Electroconvulsive Therapy Treating Depression \/\/FREE\\\\
Many people begin to notice an improvement in their symptoms after about six treatments with electroconvulsive therapy. Full improvement may take longer, though ECT may not work for everyone. Response to antidepressant medications, in comparison, can take several weeks or more.
electroconvulsive therapy treating depression
Even after your symptoms improve, you'll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).
Additionally, owing to the work of the CORE group, which showed the equal performance of continuation ECT and combination pharmacotherapy in preventing relapse following response to acute ECT, the Prolonging Remission in Depressed Elderly (PRIDE) group was established. The PRIDE/CORE group was established to investigate whether combined pharmacotherapy and ECT, personalized according to patient reaction, is more effective in preventing relapse in depressed older individuals than pharmacotherapy alone. For the phase I study, right unilateral ultrabrief pulse ECT combined with venlafaxine was introduced for the treatment of geriatric depression, showing that right unilateral ultrabrief pulse ECT combined with venlafaxine worked quickly and effectively against geriatric depression, with excellent safety and tolerability (Kellner et al., 2016b). Phase II participants were recruited from the remitted individuals of the PRIDE phase I study, and phase II was conducted using a novel Symptom-Titrated Algorithm-Based Longitudinal ECT (STABLE) regimen. As a result, the continuation ECT plus medication was preferable in clinical performance and did not show statistically different cognitive impairment from that of continuation medication alone (Kellner et al., 2016a), and STABLE resulted in overall net health benefits (McCall et al., 2018). As for health-related quality of life in elderly depressed patients who underwent ultrabrief-pulse ECT, an open-label study suggested that attaining remission was critical to acquiring better health quality (McCall et al., 2017).
In a study using genetically engineered mice, Johns Hopkins researchers have uncovered some new molecular details that appear to explain how electroconvulsive therapy (ECT) rapidly relieves severe depression in mammals, presumably including people. The molecular changes allow more communication between neurons in a specific part of the brain also known to respond to antidepressant drugs.
Effective treatments for depression include counseling, psychotherapy, and prescription medications. However, for an estimated 100,000 people a year in the United States, like Neville, these options fall short. And for them, ECT is safe, reliable, and effective.
The treatment has evolved since the 1930s, when psychiatrists hypothesized that grand mal seizures could help treat schizophrenia, based on the observation that some nerve cells in the brains of people with schizophrenia appeared to be arranged in a way that was the opposite of people with epilepsy. However, it turned out that the seizures were most effective in treating depression and other mood disorders.
For some people with severe or hard-to-treat depression, electroconvulsive therapy (ECT) is the best treatment. This treatment, sometimes referred to as "electroshock therapy," is often misunderstood and incorrectly portrayed by popular media as a harsh, cruel treatment. In reality, it is a painless medical procedure performed under general anesthesia that is considered one of the most effective treatments for severe depression. It can be lifesaving.
ECT works quickly, which is why it's often the treatment of choice for people with highly severe, psychotic, or suicidal depression. For these people, waiting for antidepressants or therapy to work might be dangerous. However, the drawback is that the effects of ECT usually don't last, and further treatments will likely be necessary.
The number of required sessions varies. Many people have six to 12 sessions administered 2-3 times per week over a period of several weeks. After initial treatment, you might require further ECT treatments in addition to depression medicine and therapy to prevent your depression from returning.
Objectives: Repetitive transcranial magnetic stimulation (rTMS) is a potential new antidepressant method and alternative to electroconvulsive therapy (ECT). The efficacy of right prefrontal low-frequency rTMS was shown in a previous placebo-controlled, randomized study but has never been compared with ECT. The aim of this study was to compare the antidepressant efficacy and adverse effects of right prefrontal low-frequency rTMS with that of ECT.
Modern day ECT is safe and effective. It can relieve symptoms of the most severe forms of depression more effectively than medication or therapy, but because it is an intrusive procedure and can cause some memory problems, ECT should be used only when absolutely necessary.
Once ready for surgery, two holes are drilled into the head. From there, the surgeon threads a slender tube down into the brain to place electrodes on each side of a specific area of the brain. In the case of depression, the first area of the brain targeted by DBS is called Area 25, or the subgenual cingulate cortex. This area has been found to be overactive in depression and other mood disorders. But later research targeted several other areas of the brain affected by depression. So DBS is now targeting several areas of the brain for treating depression. In the case of OCD, the electrodes are placed in an area of the brain (the ventral capsule/ventral striatum) believed to be associated with the disorder.
Question What is the cost-effectiveness of electroconvulsive therapy compared with antidepressant medications and/or psychotherapy for treatment-resistant major depressive disorder in the United States?
Meaning Electroconvulsive therapy may be an effective and cost-effective treatment for treatment-resistant depression and should be considered after failure of 2 or more lines of pharmacotherapy and/or psychotherapy.
Importance Electroconvulsive therapy (ECT) is a highly effective treatment for depression but is infrequently used owing to stigma, uncertainty about indications, adverse effects, and perceived high cost.
Design, Setting, and Participants A decision analytic model integrating data on clinical efficacy, costs, and quality-of-life effects of ECT compared with pharmacotherapy/psychotherapy was used to simulate depression treatment during a 4-year horizon from a US health care sector perspective. Model input data were drawn from multiple meta-analyses, randomized trials, and observational studies of patients with depression. Where possible, data sources were restricted to US-based studies of nonpsychotic major depression. Data were analyzed between June 2017 and January 2018.
Conclusions and Relevance For US patients with treatment-resistant depression, ECT may be an effective and cost-effective treatment option. Although many factors influence the decision to proceed with ECT, these data suggest that, from a health-economic standpoint, ECT should be considered after failure of 2 or more lines of pharmacotherapy/psychotherapy.
Cognitive impairment is sometimes noticed after ECT.[48][49][50][51] It has been claimed by some non-medical authors that retrograde amnesia occurs to some extent in almost all patients receiving ECT.[52] The American Psychiatric Association (APA) report in 2001 acknowledges: "In some patients the recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in persistent or permanent memory loss".[10] After treatment, drug therapy is usually continued and some patients will continue to receive maintenance ECT treatments.[5] It is the purported effects of ECT on long-term memory that give rise to much of the concern surrounding its use.[53] However, the methods used to measure memory loss are generally poor, and their application to people with depression, who have cognitive deficits including problems with memory, have been problematic.[54]
Although the Chinese government stopped classifying homosexuality as an illness in 2001, electroconvulsive therapy is still used by some establishments as a form of "conversion therapy".[103][104] Alleged Internet addiction (or general unruliness) in adolescents is also known to have been treated with ECT, sometimes without anestheia, most notably by Yang Yongxin. The practice was banned in 2009 after news on Yang broke out.[105]
Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol).[111][112] Meduna is thought to be the father of convulsive therapy.[113] In 1937, the first international meeting on schizophrenia and convulsive therapy was held in Switzerland by the Swiss psychiatrist Max Müller.[114] The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide.[112] Italian professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant Lucio Bini at Sapienza University of Rome developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1938, experimented for the first time on a person affected by delusions. It was believed early on that inducing convulsions aided in helping those with severe schizophrenia but later found to be most useful with affective disorders such as depression. Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state.[115] Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on patients, they found that after 10-20 treatments the results were significant. Patients had much improved. A positive side effect to the treatment was retrograde amnesia. It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it.[115] ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient.[116] Cerletti and Bini were nominated for a Nobel Prize but did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria, it was promoted by Friedrich Meggendorfer. Through the 1940s and 1950s, the use of ECT became widespread. At the time the ECT device was patented and commercialized abroad, the two Italian inventors had competitive tensions that damaged their relationship.[117] In the 1960s, despite a climate of condemnation, the original Cerletti-Bini ECT apparatus prototype was hotly contended by scientific museums between Italy and the USA.[118] The ECT apparatus prototype is now owned and displayed by the Sapienza Museum of the History of Medicine in Rome.[118]