Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jan 4, 2019; 9(1): 1-6
Published online Jan 4, 2019. doi: 10.5498/wjp.v9.i1.1
Electroconvulsive therapy: 80 years old and still going strong
Gábor Gazdag, Gabor S Ungvari
Gábor Gazdag, First Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
Gábor Gazdag, Department of Psychiatry and Psychotherapy, Semmelweis University Medical School, 1083 Budapest, Hungary
Gabor S Ungvari, University of Notre Dame, Fremantle, WA 6009, Australia
Gabor S Ungvari, Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA 6009, Australia
Author contributions: Both authors contributed equally to the conception of this work; Gazdag G drafted the text; Ungvari GS reviewed, commented on and corrected the manuscript; both authors approved the final version of the text.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Gábor Gazdag MD, PhD, Associate Professor, First Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Köves út 1, Budapest 1204, Hungary. gazdag@lamb.hu
Telephone: +36-1-2896200
Received: September 6, 2018
Peer-review started: September 6, 2018
First decision: October 17, 2018
Revised: October 29, 2018
Accepted: December 11, 2018
Article in press: December 11, 2018
Published online: January 4, 2019
Processing time: 113 Days and 8.6 Hours

Electroconvulsive therapy (ECT), which is among the oldest and most controversial treatments in the field of psychiatry, has its 80th birthday this year. In this brief historical overview, the discovery of the therapeutic effects of convulsive therapy by Laszló Meduna, and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described. Meduna’s original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT. The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications, including catatonia, and pre- and postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving. Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed. The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys. This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT, which constitutes a violation of psychiatric patients’ right to an effective treatment.

Keywords: Electroconvulsive therapy, History, Indications, Utilization, Attitudes

Core tip: Electroconvulsive therapy (ECT), which is among the most controversial psychiatric treatments, has its 80th birthday this year. The introduction of convulsive therapy to psychiatry and changes in seizure induction from chemical to electrical are outlined. The place of ECT in contemporary psychiatry, particularly its most important clinical indications, is briefly discussed. Negative media representation and historical misuse are likely to have contributed to negative professional and public attitudes towards ECT and, consequently, it decreased use. Recent limitations of access to effective treatment in many parts of the world constitute a violation of patients’ rights.