ECT Treatment: A History of Helping Patients
June 11, 2024
Dr. Stephen Seiner, ECT expert, and Terry A. Bragg, MSLS, MA, McLean Hospital historian and archivist, share the history behind electroconvulsive therapy.
Electroconvulsive therapy (ECT) is used to treat patients with certain types of mental illness, including severe depression, severe mania, and catatonia. It was first developed in the late 1930s, with the first recorded treatments at McLean Hospital taking place in 1941.
Keep Reading To Learn
- The history of ECT treatment at McLean
- The evidence base for ECT as a safe and effective treatment
- How ECT has been viewed in the public eye
A few years prior to the advent of ECT, many hospitals, including McLean, used chemically induced seizures as a method to treat patients with severe mental illness. Insulin therapy and metrazol therapy were both started at McLean in 1938, but discontinued in 1941—although such therapies continued for many more years at some other hospitals. McLean doctors at the time determined that ECT was a more precise and less risky treatment.
Chemical seizure therapy required the injection of potentially toxic substances into the body, and the experience was very unpleasant for patients. Because of uncertainty about proper dosing, the patient had to wait for the seizure to come on as the chemical treatment was slowly administered, making the procedure very anxiety-provoking.
ECT, on the other hand, produced an instantaneous and reliable seizure. Patients also had no recollection of the seizure, and they therefore had less fear about the procedure after it was completed.
Aside from these advantages that helped make ECT a more tolerable experience, ECT proved early on to be a very effective treatment for certain forms of mental illness, including depression.
Depression Screening
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A Treatment Based in Research
In 1945, McLean Hospital Psychiatrist in Chief Kenneth J. Tillotson, MD, and Wolfgang M. Sulzbach, MD—the first physicians to perform ECT treatments at McLean—published one of the earliest follow-up controlled studies on ECT, “A Comparative Study and Evaluation of Electric Shock Therapy in Depressive States.”
The study compared 70 patients with depression who were treated with ECT to a control group of 68 patients with depression who were not given any treatment.
The researchers found that 80% of the patients treated with ECT experienced symptomatic improvement, versus only 50% of the control group. One year after discharge, 17% of the treated patients had relapsed as compared to 40% of the untreated patients. The average length of hospitalization for the treatment group was five months and nine days, as compared to 21 months for the control group.
Interestingly, in terms of side effects, they noted:
“Although mild amnestic and confusional syndromes were frequently encountered for a few hours to two weeks after four or more treatments, we have never observed any real or persistent deterioration in any of our patients. The opposite was seemingly true in some patients, who, subsequent to shock therapy, displayed a far more efficient intellectual as well as emotional adaptability to their environment than ever before in their life.”
Many other studies demonstrating ECT’s efficacy followed. However, ECT was slow to gain acceptance, partly because it was such a radical departure from the way things had been done for many years.
It was a very straightforward and inexpensive procedure that could be used to treat a patient in a relatively short period. In contrast, the public and those in the psychiatry field itself were accustomed to the notion of treatment as a series of one-hour sessions of psychotherapy spread out over a long period, and they were troubled by the idea of applying electricity to the brain.
In the 1950s and 1960s, the widening adoption of modified ECT—which includes the use of a muscle relaxant and general anesthesia—helped bolster acceptance of the treatment.
The muscle relaxants eliminated the convulsions associated with seizures and therefore greatly reduced the risk of injuries. (After experimenting with curare, a natural, plant-derived muscle relaxant, in the 1940s, physicians switched to a safer, synthetic muscle relaxant in the 1950s.) The anesthesia, meanwhile, made the procedure more comfortable for the patient and made it easier for the clinician to administer the muscle relaxant.
Another positive shift took place during the 1960s and 1970s, when practitioners moved from using sine-wave machines to brief-pulse devices. This change reduced reports of cognitive side effects associated with ECT treatment.
Around the same time, an antipsychiatry movement—partially fueled by the negative portrayal of ECT in “One Flew Over the Cuckoo’s Nest”—served to diminish the view of ECT in the public eye.
ECT treatment has changed a lot since it was first used; modern ECT devices utilize cutting-edge technology and the latest in health care advances
Since that time, however, thanks to increased awareness and further treatment advances, ECT has made a steady comeback.
Physicians, for instance, have recently moved toward greater use of unilateral ECT, in which electric current is applied to only one hemisphere of the brain, as opposed to both sides of the brain in bilateral ECT.
While bilateral is still considered to be the gold standard (i.e., the most powerful) ECT treatment, studies have shown that unilateral ECT can be nearly as effective at reducing symptoms of mental illness while producing fewer cognitive side effects.
Furthermore, about 10 years ago, a newer type of ECT called ultrabrief pulse was shown to be very effective and resulted in even less memory loss. This type of ECT has since become very popular, including at McLean Hospital, and has helped dramatically reduce memory impairment associated with the procedure for many patients.
Other improvements include greater uniformity of informed consent across institutions, an increasing number of national locations at which clinicians can get specialized ECT training, the development of a comprehensive textbook on how to administer ECT, greater standardization of care, and advances in anesthesia dosing and medical monitoring.
With all these advances, what was once an effective and safe treatment is now a more effective, more comfortable, and safer treatment.
Here at McLean Hospital, we now perform four times as many ECT treatments as we did in the late 1990s, and we are using the procedure to treat a broader population of patients—and not just as a last resort. This is good news, as it suggests that people are becoming increasingly aware of the safety and significant healing potential of ECT.
Stephen J. Seiner, MD, is director of the Psychiatric Neurotherapeutics Program and the Electroconvulsive Therapy (ECT) Service at McLean Hospital. Dr. Seiner’s clinical interests include neurotherapeutics and geriatric psychiatry.
Terry A. Bragg, MSLS, MA, has served as McLean Hospital’s archivist since 1981, when he was recruited to establish an institutional archive. He was also director of Professional Staff Affairs for over 30 years, a role that includes the management of professional staff credentialing and academic appointments.
To learn more about ECT, visit McLean’s Guide to ECT Treatment.
McLean Is Here To Help
McLean’s ECT Service performs over 7,000 treatments a year, making it one of the largest ECT centers in the country. For more information or to make a referral, please call us today.
Want More Information?
Looking for even more information about ECT? You may find these resources helpful.
Interesting Articles, Videos, & More
- Why ECT Is Becoming a Preferred Depression Treatment
- Deconstructing Stigma: Cynthia’s story
- Video: Depression 101
- Everything You Need To Know About Depression
- Video: Navigating the Ups and Downs of Bipolar Disorder
- Deconstructing Stigma: Kitty’s story
- Everything You Need To Know About Bipolar Disorder
- Video: How To Support Someone With Depression
- Video: Lecture – Treating Treatment Resistant Depression
Helpful Links
These organizations may also have useful information:
The International Society for ECT and Neurostimulation (ISEN)
The International Society for ECT and Neurostimulation (ISEN) is an international organization established in 1976 that is dedicated to promoting the safe, ethical, and effective use of electroconvulsive therapy (ECT) and other brain stimulation therapies for the treatment of neuropsychiatric illness through education and research.
Brain & Behavior Research Foundation
The Brain & Behavior Research Foundation is the top non-governmental funder of mental health research grants in the United States. By funding research in neuroscience and psychiatry focused on the causes and treatment of psychiatric and mental illnesses, they aim to alleviate the suffering of those impacted by mental illness.
Depression and Bipolar Support Alliance
A nonprofit organization providing support groups for people with depression or bipolar disorder, as well as their friends and family. DBSA offers education, personal wellness tools, access to research studies, and assistance with finding the right treatment.
Depression and Bipolar Support Alliance Boston
A nonprofit, self-help support organization run by volunteers, for people who struggle with mood disorders, such as depression and bipolar disorder, and for family and friends.
Families for Depression Awareness
This organization offers information and tools to help families recognize and cope with depression and bipolar disorder in order to get people well and prevent suicides.
National Network of Depression Centers
An organization that uses the power of their network of depression centers to make advancements in the areas of clinical care, research, education, and policy. They aim to advance scientific discovery and provide stigma-free, evidence-based care to patients with mood disorders, including depression and bipolar disorder.
