620 CHAPTER 15
a drug (camphor) in those early experiments. It was Italian researchers Cerletti and Bini
who first used electricity to induce a seizure in a man with schizophrenia, who fully
recovered after only 11 such treatments (Endler, 1988; Fink, 1984; Shorter, 1997). Soon
doctors were using ECT on every kind of severe mental disorder. In those early days,
no anesthesia was used because the shock was severe enough to result in a loss of con-
sciousness (most of the time). Broken bones, bitten tongues, and fractured teeth were not
untypical “side effects.”
To d a y ’ s E C T i s f a r m o re c o n t ro l l e d a n d h u m a n e. I t i s o n l y u s e d t o t re a t s e v e re d i s-
orders, and written and informed consent is required in most states. ECT has been found
to be most useful for severe depression that has not responded to medications or psycho-
therapy and in cases where suicide is a real possibility or has already been attempted.
ECT works more quickly than antidepressant medications, so it can play an important
role in helping prevent suicide attempts (APA Committee on Electroconvulsive Ther-
apy, 2001). Although relationships to clinical symptoms are not yet clear, it has also been
shown to increase the volume of gray matter and increase cortical thickness in some
areas of the brain, including the hippocampus and amygdala, areas involved in emotion
and memory (Bouckaert et al., 2015; Sartorius et al., 2015). to Learning Objec-
tive 2.11. Despite the results and these findings, ECT should not be considered a “cure.”
It is a way to get a person suffering from severe depression into a state of mind that is
more receptive to other forms of therapy or psychotherapy. Relapse is very possible in
individuals receiving ECT, and maintenance or continuation therapies are an important
treatment strategy to pursue (Nordenskjold et al., 2011; Petrides et al., 2011).What are some of the side effects? Wasn’t there something from
an earlier chapter about this therapy affecting memory?ECT does have several negative side effects, some of which last longer than others.
Memory is definitely affected, as ECT disrupts the consolidation process and prevents
the formation of long-term memories. to Learning Objective 6.12. This causes
both retrograde amnesia, the loss of memories for events that happen close to the time
of the treatment, and anterograde amnesia, the rapid forgetting of new material (APA
Committee on Electroconvulsive Therapy, 2001; Lisanby et al., 2000; Weiner, 2000). The
retrograde effects can extend to several months before and a few weeks after treatment,
and the older memories may return with time, whereas the anterograde amnesia is more
temporary, clearing up in a few weeks after treatment. When ECT is used today, every
effort is made to reduce as many side effects as possible. The modern patient is given
muscle relaxants to reduce the effects of the convulsion as well as a very short-term
anesthetic. There are even ECT approaches that use ultrabrief pulses, which appear to
have fewer cognitive side effects but not the same level of therapeutic results as other
methods (Tor et al., 2015). Despite its efficacy, the utilization of ECT in general is not
uniform. In the United States, racial differences in the use of ECT appear to be present,
with African Americans with depression less likely to pursue or receive ECT treatment
as compared to white Americans, and the overall use of ECT in general appears to be
declining (Case, Bertollo, Laska, Price et al., 2013; Case, Bertollo, Laska, Siegel, et al.,
2012).
PSYCHOSURGERY Just as surgery involves cutting into the body, psychosurgery
involves cutting into the brain to remove or destroy brain tissue for the purpose of
relieving symptoms of mental disorders. One of the earliest and best-known psycho-
surgical techniques is the prefrontal lobotomy, in which the connections of the pre-
frontal cortex to other areas of the brain are severed. The lobotomy was developed in
1935 by Portuguese neurologist Dr. Antonio Egas Moniz, who was awarded the Nobel
Prize in medicine for his contribution to psychosurgery (Cosgrove & Rauch, 1995;prefrontal lobotomy
psychosurgery in which the connec-
tions of the prefrontal cortex to other
areas of the brain are severed.
psychosurgery
surgery performed on brain tissue to
relieve or control severe psychological
disorders.
Brain activity is monitored before, during,
and after an electroconvulsive treatment
(ECT). ECT consists of applying an electric
shock to one or both sides of the head
to induce a seizure. The result is rapid
improvement in mood. It has been shown
to be most effective in treating severe
depression that has not responded to other
treatments, or where the side effects of
other treatments cannot be tolerated.