ECT causes Neurocognitive impairment
Christopher Abbott, medical director of the electroconvulsive therapy service at the University of New Mexico School of Medicine said “ECT works, we know that—but what often happens is that we solve one problem, the depression, and then create other problems with neurocognitive impairment,”[ii]
Delayed Neurological Sequalae of Low-Voltage Electrical Injury
ECT isn’t presently considered “electrical injury” in medical literature because when electrodes are properly applied to the forehead to conduct electricity, there are no burns on the skin. Electricity takes the path of least resistance. The brain and central nervous system were designed to conduct electricity. Electricity applied between the ears, "internal resistance (less the skin resistance) is only 100 ohms" meaning electricity travels farther through the body when applied to the head than any other place on the body.
The electricity of ECT impacts more than directly beneath the electrodes. Bilateral electrode placement puts the electricity focal point on the anterior of frontal lobes and brain stem. causing diffuse low-voltage electrical injury in soft brains.
Contrary to doctors claims, they cannot control electrical path through brain matter that is 73% water, regardless of benevolent intent (high voltage electrical wood burning is an excellent visual image of what low-voltage electricity does to soft, moist human tissue).
In medical literature, researchers use 1,000 volts as a threshold to distinguish between high-voltage and low-voltage electrical injuries. Progressive low-voltage electrical injury can occur in people with brief exposure to 60v of electricity. ECT machines use between 250-450v electricity. After initial exposure, exposure to low-voltage electrical injury is documented by researchers to cause progressive neurological symptoms which begin manifesting between two and ten years later, sometimes more—depending on the age of the individual and how much electricity they were exposed to at the initial exposure. ECT is no different. The only difference is that researchers have yet to track ECT patients’ neurological outcomes for longer than six months. This is problematic when symptoms of electrical injury can manifest 2-10+ years after exposure to electricity. ECT patients experience multiple exposures.
People with a history of ECT frequently discuss symptoms of electrical injury in online chat forums. Symptoms discussed by ECT survivors correlate with historical research on "low-voltage electrical injury" including: persistent bladder problems, chronic pain, loosing teeth, swallowing difficulties, dystonia, diaphragmatic paralysis, muscle fatigue, muscle twitching, seizures, dizziness, migraines, sensitivity to sound/light/touch/smell, loss of taste, Parkinsonism and motor neuron disease.
At this time, informed consent paperwork does not discuss delayed low-voltage electrical injury.
Ethical Informed Consent Practices Not in Use
Until ECT is standardized and strictly regulated, doctors, nurses, medical staff, patients and concerned family members cannot properly understand treatment risks. Current informed consent materials quoting statistical risks of one particular method of ECT administration technique cannot be applied to a larger population using different administration method techniques.
Similarly, the number of treatment variables makes it impossible to compare ECT positive or negative experiences among patients.
For example, just changing pulse-width settings from 0.3 (ultra-brief-pulse) to 1.0 (brief-pulse) on the MECTA machine is a difference between getting 20 pulses or 1920 pulses delivered in a single treatment.
Additionally, current ECT informed consent papers have yet to discuss the federal Riera V Somatics, LLC court case and the subsequent regulatory update for the Thymatron device user’s manual. The unquantified risks listed in update indicate each ECT device (regardless of manufacturer or county of purchase) carries equal risk of permanent brain damage and permanent memory loss.
The “gold-standard” assessment for brain damage and memory loss in ECT patients before and after treatment is the Mini-Mental State Examination (MMSE). Historically the MMSE is used to assess for dementia. It is also famous because studies show that lobotomized patients can pass it. The MMSE cannot appropriately identify the type of brain injury or memory loss ECT patients experience.
At this time, patients who experience changes in cognition after ECT routinely report difficulty getting assessments for a brain injury. They are denied quantitative assessments to verify or refute whether they’re experiencing historically recognized deficits. Standard MRI and CT scans do not typically
Rare Negative Side-Effects
Using the word “rare” to discuss rates of permanent brain damage and permanent memory loss is unwarranted and misleading because without standardized treatment administration protocols and without routinely assessing each patient at each facility providing ECT using structured quantitative assessments to measure historically recognized deficits, there is no clear indication of how rare or prevalent brain damage is among ECT patients.
Additionally, in eighty years of ECT use, researchers never tracked patients for longer than six months after treatment to identify incidence of delayed neurological sequalae of electrical injury.
Like the saying goes, “Absence of evidence is not evidence of absence.”
“Modern ECT” differs from ECT of the 1930’s-1960’s
"Modern ECT" uses anesthesia and muscle relaxants to eliminate the risk of broken bones during seizure. But anesthesia alters the body's seizure threshold, requiring more electricity to cause seizure that it did back in the 1960's before the use of anesthesia and muscle relaxants. The type of anesthesia can effect patients risk of permanent brain damage. Additionally, there are doctors keep patients who keep their patients on medication while receiving ECT. This can be especially problematic when the patient it taking bipolar medication which is an anti-convulsant. When a patient it taking anti-convulsants, they require even more electricity to cause a seizure.
ECT side-effects are rarely discussed or minimized in present formal informed consent paperwork, yet they occur in addition to the commonly recognized problems (autobiographical memory, inability to create new memories, difficulty remembering training/education, slowing of cognitive processing, organization, visual spatial problems).
When electricity is applied to the brain, it automatically begins working to protect itself from seizure. Consequently, patients whose brains have substantial neuroprotection who cannot achieve a “therapeutic quality seizure” even when turning on the shock device at full strength are given intravenous caffeine to “enhance seizure quality and duration.” Waking up after ECT’s anesthesia wears off in an agitated state or in complete rage is not uncommon. Frequently patients are unaware they’ve been given IV caffeine to enhance the seizure.
The introduction of anesthesia, muscle relaxants and intravenous caffeine are the only universal changes in “Modern ECT” administration compared to that of the 1930’s – 1960’s. Without standardization, it nothing else can unilaterally distinguish every form of ECT treatment from its predecessor.