Meduna was also forced to immigrate to Chicago, in the USA, in , and from there he continued his research on metrazol convulsions. Eventually, psychiatry recognized that his theory of biological incompatibility between epilepsy and schizophrenia was unfounded, but that artificially-induced convulsions were useful to reduce schizophrenia.
In , A. Bennett, a psychiatrist, combined metrazol injections with curare to neutralize the strong muscle contractions which were responsible for this and other incidents. Curare is a muscle paralyzing agent which is extracted from South American plants used by Indians to make poison darts and arrows.
It occupies the nerve receptors in muscles, blocking the normal action of acetylcholine neurotransmitter released by motor cells at that point.
Later, scopolamine was also used in conjunction with metrazol and curare, to sedate the patient and to avoid the terror of being subjected to violent convulsions while conscient this was an advantage of insulin. However, in controlled trials, metrazol seemed to be far less efficient than insulin in the treatment of schizophrenia, particularly chronic disease. Due to the appearance of many other methods to treat mental disease, including neuroleptics and electroconvulsive therapy, metrazol was gradually discontinued in the late 40's and is no longer in use.
It's importance is only historical. In , an Italian neurologist named Ugo Cerletti was convinced that metrazol-induced convulsions were useful for the treatment of schizophrenia, but far too dangerous and uncontrollable to be applied there was no antidote to stop the convulsions at the time, as it happened with insulin. Furthermore, they were highly feared by the patients. Cerletti knew that an electric shock across the head produced convulsions, because as an specialist in epilepsy, he had done experiments with animals on the neuropathological consequences of repeated epilepsy attacks.
In Genoa, and later in Rome, he used a electroshock apparatus to provoke repeatable, reliable epileptic fits in dogs and other animals. The idea to use ECT in humans came first to him by watching pigs being anesthetised with electroshock before being butchered, as a kind of anesthesia, and so he convinced two colleagues, Lucio Bini and L. Kalinowski a young German physician to help him in developing a method and an apparatus to deliver brief electric shocks to human beings.
They first experimented with several kinds of devices and animals, until determining the ideal parameters and perfecting the technique, and then followed up with a series of electroshocks in human subjects with acute-onset schizophrenia.
After 10 to 20 ECT shocks in alternate days, the improvement in most of the patients were startling. One of the unexpected benefits of transcranial electroshock was that it provoked retrograde amnesia, or a loss of all memory of events immediately anterior to the shock, including its perception.
Therefore, the patients had no negative feelings towards the therapy, as it happened with metrazol shock. Furthermore, ECT was more reliable and controllable and less dangerous to the patient than metrazol. Researchers who adopted Cerletti-Bini's method soon discovered that it seemed to have spectacular effects on affective disorders.
According to E. Soon, curare and scopolamine were being used in conjunction with ECT, and gradually it replaced metrazol and insulin-induced shock. ECT was to begin its long journey as the shock therapy of choice in the majority of hospitals and asylums around the world. Other kinds of physical shock therapy were briefly tested, such as the induction of fever by means of radiomagnetic microwaves, transient brain anoxia induced by breathing a mixture of oxygen and nitrogen and lowering the body's temperature.
Results were mixed, and they were all abandoned in favor of ECT, cheaper and more reliable. Significant improvements in the technique of ECT have been made since then, including the use of synthetic muscle relaxants, such as succinylcholine, the anesthesia of patients with short-acting agents, pre-oxygenation of the brain, the use of EEG seizure monitoring and better devices and shock waveforms. Despite these advances, the popularity of ECT greatly decreased in the s and s, due to the use of more effective neuroleptics and as a result of a strong anti-ECT movement, as we will see below.
You're taken to a recovery area, where you're monitored for any potential problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more. In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments.
Some doctors use a newer technique called right unilateral ultrabrief pulse electroconvulsive therapy that's done daily on weekdays. The number and type of treatments you'll need depend on the severity of your symptoms and how rapidly they improve. You can generally return to normal activities a few hours after the procedure. However, some people may be advised not to return to work, make important decisions, or drive until one to two weeks after the last ECT in a series, or for at least 24 hours after a single treatment during maintenance therapy.
Resuming activities depends on when memory loss and confusion are resolved. 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. No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity.
These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That's why ECT is most effective in people who receive a full course of multiple treatments. 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.
Mayo Clinic does not endorse companies or products. These portrayals have no resemblance to modern ECT practiced according to accepted professional guidelines. Such patients usually have severe disorders that can be potentially life-threatening either major depression or bipolar disorder , medication-resistant schizophrenia and schizo-affective disorder, or severe catatonia a relatively rare condition.
The memory loss generally pertains to events preceding the treatments, and may be expected to clear over a period of days to weeks Sackeim, In rare cases, this impairment may last for a considerably longer period--weeks to months to years. Even in such cases, the memory impairment does not interfere with mental functioning or cause persistent deficits in the formation of new memories or disrupt with basic cognitive functions, such as intelligence Sackeim et al.
There is a clear absence of any evidence that ECT causes damage to neurons or other brain cells Devanand et al. In New York State, persons treated by ECT must be given an explanation of the proposed procedure and course of treatment, including a discussion of the expected benefits, reasonable foreseeable risks, and any reasonable alternative to the proposed treatment.
Where there is reason to believe that the patient may lack capacity, the treatment team may appeal to the court for permission to administer ECT , when the treating physician determines that this treatment would be of greatest benefit to the patient. OMH adheres to NYS law and regulations in all cases where treatment is sought when the patient lacks capacity. American Psychiatric Association [Weiner, R.
Second Edition. Washington, D. American Psychiatric Press, A Cleveland psychiatrist who was active then once told me that the doctors and nurses used to chase the patients around the room to get them to take Metrazol. Ironically, given that ECT would become iconic as a frightening treatment, the Italian researchers who proposed using electricity instead were searching for a safer, more humane and less fearsome method of inducing the seizures.
Their colleagues, internationally, believed they had succeeded. Within only a few years of its invention, ECT was widely used in mental hospitals all over the world. Many depictions of ECT in film and television have portrayed the therapy as an abusive form of control. There is probably no fictional story that so haunts our consciousness of a medical treatment. There is no question that ECT was benefiting patients then, but there is also a lot of evidence from that period showing that ECT, and the threat of it, were used in mental hospitals to control difficult patients and to maintain order on wards.
ECT was also physically dangerous when first developed. Now there are ways to mitigate those dangers. Current practice, known as modified ECT, uses muscle relaxants to avoid the physical dangers of a seizure and anesthesia to avoid pain from the electricity.
These modifications were learned early, but it took a while for them to become standard practice. He would have been able to witness all of this. This was not a major part of ECT practice, but this is not a comfort to gay people who received the treatment, for whom it could be traumatizing. But it survived in the social memory of the therapy. By the s, the evidence that ECT was very effective for treating depression was robust. But there were also good reasons for patients to fear ECT.
These reasons, combined with widespread revolts against authority and conformity that flourished in the s, also gave rise to a revolt against medical authority — the anti-psychiatry movement.
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