by Kent Reedy

Created on: December 16, 2008   Last Updated: April 14, 2009

The actual physical procedures involved in giving someone shock treatments, or electroconvulsive therapy (ECT), as it is commonly called, are fairly well-known and clear-cut. Less certain and well-known are how ECT affects the people it is given to - especially how it affects them in the long-term; how many people it is given to and how many total treatments different people receive; and how many of the people receiving ECT freely choose to have it done after being fully informed of all its possible consequences compared to how many are misled, coerced, or forced into having it done.

Basically ECT is all about running enough electricity through a person's brain to cause them to have a seizure. This is done by attaching two electrodes to their head and then running some electricity through the electrodes. It was originally standard practice to attach the electrodes to the opposite sides of a person's head, usually near the temples - which is called "bilateral" electrode placement (BL). In recent years it has become more common to put both electrodes on the same side of the head, usually on the right side. This is called "unilateral" (UL), or "right unilateral" (RUL) placement, and it tends to cause less memory loss and other kinds of cognitive damage than bilateral electrode placement does. Another recent change is in the electric current itself - it used to be the norm to use "sine wave stimulation", but in recent years it has become very common to use something called "brief pulse stimulation" instead. Each of these two changes tends to make ECT generally less brain-damaging, though still not totally benign or risk-free.

Shock treatments were originally given without any kind of muscle relaxant or anesthesia. This caused the people being shocked to go into convulsions, which often caused them to suffer injuries such as broken bones. That is called "unmodified ECT", and it is still used in some parts of the world. In places like the United States and Britain, however, unmodified ECT has been replaced with "modified ECT", which includes the use of a muscle relaxant such as succinylcholine (a synthetic alternative to curare), and a general anesthetic. Another safety-related procedure in modern ECT is the use of a bite guard, which is placed in the mouth of the person being shocked to keep them from damaging their teeth by gnashing them together during the seizure.

There are different theories as to what it is about ECT that causes improvement in a person's mood.

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