Electroconvulsive therapy

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Electroconvulsive therapy (ECT), previously known as electroshock, is a well-established, albeit controversial, psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not responded to other treatment, and is also used in the treatment of mania (often in bipolar disorder), and catatonia.[1] It was first introduced in the 1930s[2] and gained widespread use as a form of treatment in the 1940s and 1950s; today, an estimated 1 million people worldwide receive ECT every year,[3] usually in a course of 6–12 treatments administered 2 or 3 times a week.

Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and positive outcomes. After treatment, drug therapy is usually continued, and some patients receive continuation/maintenance ECT. In the United Kingdom and Ireland, drug therapy is continued during ECT.[1] Informed consent is a standard of modern electroconvulsive therapy.[4] Involuntary treatment is uncommon in the United States and is typically only used in cases of great extremity, and only when all other treatment options have been exhausted and the use of ECT is believed to be a potentially life saving treatment.[5] Similarly, national audits of ECT use in Scotland and Ireland have demonstrated that the vast majority of patients treated give informed consent.[6] Although once frowned upon, recent years have seen an increased acceptance of ECT as a safe, effective and economical tool for the treatment of some mental illnesses. Yet it is rarely used as the first line of treatment.[7]

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