Editing Electroconvulsive therapy (section)

== History==
[[File:Bergonic chair.jpg|thumb|A ''Bergonic chair'', a device "for giving general electric treatment for psychological effect, in psycho-neurotic cases", according to original photo description. World War I era.]]
{{Further|History of electroconvulsive therapy in the United Kingdom|History of electroconvulsive therapy in the United States}}
As early as the 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, the therapeutic use of seizure induction was documented in the ''[[London Medical and Surgical Journal]]''.<ref name="Rudorfer" /><ref>{{Cite web |title=A History of Mental Institutions in the United States |url=http://www.tiki-toki.com/timeline/entry/37146/A-History-of-Mental-Institutions-in-the-United-States/#vars!panel=403723! |access-date=2025-04-10 |website=www.tiki-toki.com}}</ref> As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of ''Electricity and Medicine''. Treatment and cure of [[Conversion disorder|hysterical blindness]] was documented eleven years later. [[Benjamin Franklin]] wrote that an electrostatic machine cured "a woman of hysterical fits." By 1801, [[James Lind (physician, born 1736)|James Lind]]<ref>{{Cite web|title=Lind, James (1736–1812) on JSTOR|url=https://plants.jstor.org/stable/10.5555/al.ap.person.bm000033179|access-date=2021-05-08|website=plants.jstor.org|doi=}}</ref> as well as [[Giovanni Aldini]] had used [[galvanism]] to treat patients with various mental disorders.<ref>{{cite journal | vauthors = Parent A | title = Giovanni Aldini: from animal electricity to human brain stimulation | journal = The Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques | volume = 31 | issue = 4 | pages = 576–584 | date = November 2004 | pmid = 15595271 | doi = 10.1017/s0317167100003851 | doi-access = free }}</ref> G.B.C. Duchenne, the mid-19th century "Father of Electrotherapy", said its use was integral to a neurological practice.<ref>{{cite journal |title=An Historical Review of Electro Convulsive Therapy | vauthors = Wright BA |url= http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1256&context=jeffjpsychiatry |journal=Jefferson Journal of Psychiatry |pages=66–74}}</ref>

In the second half of the 19th century, such efforts were frequent enough in British asylums as to make it notable.<ref>{{cite journal | vauthors = Beveridge AW, Renvoize EB | title = Electricity: a history of its use in the treatment of mental illness in Britain during the second half of the 19th century | journal = The British Journal of Psychiatry | volume = 153 | issue = 2 | pages = 157–162 | date = August 1988 | pmid = 3076490 | doi = 10.1192/bjp.153.2.157 | url = http://www.breggin.com/ECT/ElctyHistoryUseTrtmntBritain.pdf | access-date = 28 December 2014 | url-status = dead | s2cid = 31015334 | archive-url = https://web.archive.org/web/20150923194358/http://www.breggin.com/ECT/ElctyHistoryUseTrtmntBritain.pdf | archive-date = 23 September 2015 }}</ref>

Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist [[Ladislas J. Meduna]] who, believing mistakenly that [[schizophrenia]] and [[epilepsy]] were antagonistic disorders, induced seizures first with [[camphor]] and then [[metrazol]] (cardiazol).<ref>{{cite journal | vauthors = Berrios GE | title = The scientific origins of electroconvulsive therapy: a conceptual history | journal = History of Psychiatry | volume = 8 | issue = 29 pt 1 | pages = 105–119 | date = March 1997 | pmid = 11619203 | doi = 10.1177/0957154X9700802908 | s2cid = 12121233 }}</ref><ref name="Fink-history">{{cite journal | vauthors = Fink M | title = Meduna and the origins of convulsive therapy | journal = The American Journal of Psychiatry | volume = 141 | issue = 9 | pages = 1034–1041 | date = September 1984 | pmid = 6147103 | doi = 10.1176/ajp.141.9.1034 }}</ref> Meduna is thought to be the father of convulsive therapy.<ref name=Bolwig>{{cite journal | vauthors = Bolwig TG | title = How does electroconvulsive therapy work? Theories on its mechanism | journal = Canadian Journal of Psychiatry | volume = 56 | issue = 1 | pages = 13–18 | date = January 2011 | pmid = 21324238 | doi = 10.1177/070674371105600104 | doi-access = free }}</ref> 

In 1937, the first international meeting on [[schizophrenia]] and [[convulsive therapy]] was held in Switzerland by the Swiss psychiatrist Max Müller.<ref>Bangen, Hans: ''Geschichte der medikamentösen Therapie der Schizophrenie''. Berlin, 1992, {{ISBN|3927408824}}</ref> The proceedings were published in the ''[[American Journal of Psychiatry]]'' and, within three years, cardiazol convulsive therapy was being used worldwide.<ref name="Fink-history" /> 

The ECT procedure was first conducted in 1938 by Italian neuro-psychiatrist [[Ugo Cerletti]]<ref>{{cite book | vauthors = Rudorfer MV, Henry ME, Sackheim HA | date = 1997 | chapter = Electroconvulsive therapy | veditors = Tasman A, Lieberman JA | title = Psychiatry | pages = 1535–1556 }}</ref> and rapidly replaced less safe and effective forms of [[Shock therapy (psychiatry)|biological treatments]] in use at the time. Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant [[Lucio Bini]] at Sapienza University of Rome developed the idea of using electricity as a substitute for [[metrazol]] in convulsive therapy and, in 1938, experimented for the first time on a person affected by [[delusion]]s. 

It was believed early on that inducing convulsions aided in helping those with severe [[schizophrenia]] but later found to be most useful with [[affective disorder]]s such as [[depression (mood)|depression]]. Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state.<ref name=Sabbatini>{{cite web| vauthors = Sabbatini R |title=The history of shock therapy in psychiatry|url=http://www.cerebromente.org.br/n04/historia/shock_i.htm|access-date=2013-04-24}}</ref> Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on patients, they found that after 10–20 treatments the results were significant. Patients had much improved. 

A positive side effect to the treatment was [[retrograde amnesia]]. It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it.<ref name="Sabbatini" /> 

ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient.<ref>Cerletti, U (1956). "Electroshock therapy". In AM Sackler ''et al''. (eds) ''The Great Physiodynamic Therapies in Psychiatry: an historical appraisal.'' New York: Hoeber-Harper, 91–120.</ref> Cerletti and Bini were nominated for a [[Nobel Prize]] but did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria, it was promoted by [[Friedrich Meggendorfer]]. Through the 1940s and 1950s, the use of ECT became widespread. At the time the ECT device was patented and commercialized abroad, the two Italian inventors had competitive tensions that damaged their relationship.<ref>{{cite journal | vauthors = Sirgiovanni E, Aruta A |title=From the Madhouse to the Docu-Museum: The Enigma Surrounding the Cerletti-Bini ECT Apparatus Prototype |journal=Nuncius |date=April 23, 2020 |volume=35 |issue=1 |page=141 |doi=10.1163/18253911-03501013|s2cid=218991982 }}</ref> In the 1960s, despite a climate of condemnation, the original Cerletti-Bini ECT apparatus prototype was contended by scientific museums between Italy and the US.<ref name=":2">{{Cite journal |last1=Sirgiovanni |first1=Elisabetta |last2=Aruta |first2=Alessandro |date=2020-09-01 |title=The electroshock triangle: disputes about the ECT apparatus prototype and its display in the 1960s |url=https://journals.sagepub.com/doi/10.1177/0957154X20916147 |journal=History of Psychiatry |language=EN |volume=31 |issue=3 |pages=311–324 |doi=10.1177/0957154X20916147 |pmid=32308035 |issn=0957-154X}}</ref> The ECT apparatus prototype is now owned and displayed by the Sapienza [[:it:Museo di storia della medicina|Museum of the History of Medicine]] in Rome.<ref name=":2" />

In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of [[sinusoidal current]] with brief pulse. It took many years for brief-pulse equipment to be widely adopted.<ref name="Kiloh">Kiloh, LG, Smith, JS, Johnson, GF (1988). ''Physical Treatments in Psychiatry''. Melbourne: Blackwell Scientific Publications, 190–208. {{ISBN|0867931124}}</ref> 

In the 1940s and early 1950s, ECT was usually given in an "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s, psychiatrists began to experiment with [[curare]], the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of [[suxamethonium]] (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants.<ref name="Kiloh"/>

The steady growth of [[antidepressant]] use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s. The [[Surgeon General of the United States|Surgeon General]] stated there were problems with electroshock therapy in the initial years before [[anesthesia]] was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media."<ref name="erica goode">
{{Cite news |url=https://query.nytimes.com/gst/fullpage.html?sec=health&res=9805E1DD1431F935A35753C1A96F958260 |title=Federal Report Praising Electroshock Stirs Uproar | vauthors = Goode E |date=1999-10-06 |access-date=2008-01-01 |newspaper=The New York Times }}</ref> ''The New York Times'' described the public's negative perception of ECT as being caused mainly by one movie: "For Big Nurse in ''[[One Flew Over the Cuckoo's Nest (film)|One Flew Over the Cuckoo's Nest]],'' it was a tool of terror, and, in the public mind, ''shock therapy'' has retained the tarnished image given it by [[Ken Kesey]]'s novel: dangerous, inhumane and overused".<ref name="Goleman 1990">{{cite news|url=https://query.nytimes.com/gst/fullpage.html?res=9C0CE0D81F3EF931A3575BC0A966958260|title=The Quiet Comeback of Electroshock Therapy| vauthors = Goleman D |date=1990-08-02|work=The New York Times|page=B5|access-date=2008-01-01}}</ref>

In 1976, Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although as of 2012 some ECT clinics still were using sine-wave devices.<ref name="LeiknesWWrev2012">{{cite journal | vauthors = Leiknes KA, Jarosh-von Schweder L, Høie B | title = Contemporary use and practice of electroconvulsive therapy worldwide | journal = Brain and Behavior | volume = 2 | issue = 3 | pages = 283–344 | date = May 2012 | pmid = 22741102 | pmc = 3381633 | doi = 10.1002/brb3.37 | doi-access = free }}</ref> 

The 1970s saw the publication of the first [[American Psychiatric Association]] (APA) task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT.<ref>See:
* {{cite journal | vauthors = Friedberg J | title = Shock treatment, brain damage, and memory loss: a neurological perspective | journal = The American Journal of Psychiatry | volume = 134 | issue = 9 | pages = 1010–1014 | date = September 1977 | pmid = 900284 | doi = 10.1176/ajp.134.9.1010 | publisher = American Psychiatric Association Publishing }}
* {{cite book | vauthors = Breggin PR | title=Electroshock: its brain-disabling effects | publisher=Springer | publication-place=New York | date=1979 | isbn=082612710X | oclc=5029460}}</ref> Specifically, critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression".<ref name="erica goode"/> In 1985, the [[National Institute of Mental Health]] and [[National Institutes of Health]] convened a consensus development conference on ECT and concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for a narrow range of severe psychiatric disorders.<ref>{{cite journal | vauthors = Blaine JD, Clark SM | title = Report of the NIMH-NIH Consensus Development Conference on electroconvulsive therapy--statement of the Consensus Development Panel--statement of the Consensus Development Panel | journal = Psychopharmacology Bulletin | volume = 22 | issue = 2 | pages = 445–454 | year = 1986 | pmid = 3774937 }}</ref>

Because of the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978, the American Psychiatric Association released its first task force report in which new standards for [[consent]] were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally, in 2001 the American Psychiatric Association released its latest task force report.<ref name="APA2001guideline"/> This report emphasizes the importance of [[informed consent]], and the expanded role that the procedure has in modern medicine. By 2017, ECT was routinely covered by insurance companies for providing the "biggest bang for the buck" for otherwise intractable cases of severe [[mental illness]], was receiving favorable media coverage, and was being provided in regional medical centers.<ref name="ECT Provided in Boise">{{Cite web |url=http://www.idahostatesman.com/news/business/article133259549.html |title=This mental health treatment isn't barbaric, it 'totally changed my life'  | vauthors = Dutton A |date=2017-02-18}}</ref>

Though ECT use declined with the advent of modern antidepressants, there has been a resurgence of ECT with new modern technologies and techniques.<ref>{{Cite web |date=October 1, 2012 |title=Electroconvulsive therapy: How modern techniques improve patient outcomes |url=https://www.mdedge.com/psychiatry/article/64868/bipolar-disorder/electroconvulsive-therapy-how-modern-techniques-improve |website=mdedge.com}}</ref> Modern shock voltage is given for a shorter duration of 0.5 milliseconds where conventional brief pulse is 1.5 milliseconds.<ref>{{cite journal | doi = 10.5348/ijcri-2012-07-147-CR-8 | volume=3 | issue = 7 | title=A case of schizophrenia successfully treated by m-ECT using 'long' brief pulse | year=2012 | journal=International Journal of Case Reports and Images | page=30 |vauthors=Hiroaki I, Hirohiko H, Masanari I |doi-access=free | arxiv=1112.2072 }}</ref>

In a review from 2022 of [[neuroimaging]] studies based on a global data collaboration, ECT was suggested to work via a temporary disruption of neural circuits followed by augmented [[neuroplasticity]] and rewiring.<ref name="Ousdal_2022">{{cite journal | vauthors = Ousdal OT, Brancati GE, Kessler U, Erchinger V, Dale AM, Abbott C, Oltedal L | title = The Neurobiological Effects of Electroconvulsive Therapy Studied Through Magnetic Resonance: What Have We Learned, and Where Do We Go? | journal = Biological Psychiatry | volume = 91 | issue = 6 | pages = 540–549 | date = March 2022 | pmid = 34274106 | pmc = 8630079 | doi = 10.1016/j.biopsych.2021.05.023 }}</ref>