Therapy 'resets' brain instantly
It is a procedure that can save lives, yet there is a lingering stigma attached to electroconvulsive therapy in the minds of many.
Performed on a regular basis in a number of hospitals around WA - in 2009-10, 429 patients underwent the procedure - modern electroconvulsive therapy (ECT) has come a long way since its chilling portrayal in the movie One Flew Over the Cuckoo's Nest.
More than 50 years on, it remains an important last-line treatment for severe depression, schizophrenia, bipolar disorder and psychosis.
Clinical director of ECT services at Hollywood Clinic Mathew Samuel said ECT essentially "reset" the brain by giving patients under general anaesthetic a small electric shock which induced a generalised cerebral seizure.
The reasons why the treatment was effective remained unclear but one theory was that it helped increase the production of chemicals known as brain-derived neurotropic factors, which are low in a person with depression, bipolar or schizophrenia.
Dr Samuel said ECT, which had a 60-70 per cent success rate, could very quickly improve a patient's quality of life and shorten their stay in hospital.
"It is actually a labour-intensive, well-modulated and well- controlled treatment with strict guidelines in terms of how you can do it and how you can't do it," Dr Samuel said.
Patients usually receive 12 treatments over four weeks. The procedure itself takes only about five minutes.
"It's an instant treatment, in the sense that you go through the process and you get the result - you don't have to wait for weeks and weeks for (drugs to have an effect). Either it works or it doesn't work," he said.
Short-term side effects include headache and in the long term, patients can suffer memory loss for the period just before and just after the procedure.
"(For those for whom it is successful) the general rule is . . . one-third will get better and not need ECT again at all, one-third will need ECT again two or three times in their lifetime, and one-third will need it on a continuous basis, but they may choose not to have that," Dr Samuel said.
"If you want an instantaneous result and to reduce the risk involved and improve the quality of life, ECT always stands out as the foremost in terms of treatment.
"Cognitive behaviour therapy (a mainstay treatment for depression) takes a long time and . . . it also depends on the severity of the depression."
Controversially, ECT is also, on rare occasions, performed on children aged under 16 and in early-stage pregnancy - occasions when drugs are likely to cause harm or take too long to take effect.
"We have to give ECT in children less than 16 sometimes because that may be the only thing that works for that person," Dr Samuel said.
"Medications are an unknown entity in children because of the side effects and what it could do to the developing brain - from a safety point-of-view, it would be safer compared to medication."
Dr Samuel said the scientific community was running out of options for treatments with medications. He expected in the next 10 years there would be a move away from chemicals to a new focus on stimulating the brain by other means.
One area of research showing promising results was a procedure that might one day eclipse the benefits delivered by ECT.
Known as repetitive transcranial magnetic stimulation (rTMS), the procedure tries to stimulate cerebral activity by applying magnetic radiation to the brain via a magnetic coil placed near the scalp.
"It is comparable to ECT and even better than ECT," Dr Samuel said. "Instead of an electric shock, you try to stimulate cerebral activity by applying magnetic radiation to the brain. This will have less impact in terms of issues with anaesthesia because with ECT one of the risks is giving them anaesthesia, with rTMS, you don't need anaesthesia."
A Health Department spokesman said approximately 50 patients had participated in the study of rTMS at the Centre for Clinical Research in Neuropsychiatry in Perth since 2009.
"RTMS studies from around the world and in other centres within Australia show some potential evidence of benefit in certain groups with depression," he said.
