Harvard Mental Health Letter

Electroconvulsive therapy

With new methods and accumulated evidence, this treatment survives its critics.

Passing an electric current through the brain to induce a seizure is not everyone's idea of a therapeutic procedure. So it's no surprise that electroconvulsive therapy (ECT) has been controversial ever since its invention in 1938. Fears of misuse are common, and movements to restrict or abolish the practice have had some success. It persists simply because it is sometimes a uniquely effective treatment for severe depression and other mental illnesses.

The familiar term "shock therapy" can be misleading. In the best present practice, patients feel no electric shock, because they are unconscious during the procedure. A more accurate term would be "seizure therapy." The purpose of the electricity is to induce a generalized seizure — a rapid discharge of nerve impulses throughout the brain. Before the advent of ECT, drugs were used for the same purpose, less effectively and with more serious side effects. Even the standard word "electroconvulsive" is not strictly correct today, because a drug suppresses the convulsions (strong involuntary muscle contractions) that occur in a generalized seizure resulting from a brain malfunction (epilepsy).

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