For many, a mention of electroconvulsive therapy (ECT) conjures images of torture or mind control from popular media like One Flew Over the Cuckoo’s Nest or Requiem for a Dream. Comparatively few know that ECT is not only still used today but is an incredibly safe and effective treatment for an array of psychiatric conditions. In this and next week’s episode, we explore this stigmatized and misunderstood therapy from its questionable origins to its current uses. We start by diving into the history of ECT and placing its discovery in the broader context of psychiatric medicine and leading notions of the causes of mental illness. We learn that ECT’s troubling reputation is not entirely unearned but is a relic of the past, as substantial advancements in safety and administration have established this as a truly powerful therapy that has stood the test of time. Tune in for a big picture view of one of our oldest and most effective psychiatric treatments.
| History | Biology |
| Sadowsky, Jonathan. Electroconvulsive therapy in America: The anatomy of a medical controversy. Routledge, 2016. | Kellner, C.H., 2012. Brain stimulation in psychiatry: ECT, DBS, TMS and other modalities. Cambridge University Press. |
| Shorter, Edward, and David Healy. Shock therapy: a history of electroconvulsive treatment in mental illness. Rutgers University Press, 2020. | Livingston, R., Wu, C., Mu, K. and Coffey, M.J., 2018. Regulation of electroconvulsive therapy: a systematic review of US state laws. The journal of ECT, 34(1), pp.60-68. |
| Berrios, German E. “The scientific origins of electroconvulsive therapy: a conceptual history.” History of psychiatry 8.29 (1997): 105-119. | Merkl, A., Heuser, I. and Bajbouj, M., 2009. Antidepressant electroconvulsive therapy: mechanism of action, recent advances and limitations. Experimental neurology, 219(1), pp.20-26. |
| Buday, Jozef, et al. “Electroconvulsive therapy portrayal in contemporary video games.” Frontiers in psychiatry 14 (2024): 1336044. | Kritzer, M.D., Peterchev, A.V. and Camprodon, J.A., 2023. Electroconvulsive therapy: mechanisms of action, clinical considerations, and future directions. Harvard review of psychiatry, 31(3), pp.101-113. |
| De Anta, L., et al. “Assessment of beliefs and attitudes about electroconvulsive therapy posted on Twitter: an observational study.” European Psychiatry 66.1 (2023): e11. | Fosse, R. and Read, J., 2013. Electroconvulsive treatment: hypotheses about mechanisms of action. Frontiers in psychiatry, 4, p.94. |
| de Mangoux, Gonzague Corbin, et al. “History of ECT in schizophrenia: from discovery to current use.” Schizophrenia bulletin open 3.1 (2022): sgac053. | Kellner, C.H., Obbels, J. and Sienaert, P., 2020. When to consider electroconvulsive therapy (ECT). Acta Psychiatrica Scandinavica, 141(4). |
| Endler, Norman S. “The origins of electroconvulsive therapy (ECT).” The Journal of ECT 4.1 (1988): 5-23. | Kellner, C.H., Greenberg, R.M., Murrough, J.W., Bryson, E.O., Briggs, M.C. and Pasculli, R.M., 2012. ECT in treatment-resistant depression. American Journal of Psychiatry, 169(12), pp.1238-1244. |
| Euba, Rafael, and Monica Crugel. “The depiction of electroconvulsive therapy in the British press.” The Journal of ECT 25.4 (2009): 265-269. | Fink, M., 2001. Convulsive therapy: a review of the first 55 years. Journal of affective disorders, 63(1-3), pp.1-15. |
| Fink, Max. “Convulsive therapy: a review of the first 55 years.” Journal of affective disorders 63.1-3 (2001): 1-15. | Jelovac, A., Kolshus, E. and McLoughlin, D.M., 2013. Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology, 38(12), pp.2467-2474. |
| Griffiths, Chris, and Alex O’Neill-Kerr. “Patients’, carers’, and the public’s perspectives on electroconvulsive therapy.” Frontiers in psychiatry 10 (2019): 304. | Sackeim, H.A., 2014. Autobiographical memory and electroconvulsive therapy: do not throw out the baby. The journal of ECT, 30(3), pp.177-186. |
| Kalinowsky, Lothar B. “History of Convulsive Therapy a.” Annals of the New York Academy of Sciences 462.1 (1986): 1-4. | Lloyd, J.R., Silverman, E.R., Kugler, J.L. and Cooper, J.J., 2020. Electroconvulsive therapy for patients with catatonia: current perspectives. Neuropsychiatric Disease and Treatment, pp.2191-2208. |
| Lebensohn, Zigmond M. “The history of electroconvulsive therapy in the United States and its place in American psychiatry: a personal memoir.” Comprehensive psychiatry 40.3 (1999): 173-181. | Ren, J., Li, H., Palaniyappan, L., Liu, H., Wang, J., Li, C. and Rossini, P.M., 2014. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: a systematic review and meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 51, pp.181-189. |
| Matthews, Avery Madeleine, Peter B. Rosenquist, and William Vaughn McCall. “Representations of ECT in English-language film and television in the new millennium.” The Journal of ECT 32.3 (2016): 187-191. | Singh, A. and Kar, S.K., 2017. How electroconvulsive therapy works?: understanding the neurobiological mechanisms. Clinical Psychopharmacology and Neuroscience, 15(3), p.210. |
| McDonald, Andrew, and Garry Walter. “The portrayal of ECT in American movies.” The journal of ECT 17.4 (2001): 264-274. | Pagnin, D., de Queiroz, V., Pini, S. and Cassano, G.B., 2004. Efficacy of ECT in depression: a meta-analytic review. The journal of ECT, 20(1), pp.13-20. |
| Sienaert, Pascal. “Based on a true story? The portrayal of ECT in international movies and television programs.” Brain stimulation 9.6 (2016): 882-891. | Slade, E.P., Jahn, D.R., Regenold, W.T. and Case, B.G., 2017. Association of electroconvulsive therapy with psychiatric readmissions in US hospitals. JAMA psychiatry, 74(8), pp.798-804. |
| Deng, Z.D., Robins, P.L., Regenold, W., Rohde, P., Dannhauer, M. and Lisanby, S.H., 2024. How electroconvulsive therapy works in the treatment of depression: is it the seizure, the electricity, or both?. Neuropsychopharmacology, 49(1), pp.150-162. | |
| Shin, H.R., Kim, M. and Park, K.I., 2023. Electroconvulsive therapy and seizure: a double-edged sword?. encephalitis, 3(4), p.103. | |
| Hirjak, D., Rogers, J.P., Wolf, R.C., Kubera, K.M., Fritze, S., Wilson, J.E., Sambataro, F., Fricchione, G., Meyer-Lindenberg, A., Ungvari, G.S. and Northoff, G., 2024. Catatonia. Nature Reviews Disease Primers, 10(1), p.49. | |
| Grözinger, M., Smith, E.S. and Conca, A., 2015. On the significance of elektroconvulsive therapy in the treatment of severe mental diseases. Wiener klinische Wochenschrift, 127(7), pp.297-302. | |
| Frid, L.M., Kessler, U., Ousdal, O.T., Hammar, Å., Haavik, J., Riemer, F., Hirnstein, M., Ersland, L., Erchinger, V.J., Ronold, E.H. and Nygaard, G., 2023. Neurobiological mechanisms of ECT and TMS treatment in depression: study protocol of a multimodal magnetic resonance investigation. BMC psychiatry, 23(1), p.791. | |
| Chigareva, Oxana, Daria Smirnova, Darya Astafeva, Anna Gradinar, Olga Izmailova, Mikhail Sheyfer, Paul Cumming, Alexander Sack, and Arseny J. Gayduk. “Comparing the anti-depressive effect of electroconvulsive therapy (ECT) versus transcranial magnetic stimulation (TMS) in the treatment of patients with depression.” Psychiatria Danubina 35, no. S2 (2023): S48-S55. | |
| Cusin, C. and Dougherty, D.D., 2012. Somatic therapies for treatment-resistant depression: ECT, TMS, VNS, DBS. Biology of Mood & Anxiety Disorders, 2(1), p.14. | |
| Lopez, L.V., Hartzell, G., Lowet, D., Samuels, S. and Popeo, D.M., 2025. Electroconvulsive Therapy for Catatonia in NMDA Receptor Encephalitis Unresponsive to Immunotherapy in a Five Year Old. Pediatrics, 156(4), p.e2024070580. | |
| Kraiter, F.G., May, D.T., Slauer, R.D., Abburi, N., Eckstein, C., Shah, S., Komisar, J.R. and Feigal, J.P., 2024. Catatonia in anti-NMDA receptor encephalitis: a case series and approach to improve outcomes with electroconvulsive therapy. BMJ Neurology Open, 6(2), p.e000812. | |
| Leiknes, K.A., Schweder, L.J.V. and Høie, B., 2012. Contemporary use and practice of electroconvulsive therapy worldwide. Brain and behavior, 2(3), pp.283-344. | |
| Tørring, N., Sanghani, S.N., Petrides, G., Kellner, C.H. and Østergaard, S.D., 2017. The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis. Acta Psychiatrica Scandinavica, 135(5), pp.388-397. |
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