Electroconvulsive Therapy started as a medical treatment to treat people with certain disorders. It consists of a machine that has attachments that connect to the body and deliver shocks to the body in order to "fix" the problem. Electroconvulsive therapy originated in the United Kingdom, this is where the first treatments were received. It was first used in April 1938, in Italy. After some time and modifications this practice made its way to the United States. The first Electroconvulsive shock therapy done in the United States was done on January 7, 1940. It was done using a machine that was made in Italy, and brought to the United States in 1939 by Dr.Renato Almansi.
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Doctors
The first ECT was administered by Dr. David Impastato. This was done on January 7, 1940. The details of this treatment were unknown until Walter Barton (the medical director of the APA, wrote David Impastato, and asked for him to describe the first use of ECT in the United States. Doctor Barton sent this letter on January 27, 1969, about 29 years later, and received Doctor Impastato’s reply on the 24 of June 1969. This report consisted of a 13-page report titled “The beginnings of ECT in the United States. The first patient was a twenty-nine year old Italian woman who suffered from severe schizophrenia. The treatment was done in New York City and only used 70 volts. The first patient was subsequently treated at the Columbus Hospital in New York City. This was the first hospital that allowed the treatment of electroconvulsive therapy in the United States.
In December 1940 Dr. Walter Freeman requested the presence of Mr.Impastato and Almansi along with the ECT machine in Washington DC. He wanted to them to demonstrate the treatment of ECT on one of his patients a thirty-year-old man with schizoid depression.
Early Years
In the early days of ECT, treatment was given without anesthesia or muscle relaxants. Treatment was administered early in the morning on an empty stomach. The patient would lay in bed, with the patient's head resting at the foot of the bed to allow for the doctor to easily adjust the placement of the electrodes. A heavily padded double tongue depressor was then inserted into the patient's mouth and an electric current would then be run through the electrodes to induce a grand mal seizure. Typically, two or more assistants would be present to secure the patient during the unsuppressed convulsions, which were usually violent and often resulted in physical injuries due to uncontrolled muscle contractions. When the convulsions subsided, the patient would be turned on his side for recovery.
In some large state hospitals during the early days of ECT, patients were lined up in beds in a large dormitory with their heads at the foot of the beds. The ECT apparatus was wheeled from patient to patient and administered procedurally. This allowed for a higher throughput in treatments. However, this en masse treatment of patients gave rise to questions of ethics regarding the ECT treatment process.
Present
Modern refinements to the ECT technique seek to improve the safety and efficacy of ECT administration. These refinements include finer tuning to waveform parameters through pulse-width modulation, individualizing dosing to each patient's seizure threshold, the administration of anesthetics, along with more targeted electrode placement.
Effectiveness
In 2003, one meta-analysis published in the Journal of ECT studied the results of 16 different research studies to analyze the efficacy of ECT in the treatment of depression. This study found a statistically significant benefit for ECT versus a control group of simulated ECT. For the rapid response of ECT, this study showed no statistically significant positive response to ECT versus the control group.
A separate literature review studying the results of different research studies concluded that "there was no evidence at all that the treatment has any benefit for anyone lasting beyond a few days (Read, 2004)”.
Side effects
In a study conducted at the Herzog Memorial Hospital in Jerusalem, Israel, 27 medication-free patients with depression were administered a comprehensive exam testing memory and other cognitive functions before and after a series of ECT treatments using modern methods. This study found significant degradation in anterograde and retrograde memory immediately after the ECT treatments. At a one-month followup, the performance of the anterograde and retrograde memory in each patient had returned to pre-treatment levels. By the six-month follow up, the levels had exceeded the one-month follow up levels.
Another study conducted in Hamilton Ontario seeking to answer the same question concluded that patients who had been treated with ECT had verbal learning and memory deficits, measured by their performance on the California Verbal Learning Test, the Continuous Visual Memory Test, and a computerized process dissociation task that examines recollection and habit memory in a single paradigm.
The Early Years
In the first few years of electroconvulsive therapy these treatments were very well received. Before ECT there was a very small understanding of mental disorders, so any treatment that offered a “cure” for these patients were welcomed with open arms.
The Press
After a few years, people who had been treated unsuccessfully by ECT started coming forward and sharing their stories with the press. In the first years of administering Electroconvulsive shock therapy there was little modification by anesthetics, or muscle relaxants. Because of this the treatments were often frightening to both watch and receive. Because of this ECT was starting to be received as a punishment for deviant behaviors, not as a treatment for psychiatric disorders.