Over the years electroconvulsive therapy (ECT) — commonly known as "shock therapy" — has gotten a bad rap.
But new research out of Italy suggests that reputation may be unwarranted. Investigators found that among bipolar patients who fail to respond to standard treatments, ECT can be a lifesaver, preventing out-of-control mood swings and dramatically lowering suicide risk.
The study — among the largest of its kind — tracked 670 Italian adults who had ECT for bipolar disorder at a single psychiatric clinic between 2006 and 2019.
"Importantly, 84% of patients showing high risk of suicide before ECT were no longer considered overtly suicidal after treatment," said lead author Dr. Giulio Brancati, a resident in clinical and experimental medicine at the University of Pisa.
"Overall, 72% of patients showed a good response to ECT," Brancati added.
For about six in 10, ECT appeared to offer relief from an array of debilitating symptoms — including delusions, aggressiveness, uncooperativeness, emotional oversensitivity, physical hyperactivity, and paranoia. Depression and anxiety were alleviated in just over one-quarter of the patients.
Based on the findings, Brancati said, "ECT should be considered a valuable treatment for severe episodic syndromes," especially the kind of overexcitement, restlessness, hostility and suspiciousness that can arise when manic, depressive and psychotic symptoms intertwine.
The study team noted that bipolar disorder affects about 1% of the population. It can manifest as fits of mania and depression, leading to a profound sense of guilt and worthlessness, and a heightened risk for suicide.
About two-thirds of patients respond well to prescription drugs, including mood stabilizers and antipsychotics. The rest do not.
Enter ECT. Pioneered in Rome in 1938 by Lucio Bini, a psychiatrist, and Ugo Cerletti, a neurologist, it spread rapidly around the world. It works by generating a short-lived electrical seizure in the brain, and is typically administered two to three times a week as part of a regimen of six to 12 sessions.
Brancati conceded that its bad reputation was not unfounded.
"It is not false that ECT has been sometimes administered in untherapeutic, if not abusive, ways," he said. For example, Brancati noted that the first electroshock patients were not medicated during treatment, "which often led to serious musculoskeletal complications."
And during the 1950s, "graphic portrayals" in movies and novels added to the stigma and fear, Brancati said.
The upshot: Over the years, ECT fell out of favor as a treatment option. But today's ECT is not the stuff of frightening cinematic depictions, like that in "Frances" or "One Flew Over the Cuckoo's Nest."
Modern ECT is administered under a combination of general anesthesia and muscle relaxants, which "dramatically reduces the risk of fractures," Brancati explained. And the electrical configurations have been revised, significantly lowering the risk for post-treatment disorientation and memory loss.
"Unfortunately, ECT and psychiatric illness are still subjected to high levels of stigma, which could prevent many severely impaired patients from achieving adequate and effective treatment," Brancati said.
Dr. Laura Fochtmann, director of the ECT Service at Renaissance School of Medicine at Stony Brook University in New York, said the old portrayals, unfortunately, persist.
"There are many examples of inaccurate portrayals of ECT and psychiatric treatments that have contributed to an unwarranted fear of ECT and ongoing stigma about ECT and psychiatric treatments and illness, in general," she said.
That's a shame, Fochtmann added.
"The benefits of ECT in patients with bipolar disorder in this study actually aren't surprising, because they confirm what we have known for quite some time about the benefits of ECT in depression, including depression that occurs in individuals with bipolar disorder," Fochtmann said.
In 2011, actress Carrie Fisher, who had bipolar disorder, disclosed that she had had shock therapy. She told Oprah Winfrey that it was quite effective and ultimately, worth it.
Brancati's team presented its findings recently at a virtual meeting of the European College of Neuropsychopharmacology. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.