How effective is electroconvulsive therapy and why

Psychiatry, Psychosomatics & Psychotherapy

02.11.2010

Electroconvulsive Therapy: A good treatment option for difficult-to-treat depression

For therapy-resistant depression, electroconvulsive therapy has so far been the most effective antidepressant treatment method, because the success rate even with these patients is still 50 to 70 percent.

Electroconvulsive therapy (ECT) can achieve good results in the treatment of depressive disorders that are difficult to treat with medication and psychotherapeutic methods. “In almost a third of people with long-term depression, drug therapy is not sufficiently effective, so that additional treatment options have to be used. Electroconvulsive therapy can significantly improve the symptoms or make them disappear, and it can also save lives when there is a high risk of suicide. For therapy-resistant depression, ECT has so far been the most effective antidepressant treatment method, because the success rate even with these patients is still 50 to 70 percent, ”advises Priv.-Doz. Michael Grözinger from the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) in Berlin. "Unfortunately, sometimes there is a further deterioration after the series of treatments, so that a refresher treatment or medication readjustment is necessary."

The ECT is carried out as a series, usually with eight to twelve sessions, which usually take place every 2-3 days. The electrical stimulation only lasts a few seconds and takes place under short anesthesia. “As far as we know today, the effect of ECT is due to an increased release of neurotransmitters and to regenerative processes in the central nervous system. However, the exact mechanism has not yet been finally clarified, ”adds the expert.

ECT sometimes wrongly has a bad reputation, which is expressed, for example, in the 1975 film "One Flew Over the Cuckoo's Nest", in which the main protagonist Jack Nicholson is forced to endure ECT without anesthesia. Overall, ECT is a less stressful procedure in relation to the desired therapeutic success. The treatment is carried out under anesthesia and the patient is given medication to relax the muscles in order to avoid injuries caused by jerky movements. “After the therapy, there may be temporary memory impairment in some cases. The most common side effect is headache. On the other hand, the depression-related reduction in mental performance and drive can improve significantly under successful ECT treatment, ”explains Priv.-Doz. Grözinger from the Clinic for Psychiatry and Psychotherapy at the University Hospital Aachen. If an improvement in the symptoms is achieved, behavioral therapy methods can be used subsequently or in addition.

In addition to ECT, there are other treatment methods that can be used if drug therapy is insufficiently successful. For example, repetitive transcranial magnetic stimulation (rTMS) uses the principle of magnetic induction to stimulate certain brain regions through the skull, the activity of which is disturbed in people with depression. However, this method is clearly inferior to the ECT in terms of effectiveness.

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