Often preceded by a bad reputation, seismotherapy or electroshock treatment can be scary. Although still enigmatic, this technique reserved for severe psychiatric pathologies has proven itself. Presentation.
Definition: What is seismotherapy or electroconvulsive therapy?
Seismotherapy, also known as electroshock treatment or electroconvulsive therapy (ECT), is an interventional psychiatry technique used to treat different types of particularly severe or resistant psychiatric pathologies. This involves brain stimulation using an electric shock which aims to trigger, under control, a convulsive attack (epileptic attack). This ancient technique, which dates back to the beginning of the 20th century, has evolved significantly over time and allows good results to be obtained.
Indications: Why and when to do electroshock treatment?
Seismotherapy is not used for mild or moderate mental disorders. It is reserved for severe pathologies, for patients hospitalized for:
- Of the severe depressive episodes with for example psychotic characteristics or melancholic forms;
- Severe depressive episodes characterized as suicidal;
- And syndrome catatonique : “a neurological syndrome that is found in 80% of psychiatry but there are also organic catatonic syndromes following overdoses or heavy metal poisoning. It is a particularly severe clinical picture with many possible complications: notably those of recumbency, corneal ulcers, pulmonary embolism, severe malnutrition, etc.“, explains Dr Jean Marchand, psychiatrist specializing in complex mood disorders, referring doctor for seismotherapy at the Parc clinic in Nantes.
- Depressive episodes characterized as resistant : patients do not respond or not sufficiently to antidepressants or even to antidepressants and adjuvant treatments which should potentiate them. “With drug treatments, we have 40% effectiveness, while seismotherapy allows us to reach 80% effectiveness. We double the output of the episode with this technique despite the fact that we were able to optimize and personalize the patient's drug treatment as much as possible.“, explains Dr Jean Marchand.
- A severe depressive episode without being able to use psychotropic medications : these are particularly fragile patients, elderly for example, who could not tolerate high doses of antidepressants for example.
There are other possible, rarer indications, such as:
- Resistant schizophrenia with very invasive hallucinations;
- Furious manias : very severe periods of excitement in bipolar patients who are no longer receptive to medication.
Who practices seismotherapy?
It is the psychiatrist who is the only one authorized to practice seismotherapy. The practice requires a technical platform, nurses, an anesthesiologist, a psychiatrist and is carried out in a hospital center or clinic.
How does electroconvulsive therapy work?
Since seismotherapy is an interventional psychiatry technique, the patient's consent is mandatory. The doctor therefore explains the procedure to the patient and why this technique appears to be the best solution. The decision is up to the patient, without his agreement, there can be no seismotherapy. When the patient is unable or unwilling to give consent, the opinion of the trusted person takes precedence.
The patient also has a prior consultation with the anesthesiologist since seismotherapy is carried out under general anesthesia. The doctor ensures that there are no contraindications to this anesthesia.
The procedure may vary slightly depending on the establishment but generally the patient is brought to the interventional psychiatry room. He is lying on a stretcher. The medical team places a venous line and oxygenates him using a mask. The anesthesiologist administers two medications: a hypnotic to put the patient to sleep, then Curare to limit muscle contractions during the procedure. Then, the doctor applies two small paddles (electrodes) to the patient's temples in the case of bilateral electrical stimulation (sometimes the stimulation is unilateral). A machine connected to the pallets delivers an electric current calculated in advance. “Not all patients need the same intensity of electric current for their seismotherapy. It depends on the characteristics of each person, in particular the seizure threshold and the medications taken. Some patients have spontaneous epileptic seizures because their threshold is low and for others a higher current intensity is required to trigger this epileptic seizure.“, specifies Dr. Marchand. The epileptic seizure is controlled during the session.
The goal is for it to last 20 seconds. If it goes beyond this, the anesthetist can stop it by injecting an anti-epileptic treatment intravenously. “Once these 20 seconds have been reached, we already have our quality criteria. Studies show that this is the sufficient duration for seismotherapy to be effective.“, confirms the psychiatrist. The patient goes to the recovery room until he becomes alert again.
Psychiatry: What is seismotherapy used for, what does this electroshock change in the brain?
The mechanism of action of seismotherapy is unknown. “Today we are not able to know what is happening at the cellular level. It is an empirical technique. More than a century ago, doctors found that patients who had a concomitant severe psychiatric illness and an epileptic illness were much better after having an epileptic seizure. They were much less symptomatic compared to their psychiatric clinical picture., explains Dr. Marchand. This observation was confirmed by experiment. The onset of these epileptic seizures has evolved significantly over a century. The techniques of the past have sparked controversy, ethical debates and stigmatized seismotherapy.
Duration: how many seismotherapy sessions are necessary?
“Sometimes, a single session allows the situation to be resolved. This is one of the advantages of this interventional technique unlike drug treatments in psychiatry, apart from the Ketamine which is a rather experimental treatment. Classic psychotropic medications take time to work: anxiolytics take several minutes or hours, antipsychotics several days and antidepressants several weeks or more. The response is extremely rapid from the first session but it is rare that a single session is enough“, recognizes Dr. Marchand.
Generally, seismotherapy takes place in the form of a course of 6, 8, 10 sessions depending on the patients and the effectiveness of the technique. It is difficult to carry out more than two sessions per week due to the availability of the anesthesiologist but also the arduousness and risks linked to general anesthesia for the patient.
Contraindications to seismotherapy
Seismotherapy presents risks linked to general anesthesia and is not recommended for people who are sensitive to it. It is also for people with intracranial hypertension, who have had a recent stroke, a recent myocardial infarction, recent and uncontrolled systemic cardiovascular diseases.
Side effects and risks of seismotherapy
Electroconvulsive therapy has undesirable side effects that are identical to those of epileptic seizures. There is confusion on the temporo-spatial level after the session which lasts a few minutes to a few hours. This is why seismotherapy is initially recommended for hospitalization and not for outpatient treatment. Seismotherapy can also cause headaches and memory problems. These memory losses caused by electroshocks limit the acceptability of the treatment. Furthermore, seismotherapy also suffers from a bad image. “It was used for political purposes under certain dictatorships, with other techniques with toxic side effects, and certain films like “One Flew Over the Cuckoo's Nest” have left traces in the popular imagination. It's difficult to explain to the patient that it's not something pleasant but that it will help them get out of their severe psychiatric state. But he has the choice between remaining in a severe psychiatric state for a long time or going through a treatment which can be difficult but which greatly improves the prognosis.concludes Dr. Jean Marchand.
