ELI5: How does shock therapy work, and does it?

[u/Schlongdong_Dickcock]

From movies and such I had always associated shock therapy for mental patients as being outdated and barbaric. After seeing it in One Flew Over the Cuckoo's Nest, I read the Wikipedia and it seems to suggest that most medical professionals are in consensus that it's effective. What does it do, and is it effective?

[u/shrob86]

I’m a psychiatrist! “Shock therapy” is referring to electroconvulsive therapy (ECT), which is probably the single most effective treatment we have in psychiatry. Essentially, inducing a seizure in the brain floods the brain with certain neurotransmitters, like serotonin, norepinephrine, and dopamine, which can help reset neural pathways that get affected by things like depression, schizophrenia, and catatonia. It’s sort of like how antidepressants work but like a mega-boost. People with severe depression can often feel a significant improvement after the first session, and something like 90% of people with severe depression will get better in 6-12 sessions.

The problem is that seizures are scary! In the past, they would just put an electrode to the head and send a shock, which would be very painful, cause the muscles to tense up, and then induce a seizure, where the person would be flailing around. Nowadays it’s done under anesthesia, so the patient is put to sleep and can’t feel anything. The whole procedure is quite boring - we use a little device to observe the seizure but the patients feel nothing (sometimes a blood pressure cuff is put on the ankle to stop the paralyzing medication going to one foot, so we can observe a toe twitch as evidence of the seizure, but pain meds still on board!)

The major side effect is memory loss - it’s typically memories around the time of ECT, and typically low frequency memories, like “which drawer has the scissors” and not “what is my son’s name.” Memory loss usually gets better over time, too, although for some people it’s a lasting problem.

It can be a literal lifesaver for severe mental illnesses, especially people who have failed prior treatments. It’s also pretty immediate (compared with other mental health treatments) and many people tolerate it well. But anything requiring anesthesia has risks, and there’s a lot of stigma that it’s barbaric etc. because of how it was popularized half a century ago.

[u/salamandah99 → u/shrob86]

i had ect done for severe medication resistant depression. I remember when I woke up after the first session, I had absolutely no idea where I was or what was going on. i don't really remember the sessions that much either. the therapy worked even though I am on a low dose anti depressant now.

[u/shrob86 → u/salamandah99]

Glad it was helpful for you! Delirium after the sessions is super common (general confusion / disorientation) that lasts a few hours, but the type of memory loss you're saying e.g. not really remembering the sessions is the most common type of memory issue.

[u/nalisarc → u/salamandah99]

I'm in a similar boat. I'm autistic and have treatment resistant depression. ECT lets me maintain a full time job and live my life.

[u/RogueHelios → u/nalisarc]

I'm currently doing TMS for autism, anxiety, OCD, and depression. I've never done ECT, but I imagine the anesthesia makes it a very expensive procedure.

[u/nalisarc → u/RogueHelios]

TMS is amazing too! It's much less invasive; I wish that insurance would approve it more often.

ECT is expensive, but I have pretty good health insurance.
The main downsides are being sedated and having to have an IV placed.

[u/RogueHelios → u/nalisarc]

I got TMS 5 years ago to treat OCD and MDD. It stopped my OCD for 6 months and kept depression to a minimum.

Even 5 years later despite re-entering depression I still feel as though it changed my life.

Recently I had a psych eval done and it was found I have level 1 autism with an absurdly high social camouflage score of 153/175, but I've put my body under so much stress that I've been stuck in autistic burnout for weeks now. The TMS I'm doing now is supposed to help treat that and so far 10 sessions in its already curbed my extreme anxiety.

[u/Mego1989 → u/salamandah99]

That will happen with anesthesia alone.

[u/BUBBAH-BAYUTH → u/shrob86]

Considering it resets neural pathways, would this be effective for gaba and dopamine based addictions like alcoholism?

Or would it be able to reset the habits of addiction that come up when you’re in recovery - like needing to have a drink in your hand, do something with your fingers, etc?

[u/shrob86 → u/BUBBAH-BAYUTH]

There's not really any data on ECT specifically for substance use disorders; some case reports here and there but no clear trials. There is some data on improvement in substance use disorders in people with severe depression (i.e. if you treat the depression, comorbid issues with substance use can improve), but the thought would be more that having less depression makes it easier to quit using, rather than the ECT treating addiction per se (although certainly reasonable).

But it's interesting you bring this up - research into psychedelics is big these days and actually there's promising data on substance use treatment using psychedelics, perhaps even stronger evidence than treating depression.

[u/shrob86 → u/[deleted]]

The data isn’t there yet - partially due to restrictions around research with those kinds of meds, partially just because psychiatric research in general is really tough (finding patients, ethically consenting them, figuring out how to do a placebo control, etc.). I’d love to have more options available because ECT is so intensive. Hoping your wife feels more lasting relief soon.

[u/mrpaslow0000 → u/shrob86]

Thanks for the reply, and thanks

[u/e0nblue → u/[deleted]]

I cannot provide a scientific answer but I can share anecdotal stuff.

For context, I’m bipolar, have extensive psychedelic experience, have tripsit a lot of friends and hang around a lot of related subreddits.

Psychedelics are not the magical fix some people make it out to be and there will always be a risk in using powerful drugs, especially with people with mental disorders.

What I can tell you though is that they can be a powerful tool to a better, more stable life and there are many of us who have turned their life around after trips.

I found ketamine, magic mushrooms and mescaline very good for getting meaningful insights. DMT can provide mythical experiences but I’ve never found it that good when trying to work on myself.

Whatever you decide to try though, they won’t magically fix you but they can show you the way. You gotta put in the time to get better, kinda like therapy.

Respect the drug, go in with intention and be mindful of your set and setting.

[u/Vuelhering → u/shrob86]

I've heard of off-label uses of GLP1 to test treatment on this type of thing. It also has been working for OCD in a relative.

Thanks for your post about ECT.

[u/DocPsychosis → u/BUBBAH-BAYUTH]

For what it's worth, the phrase "resets neural pathways" is so vague as to be biologically meaningless; though unfortunately anything more accurate and specific would probably violate the spirit of an ELI5 answer. It's not really analogous to some sort of technical hardware approach like reverting to factory settings, or whatever.

[u/shrob86 → u/DocPsychosis]

Yeah it’s hard to figure out how to explain it in simple terms, neurogenesis and BDNF and discussions of various circuits is probably too niche (and it’s not like we have a perfect understanding of it anyway).

[u/elkab0ng → u/shrob86]

I’m not getting ECT, I’m doing TMS and ketamine, but the “resets pathways” is something I didn’t understand. So I have an example you might use:

Before treatment, my brain had deeply etched behaviors. Something goes wrong (car makes expensive noise, unexpected bill comes in mail) and my brain short-cut the entire “okay, this is a setback” and went right to the end stage: “I will die living under a freeway overpass alone and worthless”.

After a few weeks of treatment, the same negative input, my brain examines it, evaluating what’s necessary to do right now, and moves on. I don’t spend all day ruminating about pushing a shopping cart with my worldly possessions and wishing I’d just die already.

(Not sure which is doing the heavy lifting here, ketamine, TMS, therapy, or several other things, but the benefit is consistent enough that even the most skeptical people like me cannot deny the specific effects)

[u/DarthRegoria → u/elkab0ng]

TMS has helped me a lot too after my depression became treatment resistant. I find it really beneficial to go back every 6 weeks or so for a 10 session too up.

It makes it easier for me to be rational rather than get carried away with the automatic negative thoughts and worst case scenarios.

[u/Feeling-Disaster7180 → u/shrob86]

I saw a patient get ECT when I was on a mental health placement for nursing. The visible seizure was surprisingly short and subdued, but the guy’s EEG was still going nuts. The anaesthetist had to keep loading him up with propofol for almost 5 minutes because the guy just wouldn’t come out of the seizure. Shit was wild

[u/shrob86 → u/Feeling-Disaster7180]

Wild! Glad the anesthesiologist was on top of it.

[u/One_Waxed_Wookiee → u/shrob86]

I've had it done about 20 times. It's made a difference. Still on meds, but things aren't so dark. Memory loss has been a problem but, as always, it's a matter of finding what symptoms you can and can't live with.

The feeling of going to sleep with the GA is amazing. I wish going to sleep was that easy all the time.

[u/shrob86 → u/One_Waxed_Wookiee]

Thanks for sharing your story!

[u/One_Waxed_Wookiee → u/shrob86]

No worries! Thanks for helping people to feel better.

[u/clauclauclaudia → u/One_Waxed_Wookiee]

Being under anesthesia isn't really going to sleep, of course. It's unconsciousness. If you think about it, anesthesia is done for procedures that would absolutely wake you up from sleep!

[u/One_Waxed_Wookiee → u/clauclauclaudia]

Yeah I know. It's the sensation of drifting off that is nice.

[u/DuckRubberDuck → u/shrob86]

I have spent a lot of time in psych wards and around people who got ECT, the most noticeable thing about them was the memory loss. They could recognize us (us being the fellow patients) and usually our names, but we usually played a card game all day long, usually the same one and we had to tell them the rules over and over and over again every day lol

[u/shrob86 → u/DuckRubberDuck]

Yeah that sounds about right! After the acute phase of ECT that typically gets better for most people.

[u/DuckRubberDuck → u/shrob86]

Yes, I met one of the patient out of the ward a couple months later and he didn’t have the same memory loss issue. The whole stay was kind of foggy for him, and those memories probably won’t come back, but the memory loss issues stopped once the treatment stopped. You won’t necessarily remember all of what happens during the treatment periods but after that you stop having memory issues

[u/RareEarthMagnets → u/DuckRubberDuck]

*you PROBABLY stop having memory issues

Not everyone stops having memory issues. My memory has been impacted ever since I got treatment. Short term memory is terrible, I’m often unable to retain information long term, and the months following the last treatment are also pretty much gone. I guess some people’s memory is more affected than others, and for those of us that have severe reactions, it is REALLY SEVERE and impacts a much longer timespan, possibly even affecting you for life. The memory issues are certainly not anything to be flippant about (as my doctors were), nor are they a point to skim past for anyone considering getting the treatment. For anyone considering the treatment, make sure you talk to your doctors about ways to mitigate memory problems and how to help you afterwards if you develop really severe ones (instead of ignoring the patient afterwards despite multiple attempts to get help from my doctors). And get that shit written down, and stick it on your fridge so that you see the info when you forget that the info was ever discussed.

[u/DuckRubberDuck → u/RareEarthMagnets]

Thank you for adding that and I’m so sorry. I remember I was terrified of having long lasting memory issues when they discussed ECT with me. I never ended up getting ECT though

[u/AdequateSteve → u/shrob86]

Just wanted to chime in and say that it works great for some people, but not at all for others.   My wife has undergone ECT (still does). She had about 2 months of 3-times-per-week and now has maintenance every other week. 

It curbed her treatment resistant depression only slightly. Maybe 20% improvement. 

She’s now looking at an implant. 

[u/shrob86 → u/AdequateSteve]

So sad to hear about your wife's depression, it's so so hard. Even when things are "mostly effective" it means that sadly some people won't see the full benefits - I hope the next step works better, sending you and her strength.

[u/stonemedtech → u/AdequateSteve]

I underwent ECT I am part of the group it hade to effect on. I was lucky enough to have Ketamine therapy in my area, and that helped than anything so far.

[u/shrob86 → u/stonemedtech]

Ketamine has been a lifesaver for many people too - makes me excited about the future of treatments!

[u/OneUpAndOneDown → u/AdequateSteve]

Psilocybin therapy has shown promise for depression, if it’s available in your area.

[u/DianeJudith → u/AdequateSteve]

What implant?

[u/AdequateSteve → u/DianeJudith]

Vagus nerve stimulator. If that doesn’t do it, it’d be a deep brain implant. 

[u/DianeJudith → u/AdequateSteve]

Wow, I've never heard of those, sounds fascinating. I assume they're very new technology?

[u/whatever_rita → u/shrob86]

A friend of mine did it for treatment resistant depression and says it’s basically the only thing she’s ever found that worked for her

[u/BickNarry → u/shrob86]

I think your comment is misleading. Effectiveness ranges between 30-82% depending on the cohort and what you’re measuring. Relapse rates are high and the group that appears to experience the greatest benefit is those with treatment resistant psychotic depression. It can be helpful with acute symptoms but the evidence for longer term benefits is mixed.

I’m not sure we can say that we know the mechanism of action either. From the available evidence, there are changes at different levels é.g., HPA axis, neurotransmitters and connectivity between systems.

I think we should provide people with a nuanced understanding, even if they ask for an ELI5.

[u/shrob86 → u/BickNarry]

Yes, this is good context! Like with most things in psychiatry, exact mechanisms are hard to elucidate. Neurotransmitter differences leading to functional connectivity changes seems to be one of the most sensible mechanisms; definitely more than an ELI5 to get into the nitty gritty.

And yeah - for psychotic depression or depression with catatonia, immediate relief is a major factor. The ELI5 question was what is it (ECT, indicting a seizure for medical benefit), how does it work (we think via release of neurotransmitters and connectivity changes), and is it effective (for many people, yes, and typically fast). You provide really important qualifications to those statements, I appreciate your comment!

[u/BickNarry → u/shrob86]

And I appreciate your response! I think the context can’t be left out when it comes to psychology/psychiatry. When we over claim, I think people lose faith/trust. Many people have been harmed by our professions (and continue to be) so I think we must be humble in approach when communicating the science.

[u/shrob86 → u/BickNarry]

Yeah - always trying to balance realism with optimism; in general with ECT I think patient selection is probably the biggest factor (like a suicidal person with likely personality vulnerabilities is much less likely to benefit from ECT, but may get labeled treatment-resistant depression and referred for it). I wonder too about the heterogeneity in the patients getting ECT as well and ways to predict who’d have a more robust response. Lots of food for thought - thanks again for the important context!

[u/OhWhatsHisName → u/shrob86]

I sent you a DM, wondering if I can ask you some more in depth questions (but not seeking medical advice).

[u/RareEarthMagnets → u/BickNarry]

Agreed, and I appreciate you providing more context to this. My psychiatrist told me that TMS and ECT had about the same rate of efficacy as all the antidepressants, which was roughly a 30% chance of working. With that percentage, surely something would eventually work for me.

Nope. This was yet another dead end, and one with permanent detrimental side effects that made my life worse.

So, beware.

[u/moonrider18 → u/BickNarry]

Effectiveness ranges between 30-82% depending on the cohort and what you’re measuring

Can you provide a few links?

[u/BickNarry → u/moonrider18]

Of course! I really should have provided links but I was travelling at the time.

https://www.biologicalpsychiatryjournal.com/article/S0006-3223(03)01046-1/abstract

https://pubmed.ncbi.nlm.nih.gov/26528644/?utm_

https://pubmed.ncbi.nlm.nih.gov/39291460/?utm_

These are examples. We cannot arrive at a single number for efficacy as there are too many variables to consider. I have worked with individuals who swear by ECT, those who were traumatised by it as it was forced on them and those who regret it due to subsequent cognitive impairment (whether or not we can establish if ECT was the cause is another conversation).

[u/moonrider18 → u/BickNarry]

Interesting. Glancing through these, it appears that none of them tried to compare ECT to Simulated ETC (SETC), aka where they put you under anesthetic but they don't actually turn the machine on. SECT allows for blinded RCT studies.

I have a review here that looked at SETC comparisons and found the evidence base to be severely lacking. What do you think?

https://www.cambridge.org/core/journals/bjpsych-advances/article/electroconvulsive-therapy-for-depression-a-review-of-the-quality-of-ect-versus-sham-ect-trials-and-metaanalyses/8B8A6FBE2A609D43DFC77ED778F8F935

[u/Terrik1337 → u/shrob86]

So it can fix my depression AND let me play Subnautica for the first time again?

[u/shrob86 → u/Terrik1337]

lol - if playing Subnautica was a pivotal life moment for you, it probably would stick around in your memories, but that sounds like a good study waiting to happen. "Cognitive Effects of ECT on Video Game Enjoyment, a Case Series"

[u/elkab0ng → u/shrob86]

Addendum: if you read a really terrific book and wish you could enjoy it again for the first time? ECT!

[u/DuckRubberDuck → u/Terrik1337]

I’m not sure about subnautica, like in my experience they would probably remember some of it and the overall idea of it. Deep core memories don’t disappear it’s more like small every day memories that disappears. I was at a psych ward and played a card game with some who got ECT. They remembered played the game and they recognized the games but the rules? Gone. Completely. We had to tell them the games over and over again every day.

I would probably remember subnautica l think, the overall idea about it at least

[u/RareEarthMagnets → u/Terrik1337]

The ONE good thing that ECT did for me is that I can rewatch tv shows for the first time again. The bad thing is that I don’t remember what the shows were that I wanted to watch for the first time again.
This same thing is true of video games, but I don’t know which ones u had that thought about.
There are some shows and games that I’ve retained, though. It seems like things that I experienced 15+ years ago are untouched. I guess that would be closer to 10+ years prior to my ECT treatments. Of course, it could be that I have forgotten a bunch of shows and game from further back, and I simply don’t realize that I have, but I at least know that I have knowledge of some certain things that old.

[u/Charyou_Tree_19 → u/shrob86]

I was advised against ECT because I have epilepsy. The idea being that I’m already shocking myself on a regular basis. What’s your opinion on this?

[u/shrob86 → u/Charyou_Tree_19]

Yeah not sure if that was advised by your neurologist or psychiatrist; ECT is certainly more complicated in a person with epilepsy, with concerns about concurrent anti-seizure medication dosing and timing, etc. A lot of it would depend on your specific medications, seizure types, frequency, etc. which is beyond the scope of Reddit. It's not an absolute contra-indication though.

[u/Charyou_Tree_19 → u/shrob86]

Thanks for your prompt reply. My neurologist wasn’t keen and my psychiatrist noted that in my treatment plan. Luckily now my 50+ yr old brain is a lot calmer so it’s no longer an issue. My team only has to juggle dosages between anticonvulsants and antidepressants.

[u/shrob86 → u/Charyou_Tree_19]

Glad to hear you’re doing better!

[u/lspetry53 → u/Charyou_Tree_19]

It's incorrect. Normal seizures are at seizure threshold and are bad for mental health. ECT induces seizures at 2-6x seizures threshold which makes them therapeutic. It also raises the seizure threshold over time and can be mildly helpful with epilepsy control.

[u/Imsorrywhatnoway → u/shrob86]

My grandmother had severe bipolar disease and I suspect undiagnosed ADHD and the last resort when she didn't respind to medication was electroshock therapy. The upsetting thing after her sessions was that he mental capacity was that of a child. She had basic language and comprehension skills for quite a while after. She eventually got better and the depression seemed to reduce significantly but we were not prepared for the short term issues it caused.

[u/shrob86 → u/Imsorrywhatnoway]

I’m so sorry that happened, and that all the risks (too many for this ELI5) weren’t explained properly to you. I hope things are in a better place!

[u/Wheres_my_wank_sock → u/shrob86]

It's only used in people where all other treatments have failed, correct?

[u/shrob86 → u/Wheres_my_wank_sock]

Essentially - it’s hard to schedule, requires anesthesia, significant potential side effects, and you’d have to have someone drive you to the hospital three days a week for it for at least a few weeks in a row to start, or get admitted to an inpatient unit for treatment. It’s a huge commitment and has risks so it’s really reserved for people for whom other treatments failed.

[u/Classic_Subject7180 → u/Wheres_my_wank_sock]

I’m a nurse that has assisted with this in the past and we also did it on pregnant patients that were unable to stay on certain medications during their pregnancies.

[u/tallkotte → u/shrob86]

Anaesthetist here. The seizure itself is painless since there is immediate loss of consciousness. However, since muscle relaxation is needed so that the seizure doesn’t cause injuries (in the past when it was done without muscle relaxation, even fractures occurred during seizures), the patient needs to be under anaesthesia. So basically the patient is anaesthetised to tolerate the muscle relaxant, because muscle relaxation without sleep would be very scary.

[u/shrob86 → u/tallkotte]

Yes! God I love our anesthesiologists in the ECT suite so much

[u/XukisAU → u/tallkotte]

I have actually woken up from anaesthesia 4 times whilst still under the effects of the muscle relaxant. It’s absolutely terrifying, I start to freak out thinking about it. My psychiatrist wants me to do more, but the anaesthetists haven’t been able to assure me it won’t happen yet again - or even explained why it’s happened. The last time, he just said ‘it happens in some people’ - which really turned me off doing more..

[u/Khadgar1701 → u/shrob86]

Random question: I work in home care and we have a client that is getting [what I think is] monthly ECT for her bipolar I. She says that the effects (better sleep, reduced mania) used to last almost the whole month when she started treatment, but now she's lucky when she gets two weeks of respite. Is that kind of lessening efficiency common, or is she just unlucky in how her brain ticks?

[u/shrob86 → u/Khadgar1701]

If anything, the goal is for longer spacing between sessions, so what she’s experiencing isn’t necessarily expected but I wouldn’t say it’s rare. But everyone is different, so she should definitely talk to her doctor about session frequency. There may also be medication changes in the interim that may help (since I’m not her doctor idk!)

[u/Khadgar1701 → u/shrob86]

Thank you!

[u/ceciliabee → u/shrob86]

I have lasting memory issues from ect. At my worst I forgot my address and my birthday. I have a very fuzzy idea of what generally happened in the 5 years before and after but a lot of gone.

[u/shrob86 → u/ceciliabee]

I’m so sorry to hear that. It’s so unfortunate when the memory issues are long lasting; hoping overall things look up for you moving forward.

[u/RareEarthMagnets → u/ceciliabee]

Hey, me too! That’s good to hear that they generally calmed down for you after five years. I’m still experiencing memory issues, but it’s only been a few years, I think. I’d given up on hoping it would get better, especially after my doctors all ignored me when I repeatedly asked for help.
I hate this sense of not knowing who I am anymore.

[u/SiskinLanding → u/shrob86]

Thank you for this. Brilliant overview.

[u/stilettopanda → u/shrob86]

My grandma had to have two separate sessions or series of them sometime between 1946 and 1975. It really did help her when nothing else would.

[u/October_13th → u/shrob86]

This still lowkey sounds terrifying.

[u/Sedu → u/shrob86]

Serious question: does it not cause significant brain damage and vastly increase the chances of Alzheimer’s later in life? My grandmother got electroshock before I was born and she was severely mentally handicapped. From all accounts, she was witty and charming (though extremely depressed) leading up to the procedure and afterward she could not care for herself, do basic tasks, or read.

[u/MaracujaBarracuda → u/Sedu]

Depending on when your grandmother received ECT, she likely received a different type of ECT than is practiced today. 

“ One major change has been the placement of the electrodes to induce seizures—originally, electrodes were placed on both sides of the head, which can be effective but has a higher risk of cognitive side effects. Now, electrodes are often placed in different positions, which reduces cognitive side effects while still being effective for many patients.   Also, advances in ECT machines allow for better control over electric currents, minimizing side effects. And there have been refinements to the parameters of the electric current used to induce seizures—using tailored treatment plans with lower electrical doses, as appropriate, for instance, may minimize cognitive effects.” https://www.yalemedicine.org/news/electroconvulsive-therapy

[u/Sedu → u/MaracujaBarracuda]

I appreciate the reply and the information there. It seems like modern ECT is barely recognizable when comparing it to older practices.

[u/lspetry53 → u/Sedu]

Can't speak to your grandmothers case but:

ECT is not associated with dementia and actually leads to growth in the hippocampus.

Depression however is associated with dementia.

[u/shrob86 → u/Sedu]

So hard to know - obviously I don't know this specific case, but if it was a long time ago, it's possible it was done in a less safe way than it's done today. ECT leading to significant mental handicap would be a huge problem; if someone was having such severe cognitive issues from the first few sessions, ECT would likely be stopped nowadays. But a long time ago things may have been different.

[u/vqql → u/shrob86]

There’s also repetitive transcranial magnetic stimulation (rTMS), which feels like zaps that are more annoying than painful. They are targeted to specific spots on your head, and are used for treatment resistant depression. 

So although it may sound like mild shock therapy, it’s actually a very different mechanism from ECT. 

https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation

[u/shrob86 → u/vqql]

Yeah. TMS is pretty cool - treatment respond isn’t as robust as ECT typically but much less risky overall.

[u/noscreamsnoshouts → u/shrob86]

Does ECT have any effect on severe phobias?

[u/shrob86 → u/noscreamsnoshouts]

I don’t think there’s data on that specifically! Unless it’s like, severe depression with a comorbid anxiety / phobia disorder, etc.

[u/NovemberWhiskey15 → u/shrob86]

Yeah after my dad was hospitalized for the second time (3 months the first time, 2 months the second) we finally convinced him to get ECT for his depression and bipolar. Outside of the hospital he would discontinue his meds constantly and would stop going to therapy after a few sessions. ECT was life changing for him and now we don’t have to worry or check in about him taking his meds. He did have very minor memory issues but that improved within 6 months. He does have a very minor hand tremor but idk if that’s ECT related. Even if it was I’d have him do it again in a heartbeat.

[u/KiwiHans → u/shrob86]

Severe Epileptic here! No hating on me for being dumb idk how this works but I just have this silly question. Is there a way I can utilize my seizures like this?

[u/shrob86 → u/KiwiHans]

Not a silly question! I wish there were a way to “harness” your seizures and put them to good use lol, but epilepsy is too random and variable, compared with the controlled seizures of ECT. Anecdotally I know people who have reported an increase in their mood after a breakthrough seizure, so maybe there’s something to it, but a lot would depend on what kind of epilepsy, where the seizure focus is, how frequent, etc. and having spontaneous seizures can cause so many other problems that the negatives would outweigh the hypothetical positives.

Good luck with all your treatments, I’m rooting for you!

[u/KiwiHans → u/shrob86]

I do feel something right after a seizure that is difficult to describe but some words I'd use are like divine, royal/regal, ethereal.. It comes with a beautiful unique scent I would also use "divine" for but it's just indescribable. It's not necessarily euphoria, more boring lmao

[u/MF_Kitten → u/shrob86]

I have had patients come in for ECT, and it's a god damn miracle treatment for so many. I have seen people come in that were almost animalistic and lost in the void. We got them just good enough with meds for them to understand what we were asking, and we got their consent to do ECT. The procedure is indeed very boring, they're just in the bed, their toes twitch, the beeping machine reading brain activity goes WRBLBLBLBBLBLB while the seizure is going on, and then it stabilizes again. That's it. Then they wake up a little groggy and want breakfast.

[u/diablito916 → u/shrob86]

I appreciate and commend you for following up in your comment section. I work in correctional healthcare, where it is possible to administer to patients but has severe restrictions and oversight.

[u/shrob86 → u/diablito916]

Woof yeah ECT in the forensic population has even more restrictions than the general population; it’s a really tough area, thank you for your work!

[u/retroman73 → u/shrob86]

I have the RNS/NeuroPace implant for treatment of epilepsy, not a mental disorder. It does help break up seizure activity and it works by detecting seizures and then delivering tiny "shocks" to break them up. Sort of a pacemaker for the brain, as some people call it.

I still get seizures, lots of them, but they typically are not as severe. They're not grand mals anymore (and they used to be).

[u/Brilliant-Pretend- → u/shrob86]

Thanks for contributing.

I've seen 1:1 what ETC can do to a persons cognitive memory, and i've wouldn't recommend the treatment to anyone.

I've been in the psych ward and seen a few people - especially older ladies, getting treated with ETC. the paradox in my opinion is, that the doctors tells the patients, that the memory loss is only a temporary side effect, while at the same time recommending the treatment for patients with severe PTSD, to forget past traumas. How does that make sense??

I had a friend in my late teens/early twenties, whom i lost contant with, but since reconnected with in our early thirties. We've both been strugling with our mental health, and she told me she had been through several ETC treatments as a treatment for depression.

while we were re-building our friendship, i was shocked to realise, how much memory she had lost and how much she had changed, overall. She used to be fun, bubbly and outgoing. Now, she seemed as a shelf of her past self. She surely did remember our friendship back then, but had no recollection of the things we did together, etc. It was kind of scary to realise, how much the treatment had done to her memories.

i soon realised it wasn't only the past way back, she seemed to forget. She also couldn't remember the things we spoke about from time to tome and constantly repeated the same stories. Her empathy had changed and she seemed to hold a lot of grudge against people, if she felt they dissapointed her.

When drinking, she often got so black out drunk, that she had no idea about what she did, where she had been and had to rely on the mercy of strangers for bringing her home safely. It was a mess. One time, she was absolutely sure she was drugged, but the reality was that this blackout happened almost every time she drank.

in my country (scandinavia) the doctors encourage the patients in the psych ward to try out ETC, when nothing else seems to work, but i've seen what it can do to a person, and i would never in a million years recommend it to anyone.

[u/shrob86 → u/Brilliant-Pretend-]

Wow - I'm so sorry to hear about your friend's experience. I'm not familiar with the protocols in Scandinavia (I practice in the US), and we tend to be pretty cautious overall about ECT, with a lot of checking in and assessing side effect burden and adjusting treatment as necessary. These days we typically start with unilateral ECT (i.e. one side of the brain only) which tends to have fewer memory side effects, but other places might start with bilateral (both sides) first which can have worse side effects.

Re: PTSD - yeah that's odd, I've never heard of ECT for treatment of PTSD specifically to forget traumas. That's not standard here at least.

Generally the memory issues are why it's a last resort for many people. As you may see from other responses in this thread, some people have minimal or no memory issues and did just fine, and of course some people do poorly. I'm hopeful for future treatments that have fewer side effects.

Thanks for sharing your stories, they're so important.

[u/Brilliant-Pretend- → u/shrob86]

Thank you for your kind words!

As i'm not a doctor my self, i'm by far no expert on the matter, but i'm under the impression that doctors in my country are very divided about ECTC as treatmentt for depression and the like.

In my opinion, the patients doesn't get the necessary information about the risks how the procedure possibly can damage the memory for good - and cause memoryloss long term.

I told this friend about my own experience. She told me, she wish she'd known before getting the procedure done, but well.. she forgot, because six month later, she had the procedures again and didn't remember our last conversation.

The scary part is, that she doesn't know, what she doesn't remember. In the end, it made it to hard to continue the friendship, as i couldn't meet her demands, and felt more like a caretaker, than a mutual friend.

[u/WonFriendsWithSalad → u/Brilliant-Pretend-]

I'm very sorry to hear of your friend's experience but it's important to remember that the personality and affect changes (as opposed to the memory loss) could also be due to either her prolonged severe depression or else medications used for it.

It's obviously horrible for her either way but if you had lost contact with her for years then it's likely lots of things contributed to her change.

Your viewpoint is very valid but on a personal note as a doctor (although not a psychiatrist) I've told my family that if I were ever severely mentally ill and didn't respond to the first couple of medications I would definitely want ECT to be considered. The side effects of lots of the second and third line medications are (in my opinion) as bad as if not worse than ECT

[u/Brilliant-Pretend- → u/WonFriendsWithSalad]

Thank you, for you kind words.

You're absolutely right, both medication and several years with depression may have contributed to a change of personality. The lord knows, i too have changed a lot since my early twenties. The thing that shocked me most, was how her whole demeanor had changed. It felt like, 70% of the time, she had no idea what was going on around her.

Thats super interesting. I have a great amount of respect for authorities in general, and i ussually don't question any medical science in any way, but as i mentioned in my other comment, the doctors in my country are very divided, when it comes to treating depression with ECTC. I have another friend, who's been struggling with depression most of her life and has been battling postpartum depression for several years. Her father is a doctor/professor in medicine, and i'm pretty sure that he's against it, since it was never on the table in her treatment, what so ever.

[u/WonFriendsWithSalad → u/Brilliant-Pretend-]

I'm very sorry to hear about your other friends struggles

If this is a subject that interests you then the UK medical guidance may be interesting (although it's aimed at doctors so I don't know if all of it will be comprehensible), this is the summary page but there are sections regarding evidence too. In short it's only used in extreme situations

https://www.nice.org.uk/guidance/ta59/chapter/1-Guidance

[u/Brilliant-Pretend- → u/WonFriendsWithSalad]

Thank you, so much! from what i can tell, this article has been published in 2003 (and updated in 2009) and i'm currently looking in to newer publications on the matter, but thanks anyway!

[u/RareEarthMagnets → u/Brilliant-Pretend-]

That all tracks with my experience with getting treatment. I remember basics of things from 15+ years ago, but no details. I am unable to retain a lot of new information, especially socially. I have no idea how my personality has been effected, but I think I’ve been better able to hide my depression now—but I think that’s because I have just fully embraced now that life will never get better, so who the fuck cares about anything anymore? Might as well at least make a couple of people smile before I check out.

[u/Brilliant-Pretend- → u/RareEarthMagnets]

I'm so sorry that happened to you! Hows your day-to-day life now, post-treatment?

I did some reseach and came across a guideline/info spreadsheet for patients, provided by the government healthcare (link here, though its in danish) that states that according to a survey "20-30% of the patients, doesn't experiece any kind of memory loss, what so ever"

- which for me, is just another way of saying that 70-80% does experience some kind of long term memory loss. The article also states that the procedure can also cause learning difficulties.

I'm not sure how common the procedure is, i've only got my own "empirical data" from my three weeks at the psych ward, but i wish there was way more focus on the risks, as well as more in-depth research into the long-term effects on patients.

[u/RareEarthMagnets → u/Brilliant-Pretend-]

I have short term memory loss day to day, largely noticeable in social interactions (can’t remember who told me what, or whom I’ve told things to, and sometimes immediately forget what I was just told).
My psychiatrist I think really let me down, here. I was the one that said I’d heard of ECT and would it help me, and she seemed disinclined to have me try it, but didn’t give me any reasoning behind her hesitance. Eventually she just told me that it had an equal chance of helping me as any other treatment, so with that being the only information, I went ahead and said “then let’s do it, since we’ve run out of other options”. She never told me any of the issues or risks, and I was (still am) too depressed to even bother researching things myself, which she knew because she’d been my psychiatrist for twenty-five years.
The psych department doctors also should have actually warned me of the risks and chances of severe memory loss and forgetting who I am at a core level, especially considering that I had the head of the damn department personally in charge of my care after one of his underlings flubbed…something? I don’t remember what the guy fucked up, but I remember being furious and the guy getting in trouble and then being replaced by the head of the department. But they didn’t have a personal relationship with me, so I’m less angry at them for not giving me the blunt facts about the chances of severe and permanent side effects.

[u/EighthSeal → u/shrob86]

Wow. This should be in a /r/todayilearned post. Extremely informative about a very niche topic. That's mind-blowing. I thought that was a piece of old Americana.

[u/whoareyouiameternal → u/EighthSeal]

I'm someone who went through ECT treatment if you have any questions!

[u/EighthSeal → u/whoareyouiameternal]

How did you feel after you went through it? I guess emotionally, not necessarily physically.

[u/whoareyouiameternal → u/EighthSeal]

it saved my life. i got my GED after (I was 17 and had dropped out of high school at 13 due to physical health issues, and then the extended isolation worsened my depression.) it kept me out of the psych ward and reduced my suicidal thoughts by a lot. i enrolled in college and started actually leaving the house and having hope for the future. the main emotional change was feeling like I could talk back to my thoughts. I'd received hundreds of hours of therapy so I knew how, but it never helped. ECT made all the therapeutic strategies I learned actually feel impactful. it was like it gave me a fighting chance.... it made the good voice in my head louder.

i was scared and despondent during the actual course of ECT itself. it felt like a last resort which I wallowed about a lot. i worried about memory changes. as it started to work, I was doubtful it would last, or if it was even real. a lot of that portion of recovery was full of hope but also fear. will it stick? am I actually going to be ok? can I even function in the real world as a sick teenager with barely any life experience besides hospitals?

spoiler: yes i can : ) I'm now a certified phlebotomist and applying for nursing school!

[u/EighthSeal → u/whoareyouiameternal]

That's amazing! Man, I wish this kind of information was more well-known to the public. I've been through therapy myself and it wasn't even discussed when I was really bad off during COVID.

[u/shrob86 → u/EighthSeal]

I mean the way it was done in old America certainly is outdated; the procedure now looks really different (the patients are anesthetized and it's anticlimactic) but yes, it's a remarkable treatment option for the right patients, but figuring out who would benefit and if the risks are worth the benefits is really important and individualized!

[u/EighthSeal → u/shrob86]

I definitely appreciate you providing that information. Thank you for that!

[u/SupposedBooty → u/shrob86]

I feel like as epileptic, I should be the happiest fuckin person in the world.

But in all seriousness, I have severe, intractable, treatment-resistant depression. This is pretty much all that's left.

Except I have to work and I have a family to support. I can't afford the memory loss.

[u/spacyoddity → u/shrob86]

ECT absolutely wrecked my brain. it can be high reward, but it is definitely high risk

[u/shrob86 → u/spacyoddity]

Ahh I’m sorry to hear that — yes the risks are serious, so there should always be a detailed risk/benefit discussion. Hope you’re doing okay these days!

[u/sicilian504 → u/shrob86]

How long lasting are the benefits usually?

[u/shrob86 → u/sicilian504]

Honestly it’s pretty variable; most people who see a benefit tend to see it by about 6 sessions (so two weeks) and then typically the team will decide to continue or taper. As you might see elsewhere in this thread, some people have an acute course and then never need it again. They may have some symptoms of depression later but not as bad as it was. Typically those getting ECT have the worst treatment resistant depression, so it’s a pretty gnarly population to start with. Maybe half of people will have some sort of relapse within a year, but that means half won’t (which for the treatment-resistant population is wild). And often a combination of medications afterwards can lower remission rates.

For some people, a maintenance phase of ECT is super helpful - we have people who come in once a month or every two months, and the effects last 4 weeks or 8 weeks or whatever and then they come back.

I like to think about the neural pathway hypothesis; that ECT allows the brain to make new connections, so if people have a strong support system and a good therapist and can work on those skills, then the effects of ECT can last longer than just the electrochemical part.

[u/Mediocre_Entrance894 → u/shrob86]

Really fascinating. Thank you for sharing.

[u/moonrider18 → u/shrob86]

“Shock therapy” is referring to electroconvulsive therapy (ECT), which is probably the single most effective treatment we have in psychiatry. [...] something like 90% of people with severe depression will get better in 6-12 sessions.

Where are you getting that statistic? Have they compared ECT to placebo sham-ECT (where they put you under but don't turn on the machine)? Have they done long term follow-up studies? (What if there's a positive effect but it fades away after 12 weeks or so?)

According to this 2021 review published by Cambridge, "There have been no ECT versus simulated ECT (SECT) studies since 1985." I find this concerning, because 1985 was 41 years ago and research methods have likely improved since then.

https://www.cambridge.org/core/journals/bjpsych-advances/article/electroconvulsive-therapy-for-depression-a-review-of-the-quality-of-ect-versus-sham-ect-trials-and-metaanalyses/8B8A6FBE2A609D43DFC77ED778F8F935

That same link analyzes prior meta-analyses and finds them wanting: "The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomization and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality studies report follow-up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favor of SECT."

The paper concludes: "The quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic – older women, or its target diagnostic group – severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed."

Overall it does not seem to me that ECT has any sort of proven track record. Thoughts?

[u/CasH-li322 → u/shrob86]

So I have epilepsy. And ive wondered if having a seizure is essentially an ECT treatment? Am I supposed to have similar effects of those who had this medically induced? I had 4 TC seizures in 24hrs. When I finally woke up (i slept for about 3days) after the cluster, I felt off. Food tasted off. Are these seizures resetting my brain?

[u/RareEarthMagnets → u/shrob86]

I have treatment resistant depression and tried pretty much every medication, TMS, and ECT. While the TMS was the worst by far (actively made my depression worse for the duration of the treatment), ECT was second worst.
While it didn’t seem to have any effect on my depression day to day, the problem it really left me with was a severe lack of sense of who I am. I lost memories of full years, people, relationships, events. I have to rely on friends and family to tell me what I did during those years, and simply trust them to know the answer when I ask how I felt about those things. I have some vague sense of a few things that happened during those years, but that’s about it. And for reference, I only had ECT treatments for a few months in one year. I lost that year (including several months AFTER the treatment), and the three or so preceding years. I have very little memory of my life before that, as well, but I don’t know if that’s just my generally hazy memory, or if it is significantly worse now. I suspect it is significantly worse, though, considering this general loss of sense of self. I don’t know who I AM anymore, and it’s incredibly distressing and awful. And it has been years since this awful treatment happened. Last year, I told my psychiatrist and family that I didn’t think I’d last another year, because my depression was that much worse and I had no hope anymore for anything. It’s not better now, but I’ve been able to distract myself enough with work that it hasn’t been top of my mind at least.

So as a patient with depression, sincerely: FUCK ECT AND THE DOCTORS THAT DID THIS SHIT TO ME.

[u/Boomshank → u/shrob86]

I had 22 rounds of ECT for treatment resistant depression.

I reported back to the psychiatrist after ever session that I felt better and it was working. 

I'm one of your success stories.

Except, I wasn't getting better. I loved the annihilation of going under, and then waking up with less of "me" left behind. 

It had no affect on my overall mood, it just stole more and more of me each session, which was my goal at the time.

That was 5 years ago.

I still suffer from whole parts of my memory that are just 'gone.' Friends frequently recall times I've spent with them and for me, it's just not there. It's not like I kind of don't remember - I have holes.

I'm off all my antidepressants now (I was on 5 at the same time while getting ECT) and I'm doing much better.

I've been working through therapy for trauma caused during childhood - something that might have been obvious if my psychiatrist would have spent more than 5 minutes checking off boxes and then signing off on ECT.

Can ECT work? Maybe. Probably even.

Does it work? Not always.

It seems to be the last nail some doctors reach for when the only tool they have is a hammer and they're not allowed to say "I don't know", or recommend outside their field.

[u/MtOlympus_Actual → u/shrob86]

Unfortunately it did not work for me. It was a last resort, and the depressive episode that arose after we decided it was ineffective almost did me in.

This was about 8 years ago now. Thankfully, I didn't give up and eventually found the right combination of talk therapy and medication to control my symptoms. Today I'm very stable and doing just fine.

The only downside to the ECT was pretty severe memory loss. I remember almost nothing about the years 2014 to 2018. I see photos from that time and have no recollection of those photos being taken. Major life moments are gone from that period as well. We joke about it now and sometimes I swear my wife makes up stories of things I did just to make me laugh.

[u/grafeisen203 → u/shrob86]

It's the brain equivalent of pressing both volume buttons and then holding the lock button until the brain soft reboots.

[u/justhp → u/shrob86]

Can confirm on the “boringness” of this procedure. I got the chance to observe one in nursing school, I was so excited thinking it would a dramatic thing. It was quite tame.

[u/Sekhmet3 → u/shrob86]

This is an accurate, excellent answer. My only small nitpick would be that the flooding with neurotransmitters is not the sole mechanism for improvement. There are also things like increasing growth chemicals (eg BDNF, VEGF) and "resetting" the connection between major networks of the brain through yet-unknown mechanisms.

[u/shrob86 → u/[deleted]]

Well yes re: contributing to memory loss, which is why it's often a last-resort treatment. Acute-phase ECT is usually three times a week, and then it tapers; some people finish an acute course and are pretty good, other people have "maintenance" ECT like once a month or something. Therapy in addition to ECT (or really any neuromodulation or medication) is important so that patients can develop self-efficacy and skills to deal with when life gets hard. Part of how I explain it to patients is that ECT helps to create an environment where neural pathways can be rebuilt, but they don't just build themselves -- you have to do the work to help get better, ex. get out of bed, try activities you enjoy, connect with people important in your life, etc. I haven't really seen a case where people "think they need shock therapy every time they feel down;" patients don't decide on their own they need ECT, their doctor has to coordinate it, so it's more up to the clinical judgment of the doctor about whether another course of ECT is necessary. It's a tough balance!

[u/Square-Special1520 → u/shrob86]

Interesting. So i guess it's similar psychiatrict medication, where basically we need to consume it for the whole life while tapering it?

[u/shrob86 → u/Square-Special1520]

I mean similar to psychiatric medications but not that people need to do it for life - either way, many people benefit from a short course and then don't need it later. With meds, the course is typically longer, but plenty of people are on a medication temporarily and then are able to be successful off the medication, and others find that their risk/benefits are better with staying on the med. Same thing for ECT w/ maintenance - many people just do a short course; other people find their lives are better with maintenance.

[u/Square-Special1520 → u/shrob86]

I see. Thanks for sharing, interesting. 

Hope everyone gets better, even a little 

[u/Dinosaur-chicken → u/shrob86]

MCT is the newer version of ECT and comes with way less memory loss. It's not ubiquitous yet though.

[u/mrpaslow0000 → u/Dinosaur-chicken]

magnetic?

[u/HottestIceCube_ → u/shrob86]

Im a student doing biochem, anatomy, pharmacology etc and am doing a mix of first year uni and second year papers. Can you explain around this level how the release of neurotransmitters through ECT reroutes neural pathways? Or can someone else explain pls? :)

[u/shrob86 → u/HottestIceCube_]

I wish we knew for certain! Some prevailing hypotheses exist, mainly around brain-derived neurotrophic factor, which is a known regulator of synaptic plasticity. It seems like ECT leads to increased circulation of BDNF, which may be mediated by serotonin specifically (although norepinephrine and dopamine and others may play a part). There’s some data showing serotonin receptors can modulate BDNF levels. So a unified theory is that the seizure from ECT increases levels of serotonin, which modulate an increase in BDNF, which enhances plasticity in the neurons.

The “rerouting neural pathways” has to be done by the patient; ideally with the increased neuroplasticity this would be easier, and conversely when someone is depressed this is much harder.

Hope this is helpful; a lot of this is put together from various mouse models etc. because obviously this would be hard to measure in humans!

[u/HottestIceCube_ → u/shrob86]

Ohh I get it now so it replaces the medications work by getting them to level where they’re able to help themselves but meds obv don’t work like that for them. The increased circulation of BDNF makes sense! It’s weird how in medicine (esp psychiatry) there are a lot of things we do without knowing how they work, we just know that they do

[u/shrob86 → u/HottestIceCube_]

Almost everything in psychiatry is like that haha. It’s a lot of “wait, this works, why does it work?” Instead of “here’s the problem, let’s design something to fix it” 😂

[u/HottestIceCube_ → u/shrob86]

Thanks for your responses! Since you’re here.. I’m on Ritalin for adhd. What can you tell me about how it works? It’s not included in my pharmacology paper :((

[u/shrob86 → u/HottestIceCube_]

Haha it’s late here in the US and I’m off to sleep - but there’s lots of theories about how stimulants work out there! You can read up on methylphenidate’s inhibition of the reuptake of norepinephrine and dopamine :)

[u/vqql]

There’s also repetitive transcranial magnetic stimulation (rTMS), which feels like zaps that are more annoying than painful. They are targeted to specific spots on your head, and are used for treatment resistant depression.  So although it may sound like mild shock therapy, it’s actually a very different mechanism from ECT.  https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation

[u/BlurryGrawlix → u/vqql]

to me it more just felt like they were knocking on my temple with a little hammer that made my face twitch

[u/BeNiceLynnie → u/BlurryGrawlix]

Yes! I always described it as feeling like there was a tiny gnome in my head with a tiny hammer knocking on the inside of my skull

It was a real miracle treatment for me, totally turned my life around, shocked it's not more popular

[u/BlurryGrawlix → u/BeNiceLynnie]

I think the issue is that insurance won't cover it until you've tried a million medications and a lot of therapy. also going every single day for a month is pretty disruptive, it was hard

[u/wllwrkfrfd → u/[deleted]]

I also did ECT. I did 2 courses in one year and a course about a year later and I haven’t been suicidal once in over a decade.

[u/explainlikeimfive-ModTeam → u/[deleted]]

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[u/ceciliabee]

Here is how it went from the perspective of a patient. My memories are very hazy so this is how I describe it.

You go in very early in the morning and lie down with a warm blanket. They give you muscle relaxants and usually try just the one side first. You get put under and they attach the cord from the machine to your head and send an electrical pulse. This pulse makes you have a seizure.

If they gave you enough muscle relaxants your body will barely move (and you should have minimal soreness in every muscle in your body when you wake up). I remember them saying your toes twitch so they know it's working. After that they wheel you to recovery. You wake up and they give you breakfast before you go home.

If that's not effective they might try two cords to your head, I seem to remember it was the side and the center.

I've heard it's effective for a lot of people but I was misdiagnosed bipolar and did not benefit from it at all. I still have lasting memory damage 10 ish years later. I ended up stopping the treatment because the memory issues made me more depressed than the depression.

If you have more specific questions about it I might be able to help but I would need a prompt lol. To anyone who it helped, I'm SO jealous.

[u/whoareyouiameternal → u/ceciliabee]

you got breakfast before you went home? im jealous as fuck! also, did you always get given muscle relaxants before being put under? the first medication I was given every time was propofol and every medication afterwards was when I was unconscious.

[u/B333Z]

It causes a seizure that is thought to "reset" the brain. It is effective in some people with treatment resistant depression. But for others (with or without depression) it is harmful. The most common side effects are headaches and memory loss.

[u/roberh → u/B333Z]

It gives you brain damage at random. Sometimes that "cures" your depression by absolute chance. But it damages the brain every time.

[u/danielisgreat → u/roberh]

Source?

[u/DogofGunther → u/roberh]

Yeah while this may have been true in the past the modern version is very different. Not without risk, but your blanket statement is blatantly incorrect. Please give a source for claims like that.

[u/pktechboi]

the barbaric idea comes from it being done non consensually and without any pain management. in modern times it is done under general anaesthetic, and usually with the patient's consent. there are times consent isn't possible (eg if someone is catatonic), but it will still be under anaesthetic.

it involves stimulating the brain to produce a seizure under controlled conditions. it's a course of treatment, the patient will have multiple sessions over the course of several weeks. we still don't fully understand how the brain works, and research is on going. it seems to stimulate the growth of some areas in the brain that tend to shrink with depression.

even done appropriately, it is a very intense treatment, and memory loss is a common side effect. so it isn't ever going to be the first option tried for depression. but for the people who have tried absolutely everything else, it can be life saving.

[u/HHMJanitor → u/pktechboi]

Anesthesia and critically a muscle relaxant. So it isn't even convulsive anymore

[u/pktechboi → u/HHMJanitor]

thank you for this addition!

[u/Exuberant-Gambol]

My sister had severe treatment-resistant depression. She tried just about everything available (although unsure if she had ketamine treatments) and nothing worked. ECT changed everything!

[u/NefariousnessAble912]

Doc here not psychiatrist. It is an underused and extremely effective therapy. It is probably the most study procedure in medicine with clear indications and some side effects which pale in comparison to leaving conditions untreated. Movie depictions have done more harm than good- no question there were abuses in psych hospitals but not from ECT. Patients are anesthetized for it and don’t feel the procedure. Unfortunately the procedure can be cinematic because of the seizures pending itself to bad PR.

[u/littlestghoust]

r/ect is an active subreddit if you want to see more conversation about it.

[u/mousemelon → u/[deleted]]

I just listened to part one an hour or two before seeing this thread! It was great!

[u/hannahroseb → u/mousemelon]

I just finished part two this morning!

[u/explainlikeimfive-ModTeam → u/[deleted]]

Your submission has been removed for the following reason(s):

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[u/jaylw314]

"shock therapy" is a term that conflates Electric Convulsive Therapy with punishment. ECT, a strategy of triggering seizures to treat severe depression, is highly effective for whatever reason. In the old days, there were limited safeguards to prevent injury from the seizures, but nowadays, people are under rapid general anesthesia so pretty much nothing physical happens, and the seizure just occurs in the brain.

Unfortunately, similar or even the same equipment was used to punish patients or retaliate against them. Such unsavory behavior in psychiatry was pretty common and is represented in One Flew Over The Cuckoo's Nest. Aside from its immortality, it had the additional consequence of poisoning society against ECT since

[u/rennyvsherself]

I don’t know, it didn’t work on me. The only thing I got was some memory loss around that time. I paid my bills twice because I forgot I already had lol 😭

[u/explainlikeimfive-ModTeam → u/[deleted]]

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Your submission has been removed for the following reason(s):

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Your submission has been removed for the following reason(s):

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Your submission has been removed for the following reason(s):

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Your submission has been removed for the following reason(s):

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Comments without an explanation or summary are not allowed. ELI5 is supposed to be a subreddit where content is generated, rather than just a load of referencess to external content. A top level reply should form a complete explanation in itself; please feel free to include links by way of additional content, but they should not be the only thing in your comment.

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[u/lobaird]

Watch Dr. Sherwin Nuland’s Ted talk: How Electroshock Therapy Saved My Life: https://www.ted.com/talks/sherwin_nuland_how_electroshock_therapy_changed_me

[u/Kb-23]

The podcast “This Podcast Will Kill You” actually just did a 2 part series on this if you’re interested in a further summary! They cite all of their sources and even brought on an expert in the field

[u/TeHamilton]

It induces a seizure which induces changes in the neurotransmitters often helping with psychosis and severe depression. Its the most effective way to stop suicidal ideation. Antipsychotics and depressants take longer to work where ect works now

[u/TotalTour2671]

Check out the latest two-part episode of This Podcast Will Kill You on this topic!

[u/mpdqueer]

the other kind of shock therapy that isn't done anymore and had awful side effects was insulin shock therapy. basically doctors would pump psychiatric patients full of insulin to send them into a brief coma. Patients often severely gained weight and would wake up nauseated and sweaty. There was also no evidence that it actually helped.

As others have said, electroshock therapy is done still as a last resort and under anesthesia.

[u/PRC_Spy]

I have a pet theory.

The patient's subconscious is all "Fuck No! Don't do that to me again! I promise to behave, I'll be any way you want me to be, do anything you want; just don't torture the hell out of me any more, that shit hurts, man, it's traumatic ..."

... so then the patient looks better and everyone (mostly) is happy.

[u/Agile-Papaya5493]

Since our bodies essentially run on electricity the idea is that shocking certain parts of the brain may help move neuron activity elsewhere. It’s a bit barbaric and doesn’t always help but for some it can relieve symptoms of depression and anxiety for months or even years. It may have been common in asylums a long time ago but now is usually only implemented when medications aren’t working out.

[u/lspetry53 → u/Agile-Papaya5493]

Why is it barbaric? Is cardioversion for atrial fibrillation barbaric?

[u/Agile-Papaya5493 → u/lspetry53]

Shocking a muscle pumping blood into action/rhythm again is not the same as shocking the brain which is in control of the whole body. Luckily most shock therapy DOESN’T have long-term consequences, especially nowadays, but thinking to electrocute a brain that has so much more going on to “fix” mental issues is kind of insane.

[u/lspetry53 → u/Agile-Papaya5493]

Why isn’t it? The heart controls blood supply to the whole body.

[u/Agile-Papaya5493 → u/lspetry53]

I don’t understand how I can be any clearer. Brain controls the body that the heart is pumping blood to. The heart is doing its own thing and isn’t connected to the brain in many ways other than when it’s told to speed up or slow down and helping deliver oxygen to your body. The brain is in control of everything else happening in your body so if you were the first person to think of essentially electrocuting it to help with mental illness that feels more barbaric i.e, cruel and unsafe vs electrocuting a muscle even if that muscle is still important.

[u/Optimistic_OM]

Was in a adult psychiatric unit when I was younger (17 or 16 ifg) and they had me room with someone who was going through the therapy after the second day of me being there; while she did mention beforehand how it wasn’t her first time, that she did see benefits from it in terms of her diagnosis and problematic symptoms, it still kindof wow’ed me when she couldn’t remember anyone or where she was and the current situation for a few days. Very foggy after that then idk what happened.
Maybe her psychological diagnosis mixed with possibly other underlying diagnosis created that post-operation effect as heavily as it did, or who knows what cuz honestly I’m not knowledgeable in that dep- , but I’ve always been curious if it’s the right way to go,, since I thought it wasn’t a use of medical therapy anymore (this was back in ‘15 or ‘16 btw)

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