Another biological treatment is electroconvulsive therapy (ECT). This therapy is declining in use but is still used to treat severe depression if drugs have not worked. ECT is now much safer to perform than in the past as previously ECT could result in broken bones because of the strong muscle spasms it induced in patients. Now however patients are administered a general anaesthetic and muscle relaxants. As well as this, the shock levels used have also been decreased and so after 5-10 minutes consciousness is regained. There are two main types of ECT. The first is unilateral ECT where electrodes are placed on just one side of the head (usually the non-dominate side of your brain). The second type of ECT is bilateral ECT where electrodes are placed on both sides of the head. After these electrodes have been applied, a current of between 100 and 200 volts is passed for between half a second to 5 seconds. It is suggested that ECT works by causing changes in neurotransmitters causing increased sensitivity to serotonin and an increase in noradrenalin and dopamine. Benton also proposed that ECT could work in one of three ways; firstly he proposed that ECT may negatively reinforce behaviour through conditioning as ECT could be seen as a punishment. He also proposed that memory loss due to ECT could permit cognitive restructuring and stop negative thinking. Finally he also proposed that ECT could stimulate neurotransmitters to receive more serotonin.
Finally the third therapy available under the biological model is psychosurgery. Psychosurgery is used to treat severe mood disorders, aggression, OCD, eating disorders, anxiety and schizophrenia. Most operations involve destroying some of the nerves of the limbic system which is responsible for control and regulation of emotions, and areas of the brain can be isolated by cutting its connections with the rest of the brain. However this therapy is only ever used as a last resort when chemotherapy and ECT has not worked. There are several forms of psychosurgery, the original being the prefrontal lobotomy developed by Moniz who observed that aggression in chimps could be stopped by removing part of the frontal lobes and severing connections. Moniz claimed a 70% success rate with human patients and was awarded a Nobel Prize for his work. The most up to date form of psychosurgery however is “radio surgery” using a gamma knife, which is a refined surgical technique which causes very precise damage to defined areas.
Evaluate one or more of these therapies in terms of the issues surrounding their use (e.g. appropriateness, effectiveness) (15 marks)
ECT is appropriate to treat those with severe depression and drug-resistant depressive disorders; however ECT is not appropriate for pregnant women or children because of its potential side effects. There are several side effects to ECT although the procedure has become much safer in recent years. A common side effect amongst ECT patients is memory loss, immediately following the treatment and may last for several weeks and typically patients tend to forget what happened shortly before the procedure. Having said this, MRI scans show that ECT does not damage the brain and in fact could help treat epilepsy. As well as this ECT also carries a risk of cardiac arrest and may not be suitable for those with heart problems.
In terms of effectiveness, Weiner found that ECT is extremely effective at treating depression with 80% of patients showing a significant improvement. ECT is also extremely rapid to work unlike some drugs and so is effective to treat suicidal patients. However in a survey of 308 patients, two thirds did not find ECT helpful and half of those actually felt ECT had been damaging. A study in 1995 also found that 78% of patients also would never have the treatment again. Geddes et al however, reviewed 73 studies and compared ECT with placebo ECT and drug therapy. The results showed a significant benefit with ECT though temporary amnesia was a side effect.
Ethically there are issues with ECT because we are unsure as to how it actually works which begs the question, should we be using this therapy at all? In this sense ECT could be likened to kicking a television when it is not working. However ECT does follow ethical guidelines as informed consent is required.
Psychosurgery is also appropriate to treat depression, in addition to other mood disorders, aggression, OCD, eating disorders and anxiety disorders. Psychosurgery is also proven to be effective, with a study by Mind finding out of 42 operations carried 34 patients had some to significant improvement. Baer et al also found that OCD patients also improved following psychosurgery. Recently magnetic stimulation has also been found to help stuttering in patients.
As with ECT however, Psychosurgery also has a number of side effects including: epilepsy, memory loss, paralysis, confusion and permanently reduced creativity.
Ethically psychosurgery is also questionable because it is irreversible (except for magnetic stimulation) and again we are not sure how it works so should it be performed? Again though there are ethical considerations that must be taken into account and informed consent is needed along with an independent doctor’s agreement.
