ECT may be recommended if you have treatment-resistant schizophrenia or symptoms such as depression or catatonia.
Schizophrenia is a psychological disorder that has a significant impact on how you feel, think, behave, and interpret reality.
The first-choice treatment for schizophrenia includes dopamine-reducing antipsychotic medications, as they are fairly effective in reducing symptoms of psychosis.
Still, up to 30% of people with schizophrenia don’t respond well to these drugs.
Electroconvulsive therapy (ECT) is considered a viable option if you’re treatment-resistant, or if you have certain features of the disorder, such as depression or catatonia.
ECT was first introduced in 1938 as a treatment for schizophrenia and other psychotic disorders.
However, with the introduction of the first antipsychotic drug (chlorpromazine) in the 1950s — and the continued development of other effective medications — ECT use declined significantly, particularly in the United States and Europe.
Today, ECT is a therapeutic tool that delivers a series of small electrical pulses to the brain via electrodes. These pulses trigger a brief, controlled seizure while under general anesthesia.
While it’s still unclear exactly how ECT improves mental health symptoms, it’s believed that the flood of electrical activity positively alters your brain chemistry and blood flow. Many see it as a brain “reset.”
How does ECT work?
ECT is typically administered by a medical team, including a psychiatrist, anesthesiologist, and nurses.
While unconscious under general anesthesia, you’ll receive a series of minor electrical pulses to your brain via electrodes. These pulses lead to a brief (about a minute-long) seizure safely controlled by a muscle relaxant.
A cuff is placed around one ankle, restricting the muscle relaxant from reaching that foot. Clinicians closely watch the twitching in this foot and your brain activity on the EEG to monitor activity level.
Most people who receive ECT have two or three sessions per week for several weeks. Some people will notice a difference after the first session, while others might not notice a difference until several sessions later. Some don’t notice a difference at all.
ECT is still recovering from historical stigma
ECT is still recovering from the deep stigma of its early use, when it was also known as “shock” treatment.
In its early days, ECT would deliver a strong electrical current to the brain causing a whole body seizure. With such a large shock and no muscle relaxant, harmful effects might occur, such as a bitten tongue or even broken bones. This early procedure has given ECT a lingering stigma that remains today.
However, that early procedure bears little resemblance to today’s technique which has been highly refined over many decades to improve outcomes and reduce side effects.
Available research on ECT suggests that it’s a safe and effective treatment for people with schizophrenia.
One review found that ECT is beneficial in treatment-resistant schizophrenia as well as several other situations.
Today’s ECT treatment guidelines vary, but in general, ECT is considered a beneficial option for people with schizophrenia who also have the following symptoms or conditions:
- Treatment-resistant schizophrenia. ECT may be an especially good option for those not responding to clozapine.
- Catatonia. A large review shows that about
53%of people with catatonic schizophrenia respond to ECT.
- Suicidal ideation.
- Severe symptoms.
Researchshows that ECT is most effective for mood disorders, such as major depression and bipolar disorder. About 80% of people with uncomplicated major depression see a significant improvement after ECT.
In the above review, the most common accompanying symptoms for the participants who received ECT were (in order) catatonia, aggression, and suicidal thoughts. People with catatonic schizophrenia responded significantly better to ECT than those with any other feature of schizophrenia.
Another study with schizophrenia inpatients found that an ECT-medication combo significantly relieved positive symptoms (hallucinations and delusions) and negative symptoms (blunted affect or limited motivation).
ECT may also help decrease psychiatric hospitalizations. One study compared 380 Korean participants with schizophrenia who’d had more than six ECT sessions to 1,140 schizophrenia/non-ECT controls.
The two groups were matched according to psychiatric hospitalizations. The researchers found that, one year later, the ECT group had a larger decrease in psychiatric hospitalizations.
Modern ECT is much safer than it used to be, but some people can still experience side effects.
The most common side effects include the following:
- muscle soreness
- short-term memory loss
While most of these symptoms tend to diminish after the first day, some people may experience more memory loss than others. Some clients may have trouble remembering what happened just before the ECT, while others may have trouble remembering up to weeks or months before.
For most people, this memory loss improves with time.
ECT may be beneficial if you have treatment-resistant schizophrenia. It’s also particularly effective if you have depression or catatonia. For many people, particularly those with severe depression, the benefits may outweigh the risks of memory loss.
Consider speaking with a doctor to find out if ECT may be a good option for you. Each person’s ideal treatment plan for schizophrenia varies.
If you have schizophrenia symptoms that haven’t responded to medication, or if you have specific symptoms such as depression or catatonia, you may be a good candidate for ECT.
Some people should not have ECT. These include people with the following conditions:
- recent heart attack or other heart condition
- recent stroke, aneurysm, or other cause of bleeding in the brain
- lung disease such as chronic obstructive pulmonary disease (COPD)
- conditions that increase pressure inside the skull (brain tumors or intracranial hypertension)
ECT has come a long way since it was first developed in the 1930s. Today it’s a safe and effective treatment for people with treatment-resistant schizophrenia or those with severe depression or catatonia.
As we continue to gain a better understanding of the brain, ECT may become even more effective over time. And while it’s not a cure, ECT can improve your well-being and help you return to a productive life.