Significant depression can be a severe and crippling problem. Electroconvulsive therapy (ECT) is believed to be the most efficient cure for extreme clinical depression disorder. ECT is a well-researched and tested procedure for the management of many mental conditions, and various meta-analyses have shown its effectiveness and security in the treatment of depression. However, generalizing results from clinical studies and contextual to clinical settings remains a concern for physicians, particularly when evaluating patients with elevated incidences of somatic and psychological illnesses. Therefore, if a competent clinician recommends ECT for a patient, the recommendation is based on evidence involving a specific category of patients.
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Multiple indicators can be provided to confirm the success rate of ECT on depression. For example, psychotic subtype disorder patients have better ECT success rates than people without mental conditions. Equally, critically ill patients afflicted with melancholic mental illness still have superior ECT clinical outcomes. The success rate could also be high among the aged (Albves et al., 2016). In addition, the rapid clinical response generated, which is sometimes quicker than the drug-induced response, renders ECT a first-line therapy in emergency clinical circumstances such as extreme suicidal ideation, severe schizophrenia, catatonia, and food deprivation in patients with food rejection due to depressive disorder. This research, therefore, utilizes a systematic literature review to evaluate the PICOT question; in the clinical population specifically, those suffering from major depression, what are the advantages of those who undergo ECT relative to those who reject ECT? The research is focused on the premise that people who suffer from major depression and have undergone ECT would have a better psychological status relative to those who have declined ECT treatment.
Background of the Problem
Serious depressive conditions cause a severe illness burden and have been listed as the fourth primary cause of impairment globally. In comparison to symptoms, mental impairment is deemed a major depressive cause. Cognitive impairment includes diminished memory and mental skills, focus, and concentrating (Biedermann et al., 2016; Sorri et al., 2018). Information deficiencies can also arise in the first onset of depression. In particular, it was presumed that chronic neurocognitive deficiencies may also forecast the regression of depressive symptoms (Oltedal et al., 2015). In the long term, severe depression also affects episodic memory and concentration, individually impacting functional outcomes and contributing to the poor educational, workplace, and everyday activity (Biedermann et al., 2016). Electroconvulsive therapy (ECT) is the most successful and well-accepted immediate intervention for serious and therapy-resistant depression. A significant amount of study has been done to examine the probability and extent of mental side-effects correlated with ECT therapy. Primarily, memory side-effects include intense temporary distress as well as amnesia. While clinicians sometimes risk persistent cognitive dysfunction, which often contributes to ‘hesitant’ usage, ECT-associated mental disorders are usually restricted to the first 3 days following treatment. In addition, it has been reported that 15 days after therapy, working and anterograde memory, and certain facets of cognitive control increase beyond normal thresholds.
Recent data indicates that neuroprotective results as facilitators of antidepressant ECT actions can not only be observable at genetic and ultra-or micro-structural stages but may also induce mesoscopic reactions on the quality of the fiber duct. Although data are still scarce, recent research recorded results in ECT patients extracted from ultrasonography, an MRI technique, particularly vulnerable to variations in white matter (Nickl-Jockschat et al., 2015). In the course of this research, numerous works of literature have been examined to evaluate the effectiveness of ECT, especially in mental wellbeing among depression patients. While the baseline contrast between patients and the socioeconomically balanced comparison group did not indicate any substantial variations in overall brain functions, there were major improvements in anisotropy inpatient treatment (Alves et al., 2016). Both baseline and transfer to standard treatment, a substantial rise in fractional anisotropy were reported. Strikingly, treatment-related changes in fractional anisotropy have been documented to be correlated with lowered ratings on depression inventory levels, thereby reinforcing the theory that improved fiber integrity in the anterior frontolimbic channels could be implicated in the ECT depressive therapy process (Nickl-Jockschat et al., 2015). However, amid these extremely promising developments, the association between anisotropy increases in fronto-limbic receptors and ECT depressive results continues to be adequately clarified. As a consequence, there is a need for clarification on whether ECT facilitates mental health or not.
As indicated in the background section various authors have attempted to explain the efficacy of electroconvulsive therapy on depression. For instance in a recent study Thomas et al., (2015) investigate morphological changes required to link the treatment outcomes of electroconvulsive therapy. In particular, the author aimed at investigating whether the therapeutic reaction of electroconvulsive therapy matches mesoscopic impact in a patient’s grey or right brain matter. The researchers used a sample of 21 patients out of which seven were females and 15 were males. The study participants comprised of patients with major depressive illness treated with electroconvulsive therapy. The findings showed a positive impact of electroconvulsive therapy on patients is it improved their clinical symptoms during the cause of the therapy.
More research confirms the relevance of Electroconvulsive therapy in various mental illnesses. For instance, Elias et al., (2018) investigate the role of electroconvulsive therapy in the management of depression. In particular, the authors sought to find out whether electroconvulsive therapy is efficient in igniting remission from depressed patients. The authors incorporated literature review methodology using academic databases including MEDLINE, PsycINFO, and Embase among others. Baby such a selected 436 patients for the meta-analysis study. The findings indicated that continued ECT accompanied with pharmacotherapy indicated a positive impact on depressive symptoms. The findings agree with those of Thomas et al. (2015) that indeed ECT has a positive impact on patients displaying depressive symptoms.
Electroconvulsive therapy has also demonstrated efficacy in promoting overall mental health. In another recent study, Ahmadi et al. (2016) investigated the importance of ECT on sustainable clinical symptoms of major depressive disorder and post-traumatic stress disorder. The authors used a case-control study involving a sample of 22164 subjects. In particular, the clinical global impression was utilized in assessing the role of ECT. The findings illustrated a positive correlation between ECT and reduced signs of depression and PTSD. Additionally, ECT ignited particular brain neural functions that decreased incidences of suicidal thoughts, cardiovascular conditions, and mortality. The findings agree with those of Thomas et al. (2015) and Elias et al. (2018) who support the notion that electroconvulsive therapy is effective for depression. The efficiency of ECT is apparent in various clinical findings including the treatment of depression. However, its long-term consequences particularly on cognitive and behavioral functioning have not been adequately assessed. Therefore, this study assesses the effect of ECT on clinically diagnosed depression. Electroconvulsive therapy is an efficient treatment process that capitalizes on electric current passed through a patient’s brain to relieve psychotic and depressive symptoms. Therefore, the researchers clearly illustrate that indeed electroconvulsive therapy is essential among the psychiatry population, particularly those suffering from major depression through living the harmful symptoms.
ECT has a positive impact on other cognitive-related functions including neural functioning. For instance, Sorri et al. (2018) conducted a study to understand the consequence of ECT on plasma and serum amounts and their associations with impatiens expressing depressive symptoms. The authors used a survey of 30 patients with depressive symptoms. The study subjects’ serum and plasma samples were examined using the therapy’s baseline five sessions and assessments taken. The findings illustrated the therapy had no significant contribution to two changes in serum levels. However, ECT contributed to decreased plasma levels. No links were shown between plasma and serum amounts. Although the current study finding does not directly link to the topic of the study the findings indicate no link between electroconvulsive therapy in plasma or serum level implying no negative effects of the therapy on a patient. The findings, therefore, contributes to the notion that indeed electroconvulsive therapy has a positive impact on patient particularly those suffering from clinical depression as elaborated in the previous reviews in this section.
ECT also positively contributes to other mental functions such as verbal memory. Biedermann et al. (2016) researched the contribution of electroconvulsive therapy to verbal memory functioning among patients with depressive symptoms. The study was motivated by the fact that the therapy is highly effective for the treatment of severe depression and cognitive impact. Importantly, the author maintained that cognitive impairment negatively affects patients overall functioning. Thus, the authors employed clinical experiment methodology to assess the role of ECT on depression. Patients with severe depressive symptoms were treated with electroconvulsive therapy while their healthy counterparts were considered as the control group. The research took part in 2 months after which the study participants were tested on their verbal memory capacities. The findings showed that before the treatment session patients with depressive symptoms performed poorly as matched to those of the control group. However after treatment the patients or showed significant advancement in their verbal memory performance. The authors conclude that contrary to the commonly held conception that electroconvulsive therapy creates long-term memory effects, the study confirmed that the therapy is vital for improving verbal memory particularly among patients showing depressive symptoms. Although the findings of this study do not directly match the topic of the current study, the findings support that ECT has various positive health care impacts on patients such as improving their verbal memory performance. Indeed, the study supports the current hypothesis that electroconvulsive therapy has a positive impact on patients suffering from depressive symptoms.
Electroconvulsive therapy is also efficient in naturalistic studies depicting its application to practical settings. For example, Alves et al. (2016) conducted and naturalistic research to test the performance of electroconvulsive therapy among depressed patients. The authors used experimental methodology on depressed adults. In particular, a sample of 43 patients was used in the research. The findings indicated that a high dose of electroconvulsive therapy was essential in reducing the intensity of depressive symptoms among patients. Similarly, Oltedal et al. (2015) investigated the purpose of electroconvulsive therapy in treating depressed patients. The authors employed experimental research using a sample of 40 patients displaying depressive characteristics. The findings confirm that electroconvulsive therapy was effective in treating major depression as well as other cognitive disorders. The studies match or mirror those of Thomas et al and Elias et al supporting the efficacy of electroconvulsive therapy in treating depression.
Description of First Category of Findings
A systematic literature review was considered ideal for the research given the timeline and availability of resources. In particular, academic sources from academic databases were used in the analysis of the study. Only research incorporating primary findings was employed. In particular, the research was limited to those published within the last 5 years. Equally, the selected sources were assessed for their relevance to the current topic of study. The key terms and phrases used to retrieve the sources include “Depression,” “Major Depressive Symptom,” “ECT,” and “Electroconvulsive Therapy.” A total of 10 articles were retrieved but only 3 fulfilled the study criteria; Lucas et al. (2016), Sorri et al. (2018), and Li et al. (2020). The findings are elaborated and discussed in the following section.
The study employed a naturalistic study which is considered useful in understanding the function of intervention in actual clinical practices. In an application, the authors sought to explain the findings of a naturalistic and treated group of patients suffering from depression using the presence or absence of unilateral electroconvulsive therapy. Naturalistic studies are vital to research approaches as they investigate study subjects within their natural environments. During the study, a researcher collected findings from a set of participants either those impacted by the study intervention or those not taking part in the intervention strategy. In particular, the author used a sample of 144 patients. 40 study participants were integrated into a unilateral electroconvulsive therapy group while another 104 subjects are included in a test group. Specifically, no differences in mental symptoms were used in separating the two groups to facilitate the validity of the findings. In the study outcome, the unilateral test group had a mean of HDRS17 which is higher when compared to the non-test group during admission. Importantly, no significant distinction was identified at discharge. The only identifying finding was that the test group had a larger HDRS score reduction after treatment. No significant differences were recorded in the responses and emissions among the two groups. The researchers concluded that a high dose of electroconvulsive therapy can be regarded as useful in the treatment of depression symptoms in clinical practice to diminish the impacts of depression among patients.
The main outcome of the evaluated research was that through naturalistic design, using a high dose of unilateral electroconvulsive therapy in a clinical setting is still essential in reducing the intensity of symptoms among depressed patients. The study clearly illustrated that the patients who received the stated therapy method showed even more intense depression symptoms during admission to the study. However, the patients symptoms reduced significantly in comparison to the test group at the end of the study. The naturalistic study can better represent the outcome of the clinical practice setting. Concerning the current topic, the findings confirm that even in naturalistic settings electroconvulsive therapy can replicate the literature findings indicating its positive impact on treating depression.
More research supports the role of ECT in mental wellbeing especially among people previously diagnosed with mental illnesses. Sorri et al.’s (2018) research were also relevant to the current investigation. As illustrated, the authors aimed at investigating the impact of ECT therapy on neurotrophic factors among depressed patients. Here, they studied factors that have a direct connection to brain functioning. In particular, the author investigated the therapy’s impact on plasma and serum levels an experimental research design was also used in this study to stop in particular 30 respondents why used it in the study. The participants’ plasma and serum levels were examined before and after treatment. The therapy was shown to have no significant impact on some level however a decrease in plasma levels was recorded after an electroconvulsive therapy session lasting two hours. The authors concluded no significant impact of electroconvulsive therapy on plasma and serum levels.
Electroconvulsive therapy shows significant outcomes on various mental health conditions. For instance, Li et al. (2020) investigated the effects of ECT and its potential using literature reviews. The authors searched through PubMed for studies conducted between 2010 and 2018 using the key terms depressive disorder, depression, therapy, and ECT. Only publications written in English were included in the study. The findings attested high remission and response when with the use of ECT on depressed patients. In particular, the findings illustrate that improved clinical depression with more rapid response in the bilateral electrode and best performance of the bitemporal leading to ameliorated depressive symptoms. Unilateral ECT was also linked to reduced relapsing cases among depressed patients. Importantly, the researchers included a functional analysis revealing increased heat in the hippocampal region. ECT was found to enhance hippocampal activity, which was linked to decreased depressive symptoms. Resting-state networks linked to neural structures of the brain indicated high potential in the dorsomedial prefrontal cortex such as the posterior cingulate cortex, orbitofrontal cortex, and prefrontal cortex. Other brain functions with improved neural activity include the sensorimotor cortex, dorsolateral prefrontal cortex, and parahippocampal gyrus indicating recovery from depression. Moreover, a feedforward cortical-subcortical link from the fusiform to the amygdala was evident in depressed patients who completed a series of ECT (Li et al., 2020). Overall, the research attested that ECT has a positive effect on depressive symptoms. In particular, MRI studies confirmed that ECT ignited brain neuroplasticity in neural networks and the hippocampus leading to profound brain activity.
Concerning the clinical use of ECT, several reports support its potency and comparative safety.
- ECT eased depressed symptoms: Originally, ECT is generally applicable to therapy-resistant depressed patients, but it is often utilized for other psychiatric illnesses (Sorri et al., 2018).
- ECT has effectively improved certain depressive symptoms among patients whereas when combined with some antidepressants, its impact on depression is more efficient (Nickl-Jockschat et al., 2015).
- ECT continuation is advised for its capacity to avoid relapse of depressive symptoms (Elias et al., 2018)
- With regards to cognitive characteristics before and after ECT, there is little proof that ECT causes cognitive impairment than antidepressants (Li et al., 2020).
- However, memory deficiency is normal in depressive patients. No trials have verified discrepancies in cognitive functions among individuals, partly due to the variability in clinical findings (Li et al., 2020).
- While Electroconvulsive therapy is safe and efficient, its implementation is rare as the last option to the treatment of mental health issues (Li et al., 2020). Overall, research supports the effectiveness of ECT in treating depression through positive effects on relevant brain structures.
Ahmadi, N., Moss, L., Simon, E., Nemeroff, C. B., & Atre‐Vaidya, N. (2016). Efficacy and long‐term clinical outcome of comorbid posttraumatic stress disorder and major depressive disorder after electroconvulsive therapy. Depression and anxiety, 33(7), 640-647. Web.
Alves, L. P., Freire, T. F., Fleck, M. P., & Rocha, N. S. (2016). A naturalistic study of high-dose unilateral ECT among severely depressed inpatients: how does it work in the clinical practice? BMC psychiatry, 16(1), 1-8. Web.
Biedermann, S. V., Bumb, J. M., Demirakca, T., Ende, G., & Sartorius, A. (2016). Improvement in verbal memory performance in depressed in‐patients after treatment with electroconvulsive therapy. Acta Psychiatrica Scandinavica, 134(6), 461-468. Web.
Elias, A., Phutane, V. H., Clarke, S., & Prudic, J. (2018). Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses. Australian & New Zealand Journal of Psychiatry, 52(5), 415-424. Web.
Li, M., Yao, X., Sun, L., Zhao, L., Xu, W., Zhao, H.,… & Yang, W. (2020). Effects of Electroconvulsive Therapy on Depression and Its Potential Mechanism. Frontiers in Psychology, 11. Web.
Nickl-Jockschat, T., Gallagher, N. P., Kumar, V., Hoffstaedter, F., Brügmann, E., Habel, U.,… & Grözinger, M. (2016). Are morphological changes necessary to mediate the therapeutic effects of electroconvulsive therapy? European Archives of Psychiatry and Clinical Neuroscience, 266(3), 261-267. Web.
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Oltedal, L., Kessler, U., Ersland, L., Grüner, R., Andreassen, O. A., Haavik, J.,… & Oedegaard, K. J. (2015). Effects of ECT in treatment of depression: study protocol for a prospective neuroradiological study of acute and longitudinal effects on brain structure and function. BMC psychiatry, 15(1), 1-10. Web.
Sorri, A., Järventausta, K., Kampman, O., Lehtimäki, K., Björkqvist, M., Tuohimaa, K.,… & Leinonen, E. (2018). Effect of electroconvulsive therapy on brain‐derived neurotrophic factor levels in patients with major depressive disorder. Brain and behavior, 8(11), e01101. Web.