Electroshock therapy

Leon Eisenberg, MD, e-mail correspondence, May 9, 2000. Source for the effect of thyroid removal and electroshock therapy on mental health. 

Electroshock therapy Avoid concurrent administration of maprotiline with electroshock therapy because of the lack of experience in this area. 

Neuromuscular blocking agents (curare alkaloids and certain synthetic compounds), which interfere with transmission from motor nerve endings to the membrane of the skeletal muscle, are of great practical interest. They are used in anaesthesia (to reduce the muscle tonus) and in psychiatric electroshock therapy (to reduce the intensity of... 

Sharp, L. I., Gabriel, A. R., Impastato, D. J. 1953, Management of the acutely disturbed patient by sedative electroshock therapy, Dis.Nerv.Syst, vol. 14,... 

Weinstein, E. A., Linn, L., Kahn, R. L. 1952, Psychosis during electroshock therapy its relation to the theory of shock therapy, Am.J.Psychiatry, vol. 109,... 

Impastato, D. J. (1957, July). Prevention of fatalities in electroshock therapy. Diseases of the Nervous System, Sect. 2, 18, 34-74. 

The first half of the 20th century brought further attempts to use drugs and other therapies to treat mental illness. For example, tests were conducted on the effectiveness of giving amphetamines to depressed and narcoleptic patients, and carbon dioxide inhalation procedures were used in the treatment of illnesses referred to as psychoses and neuroses. Also used in the treatment of psychoses were antihistamines, insulin shock, and psychosurgery. Electroshock therapy was used to treat severe depression (a procedure still used today). Finally, in 1949 an Australian physician named John Cade discovered that the alkali metal lithuim successfully moderated manic conditions, although concerns about toxic reactions to it prevented its approval for use in the United States until 1970. Lithium remains a mainstay in the treatment of bipolar illnesses today. 

In the quest for more effective and selectively acting drugs for these disturbances, the medicinal chemist set out to produce a myriad of structural alterations. This intense effort by many industrial and academic institutions gave birth to the breakthrough in the chemotherapy of mental illness. Until 1952 the major therapeutic tools available were insulin or electroshock therapy and psychotherapy. 

Like much mischief in medicine, the notion that we can infer disease from treatability was created by psychiatrists. Yet, a famous psychiatrist—Manfred Bleuler (1903—1994), the son of the famed psychiatrist Eugen Bleuler (1857—1939), aprofessor of psychiatry at the University of Zurich and director of the Burgholzli mental hospital— warned After the introduction of sleep therapy, and cardiazole-, insulin-, and electroshock therapies for schizophrenics, the argument was often raised that the discovery of a specific physical therapy indicated a specific physical disease. Subsequent experience effectively refuted such assumptions. The assumption is, a priori, fallacious. 

External stimulating electrodes used for humans and animals are usually concave discs contoured to fit the area of the body to which they are applied. The head and chest are the principal regions for stimulation relating respectively to electroshock therapy and electronarcosis, and cardiac defibrillation. Needles are generally used in neurologic work. 

There is no effective treatment of the poisoning. One case of toxic psychosis was treated with electroshock therapy (Boyd et at 1957). Symptomatic treatment with barbiturates has been recommended (Raz-SUDOV 1976). No effect is obtained by BAL, EDTA, or penicillamine which are used in the management of poisoning with inorganic lead (Boyd et at 1957, Cremer 1959, Kitzmiller et at 1954). 

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