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Digital Subscriptions > Mental Health Nursing > AugSept 2018 > Electro convulsive therapy: Milestones in its history

Electro convulsive therapy: Milestones in its history

Colin Jones ECT lead nurse, Cheshire and Wirral Partnership NHS Foundation Trust Steven Jones MSc programme leader, Edge Hill University

Correspondence: colderjones@hotmail.co.uk

Abstract

ECT is a treatment where an electrical current is passed briefly through electrodes applied to the scalp to induce generalised seizure activity. This article explores the origins and developmental milestones of ECT, examines the literature on the history of ECT and concludes with the author’s work experiences.

Key words

ECT, electro convulsive therapy, history, practice, treatment

Introduction

This year marks 80 years since electro convulsive therapy (ECT) was first used as a treatment in psychiatry. ECT is an emotive subject for service users and practitioners alike, with varying opinions of its position in current psychiatric practice.

This article examines the origins and developmental milestones of ECT, explores the literature relating to the history of ECT and concludes with our own work experiences.

Before embarking on the history of ECT, it is beneficial to start with a description of current ECT practice in the UK. We accept that we have not captured all the evidence in this work.

ECT explained

ECT is a treatment where an electrical current is passed briefly through electrodes applied to the scalp to induce generalised seizure activity.

The procedure is carried out under general anaesthetic in the UK with the use of a muscle relaxant. ECT electrodes can be placed on both sides of the head (bilateral ECT), or on one side of the head (right unilateral) (NICE, 2003). In certain circumstances, bifrontal may be used (Kellner et al, 2010).

ECT should be considered for severe depression that is life threatening or where a rapid response is required or where other treatments have failed (NICE, 2009). ECT should not be used routinely in moderate depression but could be considered if there has been no response to multiple drug treatments and psychological treatments (NICE, 2009). ECT may be considered for treatment of a prolonged or severe manic episode and in catatonia (NICE, 2003). The consensus group for ECT concluded that ECT should be considered as a fourth line option for patients with schizophrenia for whom Clozapine had already been proven ineffective or intolerable (Scott, 2005). Clinical indications for the use of ECT should be based on a thorough documented assessment of harms risk and potential benefits to the individual. These include risks relating to anaesthesia, current co-morbidities, anticipated adverse events particularly cognitive impairment and the risks of not having treatment.

This paper contextualises the history and development of ECT. The use of language in the paper is from evidence of the period cited to encourage reader reflection on the use and evidence base of ECT.

Historical context

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About Mental Health Nursing

The August/September issue of MHN is a special themed edition on ECT, including: - The history and use of ECT in modern practice • Service user views • Using recovery staff in ECT anaesthesia • Student perspectives on ECT • The National Association for Lead Nurses in ECT • Interview with an ECT lead nurse • Organising a Twitter chat on ECT