Published on April 11th, 2018 | from CAMH

The past, present and future of electroconvulsive therapy (ECT)

If you thought ECT was an ineffective or outmoded historical relic from the past, think again

By Dr. David Goldbloom, Senior Medical Advisor

Today marks an important anniversary in the history of psychiatry. Exactly 80 years ago, on April 11, 1938, the first treatment using electroconvulsive therapy (ECT) was administered in Rome, Italy.

In 1938, there were no effective medications for the treatment of mental illness; the modern era of psychopharmacology was still more than 15 years away. However, in 1934 insulin had been used to create a comatose state and chemicals had been used to induce epileptic seizures, both as novel forms of treatment for people with schizophrenia; these treatments rapidly became popular around the Western world as an antidote to therapeutic hopelessness. But they also carried risks, and Professor Ugo Cerletti, the head of the University of Rome psychiatric clinic, working with his junior colleague Lucio Bini, developed an electrical alternative for inducing brief seizures in people with psychiatric illness.

After experimentation with animals to determine safety, the world’s first ECT was administered 80 years ago.

The benefits of ECT led to its rapid spread around the world. It was first used in South America in 1939, in the United States in 1940, and in Toronto by 1941. It rapidly became clear that it was a potent treatment for people with severe depression or catatonia.

Depictions of ECT in popular culture

Despite the excitement surrounding ECT as an effective remedy, there was – understandably – something terrifying about the idea of electrical current being passed through the brain, even if the goal was to relieve illness.

Iconic “It’s Alive!” scene from Frankenstein, 1931

Perhaps this emanates from ghoulish perceptions suggested by the popular 1931 film Frankenstein, in which the monster is brought to life by electric currents.

Frightening depictions of ECT in popular culture, such as the 1948 movie The Snake Pit and, most iconically, the 1975 movie One Flew Over the Cuckoo’s Nest, reinforced the fear. These movies showed ECT given without medication, without consent, and without benefit; in the 1975 film, it was given as punishment for bad behaviour to someone who didn’t even have a psychiatric illness to start with.

By contrast, cardiac defibrillation with an electrical stimulus is commonly shown on TV as a lifesaving treatment – and so simple it can be used by non-professionals in hockey arenas and movie theatres.

The realities of ECT, off the silver screen

The realities of ECT in 2018 bear little resemblance to the cinematic depictions. The commonest reactions of nursing and medical students, witnessing the treatment for the first time is: “That’s it?”

They are taken aback by its lack of drama.

At CAMH, where each weekday 20 to 25 people receive ECT as part of their acute or ongoing treatment, most are outpatients who go home an hour after they have been treated. Most of them are having ECT for depression, while some have it for schizophrenia that has had limited response to antipsychotic medication.

ECT has the unusual status of being one of the most vilified and validated treatments in all of psychiatry and indeed in all of medicine. The only reason it’s still in use 80 years after its development is that it works. And for people with severe depression, it works better and faster than any medication.

Hear three leading CAMH scientists discuss ECT and other therapies for treatment-resistant depression and dementia on this episode of the CAMH Podcast:

Like all treatments throughout medicine, ECT has side-effects, with memory disturbance being the most troublesome for patients and their families. That’s why, at the CAMH’s Temerty Centre for Therapeutic Brain Intervention  there is active and rigorous research on other forms of therapeutic brain stimulation, such as rapid transcranial magnetic stimulation and magnetic seizure therapy.

But so far, nothing outperforms ECT, which explains its continued use not only at CAMH but at every general hospital in Toronto.

If you thought ECT was an ineffective or outmoded historical relic from an earlier era, think again. ECT remains an evidence-based intervention among the broad array of ways, from housing, employment, and education, through to psychotherapy and medications, to help people struggling with mental illnesses.

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