As controversial as it may be, electroconvulsive therapy, or ECT, has long been one of the most effective treatments for severe depression. Thanks to its portrayal in films such as One Flew Over the Cuckoo's Nest, it's developed a slightly barbaric reputation, but that doesn't change the fact that, for many patients who don't respond to medication, it's the only thing that alleviates their symptoms.
Still, despite its effectiveness, ECT does come with a host of not-so-minimal potential side effects, including memory loss, confusion and heart problems. But now medical researchers from the University of New South Wales (UNSW) in Australia have demonstrated that a new, gentler type of ECT can be just as effective, and comes with far fewer side effects.
"This new treatment, which is slowly coming into clinical practice in Australia, is one of the most significant developments in the clinical treatment of severe depression in the past two decades," said lead researcher and psychiatrist, Colleen Loo, in a press release.
Called ultra-brief pulse stimulation, the treatment is similar to traditional to regular ECT in that patients have electrodes attached to their head under general anaesthetic, and then receive tiny pulses of electric current targeted to the brain's prefrontal cortex, which is under-active in patients with depression.
But it differs because these electrical pulses are so short - only 0.3 milliseconds, compared to 1 millisecond for traditional ECT - that they stimulate the brain tissue a third less than traditional ECT pulses.
In the past researchers assumed that this meant ultra-brief pulse stimulation must be less effective, but after looking into six international studies involving more than 689 patients, the UNSW team found that it can work just as well - patients just need to have one more treatment than they would with ECT.
This is the first systematic review to examine the effectiveness and cognitive effects of standard ECT treatment versus ultra-brief pulse stimulation ECT, and the results show that the new treatment has far less side effects, making the longer treatment period worthwhile for patients who aren't at immediate risk of suicide or self-harm.
"Our analysis of the existing trial data showed that ultra-brief stimulation significantly lessened the potential for the destruction of memories formed prior to ECT, reduced the difficulty of recalling and learning new information after ECT and was almost as effective as the standard ECT treatment," said Loo.
She hopes the research will encourage more doctors and patients to try ultra-brief pulse stimulation when other treatments have failed - it's currently estimated that 10,000 Australians with severe depression don't respond to medications. And with many of those patients experiencing suicidal thoughts or contemplating self-harm, it's crucial that we find new treatment options.
"Our review confirms, yes, this should be a clinical treatment, it is very effective as a treatment and that it definitely does reduce the memory side effects," Loo told Elise Worthington at ABC News. Researchers around the world are also looking into ways they can embed electrodes into the brain to stimulate more specific regions, sort of like a neurological pacemaker.
Perhaps the main challenge will be to change the stigma surrounding ECT, but hopefully enough success stories will help us accomplish that. The results have been published in the Journal of Clinical Psychiatry.
Find out more about the ground-breaking research happening at UNSW Medicine.