Advertisement

The Historical Struggles of Modified Electroconvulsive Therapy: How Anesthesia Came to the Rescue

Published:March 18, 2021DOI:https://doi.org/10.1016/j.janh.2021.03.001

      Highlights

      • ECT safety improved by the addition of anesthesia.
      • Evolution of ECT paralleled the developments in the anesthesia clinical practice.
      • Socioeconomical and medicolegal factors caused uneven progress of modified ECT.
      • Anesthesia helped ECT to overcome negative stigma.

      Abstract

      The complicated history of modified electroconvulsive therapy (ECT) started back before anesthesia was incorporated when unmodified electroconvulsive therapy was not considered humane. When anesthesiologists started working with psychiatrists, ECT gradually regained acceptance by decreasing the obstacles inherent to this therapy despite the complexities of the anesthetics. However, the sociopolitical and medicolegal factors negatively impacted the use of modified ECT leading to a period of time when it was banned from use in the United States. Fortunately, as advances in anesthesia and technology continued to develop, anesthesiologists helped ECT regain widespread usage improving the safety profile, cost effectiveness, quicker onset of seizures, and ease of control despite its stained past. This allowed more accessibility, especially for high-risk medical patients, to a relatively safe and effective treatment for psychiatric diseases.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Anesthesia History
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wright B.A.
        An historical review of electroconvulsive therapy.
        Jefferson J Psychiatry. 1990; 8 (June): 68-74
        • Harms E.
        The origin and early history of electrotherapy and electroshock.
        Am J Psychiatry. 1955; 111 (June): 932-933
        • Sakel M.
        The methodical use of hypoglycemia in the treatment of psychosis.
        Am J Psychiatry. 1937; 94 (July): 111-129
        • Sadock B.J.
        • Sadock V.A.
        Chapter 36.37: Brain stimulation methods.
        in: Sadock BJ Sadock VA Grebb JA Pataki CS Sussman N eds. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 10th ed. Lippincott Williams & Wilkins, Philadelphia, PA2007: 1117
        • Shorter E.
        The history of ECT: unsolved mysteries.
        Psychiatric Times. 2004; 21 (February): 1-3
        • Sabbatini R.M.E.
        Ugo Cerletti, a brief biography.
        Brain Mind Mag. 1997; (August/SeptemberAvailable at:) (Accessed on March 25, 2019)
        • Rudorfer M.V.
        • Henry M.E.
        • Sackeim H.A.
        Electroconvulsive therapy.
        in: Tasman A Kay J Lieberman J eds. Psychiatry. 2nd ed. John Wiley & Sons Ltd, Chichester, United Kingdom2003: 1865-1901
        • Baghai T.C.
        • Mӧller H.J.
        Electroconvulsive therapy and its different indications.
        Dialogues Clin Neurosci. 2008; 10: 105-117
        • Pal R.
        • Pal V.S.
        Anesthesia for electroconvulsive therapy: a noble approach.
        Int J Med Res Health Sci. 2015; 4: 890-895
        • Khan A.
        • Mirolo M.H.
        • Hughes D.
        • Bierut L.
        Electroconvulsive therapy.
        Psychiatry Clin North Am. 1993; 16: 497-513
        • Ding Z.
        • White P.
        Anesthesia for electroconvulsive therapy. 94. Anesthesia & Analgesia, 2002: 1351-1364 (May)
        • Taylor S.
        Electroconvulsive therapy: a review of history, patient selection, technique, and medication management.
        South Med J. 2007; 100: 494-498
        • Wagner K.J.
        • Mӧllenberg O.
        • Rentrop M.
        • Werner C.
        • Kochs E.F.
        Guide to anaesthetic selection for electroconvulsive therapy.
        CNS Drugs. 2005; 19: 745-758
        • Thompson G.
        Memoriam: Abram Elting Bennett.
        Biol Psychiatry. 1985; 20 (Available at:) (Accessed on March 25, 2019): 1141-1142
        • Bennett A.E.
        Preventing traumatic complications in convulsive shock therapy by curare.
        JAMA. 1940; 114: 322-324
      1. DanielBovet. Available at: https://en.wikipedia.org/wiki/Daniel_Bovet. Accessed on March 25, 2019.

        • Fredman B.
        • Smith I.
        • d'Etienne J.
        • White P.F.
        Use of muscle relaxants for electroconvulsive therapy: how much is enough?.
        Anesth Analgesia. 1994; 78: 195-196
      2. Wild Scenes in South America; Or, Life in the Llanos of Venezuela. April 17, 2017. Available at: https://www.amazon.com/Wild-Scenes-South-America-Venezuela/dp/1330480570. Accessed on March 25, 2019.

      3. Justin. Guachamacan: A 174-year-old Venezuelan Poison Mystery. Available at: https://naturespoisons.com/2015/11/19/guachamacan-a-174-year-old-venezuelan-poison-mystery-malouetine/. Accessed on March 25, 2019.

        • McKenzie A.G.
        Prelude to pancuronium and vecuronium.
        Anaesthesia. 2000; 55: 551-556
        • Garekar H.
        • Grover S.
        Electroconvulsive therapy in the elderly: anesthetic considerations and psychotropic interactions.
        J Geriatr Mental Health. 2017; 4: 83-98
        • Appiah-Ankam J.
        • Hunter J.M.
        Pharmacology of neuromuscular blocking drugs. Continuing education in anesthesia.
        Crit Care Pain. 2004; 4: 2-7
        • McCarthy G.
        • Elliott P.
        • Mirakhur R.K.
        • Cooper R.
        • Sharpe T.D.
        • Clarke R.S.
        Onset and duration of action of vecuronium in the elderly: comparison with adults.
        Acta Anesthesiol Scand. 1992; 36: 383-386
        • Lien C.A.
        • Matteo R.S.
        • Ornstein E.
        • Schwartz A.E.
        • Diaz J.
        Distribution, elimination, and action of vecuronium in the elderly.
        Anesth Analgesia. 1991; 73: 39-42
        • Cheam E.W.
        • Critchley L.A.
        • Chui P.T.
        • Yap J.C.
        • Ha V.W.
        Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy.
        Can J Anesth. 1999; 46: 49-51
        • ØStergaard D.
        • Viby-Mogensen J.
        • Pedersen N.A.
        • Holm H.
        • Skoygaard L.T.
        Pharmacokinetics and pharmacodynamics of mivacurium in young adult and elderly patients.
        Acta Anesthesiol Scand. 2002; 46: 684-691
        • Hicks F.G.
        ECT modified by atracurium.
        Convuls Ther. 1987; 3: 54-59
        • Adolf von Baeyer
        Biographical. NobelPrize.org.
        Nobel Media AB, 2019 (2019. Tue. 26 Mar 2019. Available at:) (Accessed on March 25)
        • Dundee J.W.
        • McIlroy P.D.A.
        The history of barbiturates.
        Anesthesia. 1982; 37: 726-734
        • Mokriski B.K.
        • Nagle S.E.
        • Papuchis G.C.
        • Cohen S.M.
        • Waxman G.J.
        Electroconvulsive therapy-induced cardiac arrhythmias during anesthesia with methohexital, thiamylal, or thiopental sodium.
        J Clin Anesth. 1992; 4: 208-212
        • Rosa M.A.
        • Rosa M.O.
        • Belegarde I.M.
        • Bueno C.R.
        • Fregni F.
        Recovery after ECT: comparison of propofol, etomidate, and thiopental.
        Rev Bras Psiquiatr. 2008; 30: 149-151
        • Gordon K.
        • Woloschuk D.
        • Walus A.
        Patients’ physical response to thiopental and alternative anesthetic agents in the setting of electroconvulsive therapy.
        Can J Hosp Pharm. 2014; 67: 447-452
        • Zahavi G.S.
        • Dannon P.
        Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol, etomidate, and thiopental.
        Neuropsychiatr Dis Treatment. 2014; 10: 383-389
        • Choi P.
        • Pisklakov S.
        • Tilak V.
        • Xiong M.
        Depression and electroconvulsive therapy: review of current anesthesia considerations.
        Open J Depress. 2013; 2: 32-34
        • Swaim J.C.
        • Mansour M.
        • Wydo S.M.
        • Moore J.L.
        A retrospective comparison of anesthetic agents in electroconvulsive therapy.
        J ECT. 2006; 22: 243-246
        • Cook A.
        • Stevenson G.
        • Scott A.I.
        A survey of methohexitone use by anesthetists in the clinical practice of ECT in Edinburgh.
        J ECT. 2000; 16: 350-355
        • Patel P.M.
        • Patel H.H.
        • Roth D.M.
        Chapter 19: General anesthetics and therapeutic gases.
        in: Brunton LL Chabner BA Knollmann BC eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. McGraw-Hill, New York, NY2011
        • Hooten W.M.
        • Rasmussen K.G.
        Effects of general anesthetic agents in adults receiving electroconvulsive therapy: a systemic review.
        J ECT. 2008; 24: 208-223
        • Chanpattana W.
        Anesthesia for ECT.
        German J Psychiatry. 2001; 4: 33-39
        • Vaidya P.V.
        • Anderson E.L.
        • Bobb A.
        • Pulia K.
        • Jayaram G.
        • Reti I.
        A within-subject comparison of propofol and methohexital anesthesia for electroconvulsive therapy.
        J ECT. 2012; 28: 14-19
        • Eranti S.V.
        • Mogg A.J.
        • Pluck G.C.
        • Landau S.
        • McLoughlin D.M.
        Methohexitone, propofol and etomidate in electroconvulsive therapy for depression: a naturalistic comparison study.
        J Affect Disord. 2009; 113: 165-171
        • Bergen J.M.
        • Smith D.C.
        A Review of etomidate for rapid sequence intubation in the emergency department.
        J Emerg Med. 1997; 15: 221-230
        • Jabre P.
        • Combes X.
        • Lapostolle F.
        • et al.
        Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial.
        Lancet North Am Ed. 2009; 374: 293-300
        • Patel A.S.
        • Gorst-Unsworth C.
        • Venn R.M.
        • Kelley K.
        • Jacob Y.
        Anesthesia and electroconvulsive therapy: a retrospective study comparing etomidate and propofol.
        J ECT. 2006; 22 (September): 179-183
        • Mayo C.
        • Kaye A.D.
        • Conrad E.
        • Baluch A.
        • Frost E.
        Update on anesthesia considerations for electroconvulsive therapy.
        Middle East J Anesthesiol. 2010; 20: 493-498
        • Reddy R.V.
        • Moorthy S.S.
        • Dierdorf S.F.
        • Deitch Jr, R.D.
        • Link L.
        Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol. 77. Anesthesia & Analgesia, 1993: 1008-1011
        • Avramov M.N.
        • Husain M.M.
        • White P.F.
        The comparative effects of methohexital, propofol, and etomidate for electroconvulsive therapy.
        Anesth Analgesia. 1995; 81: 596-602
        • Hartle A.J.
        • Peel P.H.
        Etomidate puts patients at risk of adrenal crisis.
        Br Med J. 2012; 345 (November): e7444
        • Allolio B.
        • Stuttmann R.
        • Leonhard U.
        • Fischer H.
        • Winkelmann W.
        Adrenocortical suppression by a single induction dose of etomidate.
        Klin Wochenschr. 1984; 62: 1014-1017
        • Berman M.
        Drug companies don't want to be involved in executions, so they're suing to keep their drugs out.
        Washington Post. 2018; (August 13) (Accessed January 15, 2019)
        • Jaffe E.
        • Wood M.
        • Stark R.
        • (Image provider)
        John (Iain) Glen Wins 2018 Lasker Prize for development of propofol: an award for all of anesthesiology.
        Anesthesiology. 2018; 129 (Available at:) (Accessed on March 25, 2019): 1055-1056
        • Miller R.
        • Eriksson L.
        • Fleisher L.
        • Wiener-Kronish J.
        • Cohen N.
        • Young W.
        Miller's Anesthesia. 2014; : 920
        • Bailine S.H.
        • Petrides G.
        • Doft M.
        • Lui G.
        Indications for the use of propofol in electroconvulsive therapy.
        J ECT. 2003; 19: 129-132
        • Moore S.
        Jackson's death ruled a homicide.
        New York Times. 2009; (August 28) (Accessed January 15, 2019)
        • Surdin A.
        Coroner attributes Michael Jackson's death to propofol.
        Washington Post. 2009; (August 25) (Accessed January 15, 2019)
        • Itzkoff D.
        Coroner's findings in Jackson death revealed.
        New York Times. 2019; (August 24, 2009) (Accessed January 15)
        • Hvisdas C.
        • Lordan A.
        • Pizzi L.T.
        • Thoma B.N.
        US propofol drug shortages: a review of the problem and stakeholder analysis.
        Am Health Drug Benefits. 2013; 6 (May-June): 171-175
        • Lyman R.
        Death row improvises, lacking lethal mix.
        New York Times. 2013; (August 18) (Accessed January 15, 2019)
      4. After E.U. threats, Missouri halts execution by propofol injection.
        Al Jazeera Am. 2013; (October 11) (Accessed January 15, 2019)
      5. Export Control Order 2008. Article 4A: provisions supplementing the torture regulation. Available at: https://www.gov.im/media/1350009/notice-1002-man-annex-f-export-control-jan-2016.pdf. Accessed January 15, 2019.

      6. Dr. Calvin Stevens. The Detroit news. November 30, 2014. Available at: https://www.legacy.com/obituaries/detroitnews/obituary.aspx?n=calvin-stevens&pid=180779524&fhid=20947. Accessed on March 25, 2019.

        • Baselt R.C.
        Disposition of Toxic Drugs and Chemicals in Man.
        8th ed. Biomedical Publications, Foster City, CA2008: 806-808
        • Domino E.F.
        Taming the ketamine tiger.
        Anesthesiology. 2010; 113 (September): 678-684
        • Clark M.R.
        • Treisman G.J.
        Chronic Pain and Addiction.
        Karger AG, Basel, Switzerland2011: 166
        • Corssen G.
        • Domino E.F.
        Dissociative anesthesia: further pharmacologic studies and first clinical experience with the phencyclidine derivative Cl-581.
        Anesth Analgesia. 1966; 45: 29-40
        • Morgan C.J.
        • Curran H.V.
        Ketamine use: a review.
        Addiction. 2012; 107: 27-38
        • Galvez V.
        • McGuirk L.
        • Loo C.K.
        The use of ketamine in ECT anesthesia: a systematic review and critical commentary on efficacy, cognitive, safety and seizure outcomes.
        World J Biol Psychiatry. 2017; 18: 424-444
        • Loo C.K.
        • Galvez V.
        Ketamine and electroconvulsive therapy.
        in: Mathew SJ Zarate Jr, CA Ketamine for Treatment-Resistant Depression: The First Decade of Progress. Springer International Publishing, Cham, Switzerland2016: 123-136
        • Fond G.
        • Loundou A.
        • Rabu C.
        • et al.
        Ketamine administration in depressive disorders: a systematic review and meta-analysis.
        Psychopharmacology (Berl). 2014; 231 (September): 3663-3676
        • McGirr A.
        • Berlim M.T.
        • Bond D.J.
        • et al.
        A systemic review and meta-analysis of randomized controlled trials of adjunctive ketamine in electroconvulsive therapy: efficacy and tolerability.
        J Psychiatry Res. 2015; 62: 23-30
        • Rybakowski J.K.
        • Bodnar A.
        • Krzywotulski M.
        • et al.
        Ketamine anesthesia, efficacy of electroconvulsive therapy, and cognitive functions in treatment-resistant depression.
        J ECT. 2016; 32: 164-168
        • Spitalnic S.
        • Blazes C.
        • Anderson A.
        Conscious sedation: a primer for outpatient procedures.
        Hosp Physician. 2000; 36: 22-32
        • Burns W.
        • Eger E.
        • Ross C.
        Terrell, PhD, an anesthetic pioneer.
        Anesth Analgesia. 2011; 113: 387-389
        • Kadiyala P.K.
        • Kadiyala L.D.
        Anaesthesia for electroconvulsive therapy: an overview with an update on its role in potentiating electroconvulsive therapy.
        Indian J Anesth. 2017; 61 (May): 373-380
        • Ishikawa T.
        • Kawahara S.
        • Saito T.
        • et al.
        Anesthesia for electroconvulsive therapy during pregnancy: a case report.
        Masui. 2001; 50: 991-997
        • Weeks H.R.
        • Tadler S.C.
        • Smith K.W.
        • et al.
        Antidepressant and neurocognitive effects of isoflurane anesthesia versus electroconvulsive therapy in refractory depression.
        PLoS One. 2013; 8: e69809
        • Calarge C.A.
        • Crowe R.R.
        • Gergis S.D.
        • Arndt S.
        • From R.P.
        The comparative effects of sevoflurane and methohexital for electroconvulsive therapy.
        J ECT. 2003; 19: 221-225
        • Goode E.
        Federal report praising electroshock therapy stirs uproar.
        New York Times. 1999; (Accessed January 15, 2019)
        • Kellner C.
        • Bryson E.
        Anesthesia advances add to safety of ECT.
        Psychiatr Times. 2012; 29: 1-3
        • Blaine J.D.
        • Clark S.M.
        Report of the NIMH-NIH consensus development conference on electroconvulsive therapy.
        Psychopharmacol Bull. 1986; 22: 445-454
        • Kenning T.
        • Mago R.
        • Huege S.
        • Certa K.
        • Pelchat R.
        Electroconvulsive therapy: a review of its current status.
        Jefferson J Psychiatry. 2005; 19: 2-12
        • Uppal V.
        • Dourish J.
        • Macfarlane A.
        Anesthesia for electroconvulsive therapy.
        Br J Anesth. 2010; 10: 192-196
        • Abrams R.
        Electroconvulsive Therapy.
        3rd ed. Oxford University Press, New York1997
        • Hermann R.C.
        • Dorwart R.A.
        • Hoover C.W.
        • Brody J.
        Variation in ECT use in the United States.
        Am J Psychiatry. 1995; 152: 869-875
        • Eranti S.V.
        • McLoughlin D.M.
        Electroconvulsive therapy - state of the art.
        Br J Psychiatry. 2003; 182: 8-9
        • Motohashi N.
        • Awata S.
        • Higuchi T.
        A questionnaire survey of ECT practice in university hospitals and national hospitals in Japan.
        J ECT. 2004; 20: 21-23
        • Chanpattana W.
        • Kunigiri G.
        • Kramer B.A.
        • Gangadhar B.N.
        Survey of the practice of electroconvulsive therapy in teaching hospitals in India.
        J ECT. 2005; 21: 100-104
        • Ikeji O.C.
        • Ohaeri J.U.
        • Osahon R.O.
        • Agidee R.O.
        Naturalistic comparative study of outcome and cognitive effects of unmodified electro-convulsive therapy in schizophrenia, mania and severe depression in Nigeria.
        J East African Med. 1999; 76: 644-650
        • Kala A.
        Time to face new realities; mental health care bill-2013.
        Indian J Psychiatry. 2013; 55: 216-219
        • Chanpattana W.
        • Kramer B.A.
        • Kunigiri G.
        • Gangadhar B.N.
        • Kitphati R.
        • Andrade C.
        A survey of the practice of electroconvulsive therapy in Asia.
        J ECT. 2010; 26: 5-10
        • Gangadhar B.N.
        Mental health care bill and electroconvulsive therapy: anesthetic modification.
        Indian J Psychol Med. 2013; 35: 225-226