other therapy without results.

However, it can be a safe and effective, low-risk option for individuals experiencing a variety of mental-health and brain-related disorders.

Post a Comment