April 20, 2005

Shock Therapy & Schizophrenia

The area of "shock therapy", also called ECT, has been a controversial area over the years - but this report suggests that perhaps it should be less controversial. I'm not at all familiar with the "Center for the Advancement of Health" so just because of that, I'd tend to want to wait to see a well-research review from a recognized medical school before making firm opinions one way or the other.

Electroshock therapy speeds improvement in schizophrenia patients

Shock therapy, a controversial practice conjuring frightening images of behavior control, still has a place in schizophrenia treatment, a newly updated research review shows.

Although the data confirmed that antipsychotic drugs are still the first choice for schizophrenia treatment, they also showed that electroconvulsive, or shock, therapy clearly works, and combining both treatments can accelerate benefits to some patients, the review finds.

Dr. Prathap Tharyan, head of psychiatry at Christian Medical College in Tamil Nadu, India, and colleagues analyzed 26 randomized controlled trials, involving 1,485 adult patients, 798 of whom were treated with shock therapy. Trials were conducted in India, the United States, Thailand, Canada, Hungary and Nigeria.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

" The most significant finding is that ECT combined with antipsychotics is more effective than antipsychotics alone in producing rapid clinical improvement in people with schizophrenia," Tharyan said. Rapid improvement of symptoms is potentially lifesaving, for instance, when a person with schizophrenia is suicidal.

The review also refutes a public perception that ECT is dangerous and causes brain damage and suggests that for some patients the side effects of shock therapy may be more tolerable than those of antipsychotic drugs.

ECT induces a seizure with electric stimulus shock, given by electrodes attached to the scalp. Seizures last from 25 to 30 seconds. Patients are given short-acting anesthetics and muscle relaxants to decrease anxiety and protect them from injury during muscle contractions. Patients generally receive ECT two to three times a week, usually for a total of eight to 12 treatments in a series.

The American Psychiatric Association supports use of ECT only to treat severe, disabling mental disorders. However, the National Institute for Clinical Excellence in the United Kingdom does not recommend general use of ECT for schizophrenia, although it may be indicated for catatonia.

About 2.2 million American adults, or 1.1 percent of the adult population, have schizophrenia, according to 2001 figures from the National Institute of Mental Health. Twenty percent of people with schizophrenia fail to respond to drug therapy alone. Researchers used sophisticated statistical methods to reach conclusions based on data pooled from individual, randomized studies.

Studies used a variety of tests to measure psychiatric symptoms and psychological, social and occupational functioning.

Ten trials compared shock therapy directly with drug therapy. "When ECT given without antipsychotics is directly compared to treatment with antipsychotics alone … results strongly favor the medication group," reviewers found. They also found "very limited data" suggesting that people treated with ECT are less likely to relapse.

Further, one trial indicated that the combination of ECT and antipsychotics offered significant advantages that were maintained beyond the short term.

Several trials assessed cognitive side effects, such as memory impairment. Others measured side effects often seen with antipsychotic drugs, such as tremor, slurred speech, inability to keep still, anxiety and paranoia. Some data indicated that these side effects were less severe with ECT than with antipsychotic drugs.

A small trial found more impairment with ECT and antipsychotics combined than antipsychotics alone. "However," authors noted, "when re-tested nine weeks later, memory function had improved in both groups and no significant differences were detected."

A very small trial showed a decline in visual memory after ECT compared with those who were given anesthesia and nothing else.

Dr. David Spiegel, professor of psychiatry at Stanford University School of Medicine, has used ECT to treat patients with depression but views its use in schizophrenia as a last resort.

"I would worry that in some of the studies, patients may not have been on an aggressive enough drug schedule to treat early symptoms rapidly," Spiegel says. "You would have to include only studies where drug control was optimal.

"Lots of people -- especially many with delusions -- are still uncomfortable with ECT, although it's terrific for depression," Spiegel says.

ECT came into use in the late 1930s, but it waned in developed nations with the introduction of antipsychotics and antidepressants in the 1950s.

Tharyan says that in countries with few state-funded social services, ECT can be useful as the more rapid treatment because the impact of long-running schizophrenia can cause both patients and family caregivers to stop working. ECT is more available and less expensive than antipsychotics in many developing areas.

Source: The Center for Advancement of Health


What is the record for cognitive behavior therapy as an intervention in schizophrenia cases. Is it true that, at least for issues such as impulsivity or for attendant depression or poorly-learned social skills, this can be an essential adjunct?

Posted by: Anxiety Therapy Interestee at May 13, 2005 07:03 PM

My wife was diagnosed with a delusional disorder/schizophrenia a little over two years ago. She recently tried to commit suicide. She fights taking medications and always has a reason for not taking one drug or another. She does not drink or use alcohol and does not smoke. She is 42 years old. How else can I help her?? ECT seems like a good treatment based on what I have read and the doctors taking care of her are wanting to use it once she is physically stable (she has numerous broken bones from an attempt at driving her car over a cliff). When would it NOT be wise to use ECT??
Thank you
Bill Muir

Posted by: William Muir at July 24, 2005 12:17 AM

I just wanna ask aquestion.
Is ECT efffective for those patients having long history of schizophrenia say,10-15 years, but never got treated through it?

Posted by: gautam verma at July 26, 2005 06:21 AM

I have a 22 year old friend who has just been diagnosed with schizophrenia and I was wondering if you could explain to me why they plan to freeze most of her body before she undergoes shock treatment. Also what are the best ways for me to help her through this?

Posted by: Crystal at August 18, 2005 09:33 AM

Hey, I just noticed all the comments for this news blog and they all seem to be questions. Since it would be difficult to answer all of your questions here, I would like to encourage you all to send questions to the email address: szwebmaster@yahoo.com
The comments section is more for just comments (questions are best sent to the above email address). Thanks!

Posted by: christine Administrator for www.schizophrenia.com at August 20, 2005 11:30 AM

My son is 37 years old and has schizophrenia since he was 18 years old. He is on medication but 3 years ago he also became a crac coccaine addict, is there hope for him through ECT?

Posted by: Dave Hoffmann at October 5, 2005 09:16 PM

My 23 year old son had 2 years of neuroleptic treatment for schizophrenia (2.5mgs Risperidal, 500 mgs Quetiapine, 10 mg Paxil daily ) that basically just reduced his 'manic' behaviour and did not touch the depression or cognitive defect. We finally gave in to the doctor's pressure for ECT and he had 6 treatments with no side effects. It helped tremendously to lift his depression for about a month, long enough for him to start to see a little light at the end of the very black tunnel he'd been living in. Since then, he's been taking chinese herbs on top of the neuroleptics, and has been steadily improving, though not ready to work or live on his own. Without ECT, he may not have had enough hope to drink the awful tasting goop, which we believe to be the root of his long-term improvement!

Posted by: Kay at November 1, 2005 03:35 PM

I was in a private psych hospital with no day leave for 3 weeks at the end of 2004. I have needed anti-psychotic meds since 1991, now on ZYPREXA. I needed Anatensol for one year whilst in group therapy at age 17/18, then not until age 39. I do not know is I have schizophrenia, tho' I suspect they have not confirmed it yet. I am no longer able to work, or even look for work, and find managing alone in my house difficult. Would ECT help my depression; can it be given in Australia as an outpatient (i.e. day procedure). I have NO carer with me at all, my folks are all very busy people, and I just struggle through one day after the next never knowing when I might feel able to do more again. I am now 53. My parents are going to leave to me a testamentary trust so I cannot waste money as I am also gay, and they feel a long term stable relationship will be unlikely for me to achieve.
Can anyone comment or enlighten me about ECT in Melbourne, please?


Posted by: Keith at February 25, 2006 11:21 PM

At what age would you recommend someone for this treatment?
Thank You

Posted by: ross at June 16, 2006 08:20 PM

I personally know that ECT does not work with schozophrenia. Unless the patient is on major antipsychotics and/or mood stabilizers. Drugs that are used to treat Schz cause depressive symtoms. But, most people don't need as much medication as they are perscribed. I believe that is why most turn to street drugs. It is vital for the patient to be in control of their therapy. ECT causes delirum in most patients and a lot cannot recover. Also, ECT cannot be stopped. It weakens the brain and then drugs or alternative therapies must be used to keep the brain in its shape. It is a very intrusive, dangerous procedure and should not be used without full consent and disclosure. It is a life altering therapy for everyone. Unfortunatly it is popular amongst physicians because of its cost and because there is no way a patient can stop ect and must always return.

Posted by: Paula at February 21, 2007 05:00 AM

I am interested in shock treatments but i am a little leary of it because of what i read something Gary Null said. He says it puts the patient in a semi-comatose state. I am to the limit on geodon and clozapine. But i definately need something more

Posted by: Eugene Chrysler at August 20, 2007 02:37 PM

I am a 52 years old male with severe depression since my teenage hoold. about 8 years ago I started hearing voices and they are very real to me but no one believes me. I have been taking many antisychotic meds but geting worse and nothing has worked. I am considering shock therapy treatments, however I need more info, please guide me to the top doctors in California or any where in the states.

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Posted by: Bill Kloders at December 10, 2007 01:25 PM

My husband was diagnosed with schizphrenia 6 years ago and nothing seems to work. He's been on Risperdal, Zyprexia, Abilify, Envega---you name it. I would like to know if anyone can refer me to a DR. in my area that can perform shock treatment. Gulfport,MS....Desperate please help

Posted by: Nikki at January 3, 2008 12:04 AM

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