What Are the Pros and Cons of Electroconvulsive Therapy for Depression?

Electric spasm treatment is a special treatment method for neuropsychiatric diseases, and its effect is significant. Patients with severe depression, those with strong self-harm, suicide, and obvious self-blame and self-incrimination are particularly suitable. It also reminds us that patients with severe depression should choose electroconvulsive therapy from the current international recognition level.

Electric spasm treatment

Electric spasm treatment is a special treatment method for neuropsychiatric diseases, and its effect is significant. Patients with severe depression, those with strong self-harm, suicide, and obvious self-blame and self-incrimination are particularly suitable. It also reminds us that patients with severe depression should choose electroconvulsive therapy from the current international recognition level.

The implementation of this treatment requires a professional physician with rich clinical experience and is equipped with good rescue equipment and environmental conditions. The treatment process must be closely monitored.

Electric spasm treatment is a special treatment method for neuropsychiatric diseases, and its effect is significant. In 1938, Cerletti and Bini doctors began to treat patients with electrical shock (electrical spasm). As the treatment continued, it was discovered that the treatment technology could effectively and obviously control the symptoms of mental patients, and became the only effective weapon to treat patients with mental illness before the advent of antipsychotic drugs. In the 1940s, the treatment technology was introduced into China. From 1999 to 2000, China began to popularize electroconvulsive treatment technology after anesthesia on a large scale, that is, non-convulsive electrical shock or improved electrical shock treatment. In general, anesthesia techniques need to be implemented during the procedure. Although there may be some risks to patient anesthesia, the risks should be very small under the control of the anesthesiologist. It is safer and more effective than traditional electric shock treatment, but it is necessary to strengthen the management of breathing and circulation during the treatment, keep the airway open, maintain the stability of life indicators, pay attention to the choice and combination of anesthetic drugs, and grasp the treatment time and the amount of electrical stimulation. To maximize efficacy and safety ^[1]

At present, the detailed mechanism of electroconvulsive therapy is still at the forefront of research. However, some of the findings on this therapeutic mechanism are reviewed here: by extensively discharging the cerebral cortex, the body

1) Treatment room: comfortable environment and sufficient light; there is space to ensure the normal operation of medical staff and equipment; there are waiting areas, wake-up areas and treatment areas; to the greatest extent not interfere with each other.

2) Treatment equipment: electric convulsive therapy device with EEG and ECG monitoring functions; anesthesia machine and reliable oxygen supply equipment that can meet general anesthesia; supporting facilities for tracheal intubation; vital signs monitors and defibrillators; negative pressure suction Device; medicine cabinet: for the treatment and rescue medication; mobile treatment vehicles, etc.

3) Medical staff: a senior psychiatrist; two nurses; a professional anesthesiologist; a low senior resident to observe patients who have recovered (requires simple blood oxygen monitoring equipment) ^{[ 4]}

Patients with severe depression, those with strong self-harm, suicide, and obvious self-blame and self-incrimination are particularly suitable. It also reminds us that patients with severe depression should choose electroconvulsive therapy from the current international recognition level. Secondly, no matter what kind of mental disorder patients, those who have food refusal, violations and stiff, can choose this treatment as soon as possible. Third, no matter what type of mental disorder patients have extreme excitement, restlessness, or impulsive injury behavior, they can safely and quickly choose this treatment for intervention. In addition, this treatment is also ideal for patients who are ineffective or intolerant of psychotropic medications. According to research statistics, this treatment is more effective than most neuroblockers in refractory patients. In addition, related studies abroad show that this treatment has shown a unique effect on patients with refractory epilepsy and neuralgia.

In terms of indications for related treatments, electroconvulsive therapy has broadened its scope compared to 10 years ago. In 2010, the American Psychiatric Association emphasized the situation of electric shock treatment and transcranial magnetic stimulation treatment in a special unit. It is generally believed that in the past 10 years, certain neuropsychiatric disorders have been underestimated or partially ignored. The role of physical therapy. Since the beginning of this century, this situation has been greatly improved, especially in the treatment of patients with acute mental disorders and at risk of risky behaviors. In the past, the pattern of pure drug control was changed, and electroconvulsive therapy has been widely used ^{[ 5]}

Electrical shock can cause anxiety and headaches, and ECT can cause transient degenerative memory deficits and memory loss within 30 minutes after a seizure. If the treatment is repeated within a short period of time, this memory deficit will develop. If treated only two or three times a week, this memory loss would not occur. Some patients may experience confusion, headache, nausea, dizziness, etc. that last for several hours after treatment. Some modern measures can make this side effect very mild and fairly short-lived. There are few side effects after unilateral ECT treatment. A few patients have complaints of muscle pain, especially in the lower jaw. A few have reported sporadic one month after ECT.

In fact, for contraindications, the contraindications mainly come from electroconvulsions,

The patient's previous history of anesthesia, surgery, and electrical shock; previous and current medications; pay attention to the cautious and prohibited drugs in treatment to avoid unnecessary danger; physical examination, laboratory-assisted examination; fasting 8 Hours and 4 hours of water cessation; for some patients with relative contraindications, they should consult a physician or other specialist physician; provide appropriate medical intervention for the disease to enable the treatment to proceed smoothly; and sign the MECT informed consent.

Because electrical stimulation can cause muscle convulsions and close the teeth, it can easily lead to complications such as hypoxia. Sober patients will have a sense of fear. The introduction of non-convulsive electrical shock treatment technology provides new treatments for patients with mental illness, and also puts forward new requirements for anesthesia. The characteristics of the selected drug are fast onset of action, short duration, and rapid resuscitation; it can avoid tonic or clonic seizures when the patient is shocked; and maintain stable breathing and circulation. Suitable drugs are: propofol: rapid induction, inhibit stress response, reduce brain oxygen consumption, avoid the occurrence of hypoxic brain injury during electric shock, reduce cognitive impairment in patients after treatment; remifentanil: reduce Cardio-cerebral vascular accidents, enhance muscle relaxation, and increase pleasure after resuscitation; succinylcholine: a depolarizing neuromuscular blocker; atropine: reduce transient bradycardia caused by electric shock and succinylcholine, reduce respiratory tract Secretions

Administration: Atropine 0.25-0.5mg; Propofol 1.-15mg / kg body weight, the bolus speed can be controlled according to the degree of anesthesia; Scolin 1.1.5mg / kg body weight, rapid bolus, in order to speed up Resuscitation after treatment can be appropriately administered at low doses; pressurized artificial ventilation to closely observe the tremor of the muscle bundle; once the whole body muscles relax, remove the mask, insert a dental pad into the mouth, and support the jaw; power on: press the treatment button to complete After treatment, the tooth pad was removed and oxygen was given under pressure. Assessment: Satisfactory spontaneous breathing, blood oxygen saturation above 95%, and consciousness and cough reflexes can be removed from the treatment room. 3 or 5 times a week, 6-12 times is a course of treatment; after the treatment, the patient has no pain, fear, mental symptoms disappeared or reduced.

The United States Food and Drug Administration (FDA) has found that after undergoing electrical shock treatment, there may be retrograde forgetting of personal experiences, while the memory of non-personal experiences (such as historical knowledge and common sense) has not decreased. Due to the lack of an objective assessment of individual memory and the inability to exclude the effects of age, mood, and individual disease, we are not sure that this side effect has occurred in electroshock therapy, but this finding has also received the attention of members of the expert group.

After the above evaluation, although there was no formal hand-to-hand vote, most members of the expert group chose to keep the electric shock treatment device at the original level III. In terms of the distribution of votes, psychiatrists and anesthesiologists tend to reduce it to grade II (moderate risk group), while neurologists, psychologists, biostatisticians, and public representatives believe it should be maintained at level. In the control of retrograde amnesia, only slightly more than most experts feel that existing knowledge is not enough to control this complication. ^[7]

Electroconvulsive therapy

The literature indicates that ECT treatment is effective in about 50% of patients with refractory major depression, and there are few studies on follow-up, but about half of patients have relapses within one year. In addition, it has special effects on the acute exacerbation of wood stiffness, physical disease, and schizophrenia, and it is very suitable for those with severe mental illness who have suicidal or hurtful tendency.

At the same time, it can cause many sequelae, including reduced IQ, brain dysfunction, and learning disabilities. One of the most obvious symptoms is memory loss.

A 2013 report by the BBC tracked the lives of many mental patients after receiving ECT, and most mentioned memory issues.

Helen Crane underwent two ECT treatments in the late 1990s, erasing her memories of years including overseas travel and major family events: "After the ECT check, I suddenly had an ominous hunch about my mother. I asked me What happened to my husband, my mother, he told me that my mother died about two years ago. "

It is for this reason that ECT therapy has been included in the tier 3 (high risk) list by the Food and Drug Administration. Only with the consent of a doctor can they be used as the last line of defense for mental intervention for major depression, mania and schizophrenia. Several states in the United States have so far banned the use of this therapy because they are too inhumane. ^[8]