Electroconvulsive Therapy for Mental Illness

Several electroconvulsive therapy treatments, while still unproven, are available to patients with mental illness, including veterans. Here's what you should know.

Too many Americans are seriously depressed, and the mental health profession has been looking for better cures.

So far, however, new high-tech approaches haven’t had dramatic results.

The need is great. Among all Americans, suicide rates reached an all-time high in 2018, fell during the COVID-19 pandemic, and began creeping up again, according to the Centers for Disease Control and Prevention.

Veterans, especially, have suffered enormously from depression, post-traumatic stress disorder (PTSD), traumatic brain injury, and anxiety.

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Many people have heard of electroconvulsive therapy treatment (ECT), or “shock” therapy. Among available cures based on electrical gadgets, some apply electricity to the brain in milder doses than ECT.

How much is known about electroconvulsive therapy treatments? Let’s start with cranial electrotherapy stimulation (CES): pulses of low-intensity current applied to the earlobes or scalp. About a dozen devices are available for consumer purchase in the United States, varying in price from $300 to $5,000. Patients can order them after a low-cost telemedicine visit.

The evidence isn’t persuasive, however. Fisher Wallace Labs, which produced one of the best-known products, claims to have a device that can treat depression within a week and more so after a month. Buyer beware.  

In a related approach, transcranial direct current stimulation (tDCS), patients receive a continuous low current to a particular part of the brain via electrodes on the scalp. The treatment is not approved by the Food and Drug Administration and is considered experimental. Although an international team of experts concluded that tDCS beat a sham treatment, only about a third of patients responded positively.

Neurofeedback, when you receive real-time feedback on your brain responses, has helped some people, according to an exhaustive review, but it remains unproven, expensive, and time-consuming. The benefits may take months to set in and tend not to last.

Brain wave entrainment, another approach, involves wearing earphones and goggles that stimulate different kinds of brain waves through sound and light. You’ll feel like you’re watching a light show with moody music. A research review found three studies of its effect on mood didn’t report any benefits.

You might hear that such treatments can be tailored to individuals through brain scans. A team evaluating tDCS claimed, for example, that tailored treatment was promising, especially for a patient’s brain anatomy, but the science is not there yet.

Some evidence indicates that brain scans can guide treatment in one way — which depressed patients are more likely to benefit from Lexapro and which from cognitive behavioral therapy (CBT) over three months.

For PTSD, the Veterans Administration emphasizes a type of talk therapy called cognitive processing therapy, a form of CBT. The American Psychological Association also recommends the treatment for depression.

The electrical devices may be attracting attention because they could be cheaper and faster than ECT, which in effect induces mild seizures and provides short-term relief for many people with severe depression.

It has a low relapse rate compared to other treatments, but, according to a study in Nature, as many as half of people who respond to ECT relapse by the end of the first year.

If you’re severely depressed, the hope of being among the half of ECT patients who continue to feel better is not insignificant.

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