Chapter

Electroconvulsive therapy

Max Fink

in New Oxford Textbook of Psychiatry

Second edition

Published on behalf of Oxford University Press

Published in print February 2012 | ISBN: 9780199696758
Published online October 2012 | e-ISBN: 9780191743221 | DOI: http://dx.doi.org/10.1093/med/9780199696758.003.0160
Electroconvulsive therapy

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Convulsive therapy (ECT or electroshock) is an effective treatment for those with severe and persistent emotional disorders. It is safe for patients of all ages, for those with debilitating systemic illnesses and during pregnancy. It relieves symptoms in a briefer time than do psychotropic drugs. To achieve remission, treatments are usually given three times a week for two to seven weeks. To sustain recovery, treatments are continued either weekly or biweekly for several months. The overall duration of the treatment course is similar to that of the psychotropic medications frequently used for the same conditions. The treatment is severely stigmatized and its use is discouraged, even interdicted, in the belief that the electricity or the seizures irreversibly damage the brain. Few physicians are tutored in its use and facilities are limited making ECT unavailable to many who would benefit. The ease in the use of psychotropic medications, and neither greater efficacy nor greater safety, encourages their preferential use as ECT is relegated to the ‘last resort.’ In countries where psychotropic medications are expensive, ECT is prescribed, but the expense for anesthetics limits its use to its unmodified form. Despite these hurdles of stigma, expense and lack of training, its use has persisted for more than 70 years. Indeed, its use is increasing. Whole societies where it was interdicted at the end of the 20th century, as in the Netherlands, Germany, Austria, Italy, and Japan, interest and usage has increased, texts have been written or translated, and local psychiatric societies formed to encourage its use.

Chapter.  8733 words. 

Subjects: Psychiatry

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