Elektroconvulsive

Elektroconvulsive therapy, commonly known as electroconvulsive therapy (ECT), is a psychiatric treatment that uses controlled electrical currents to induce a brief generalized seizure under anesthesia. It is primarily employed for severe mood disorders and certain psychotic conditions when rapid improvement is needed or other treatments have failed.

The procedure involves a medical assessment, administration of anesthesia and a muscle relaxant, and delivery of brief electrical pulses through electrodes placed on the scalp. Electrode placement can be bilateral or unilateral, with the choice guided by the condition being treated and the goal of balancing efficacy with cognitive side effects. A typical course comprises 6 to 12 sessions, usually given two to three times per week, though maintenance sessions may be scheduled to prevent relapse. Treatments are performed in hospital or outpatient settings.

History and mechanism: ECT was developed in the 1930s by Ugo Cerletti and Lucino Bini. Modern practice uses brief-pulse stimulation and anesthesia, which reduces cognitive side effects compared with earlier methods. The exact mechanism by which ECT exerts its therapeutic effects is not fully understood; proposed mechanisms include modulation of neurotransmitter systems, changes in brain connectivity, and promotion of neuroplasticity.

Indications and efficacy: ECT is highly effective for severe major depressive episodes, particularly with psychotic features or high suicide risk, treatment-resistant depression, manic episodes, and catatonia. It can provide rapid symptom relief and is considered when a swift response is necessary. Some patients require ongoing maintenance ECT to sustain recovery.

Safety and side effects: Common short-term effects include temporary memory impairment, confusion, headaches, and muscle soreness. Cognitive effects are typically transient and improve after the course. Serious adverse events are uncommon when procedures are performed under proper anesthesia and monitoring. Informed consent and discussion of risks are standard practice. In German-speaking contexts, the term Elektrokrampftherapie is used; Elektroconvulsive describes the general concept.