Before the discovery of psychotropic drugs in the 1950s and 1960s, the prospects for the treatment of mental diseases were really bleak.
At that time, there were only three types of treatments available-electroconvulsive therapy (ECT), insulin coma and psychiatric surgery.
As a result, many patients have been imprisoned in psychiatric hospitals all their lives, while others are in [infinite reincarnation]-once discharged from hospital, they will not be able to live a normal life, will become ill again, and will soon be hospitalized again.
Insulin-induced epilepsy for psychosis?
Researchers found that for patients suffering from both schizophrenia and epilepsy, when epilepsy symptoms worsen, mental symptoms will be relieved.
In the 1930s, a Hungarian doctor tried to alleviate schizophrenia by inducing seizures, also a form of epilepsy. Soon, other doctors began to use this method to treat epileptic seizures induced by large doses of insulin.
However, the amount of insulin used is difficult to control. As we all know, insulin regulates the blood sugar level of human body. If the dose of insulin is too large, people may die of extreme hypoglycemia.
Can ECT Treat Mental Illness?
ECT is the originator of the whole physiotherapy, which was originally used to treat patients with epilepsy and schizophrenia at the same time.
Also because of the discovery of the relationship between epilepsy and schizophrenia, ECT method was improved to achieve the therapeutic purpose by inducing epileptic seizures. This therapy took effect quickly, and most patients did not remember whether they had received treatment after being awakened. But slowly, people found that the curative effect of this therapy on schizophrenia was not very obvious.
Through trial, the researchers also found that ECT can reduce depression. Although at that time, there was no theoretical basis for this effect.
Is ECT safe for depression?
This was followed by the abuse of ECT in the 1950s, for example, hundreds of times of ECT treatment without consent. Fortunately, in that era, the efficacy of antidepressants was definitely demonstrated, and ECT was quickly temporarily abandoned.
However, the side effects of antidepressants were almost as [significant] as their therapeutic effects in those days.
Our brain is essentially an electrochemical organ, in which electrical pulses are the basis for information transmission, which in turn leads to the release of neurotransmitters. Theoretically, electrical stimulation of the brain should cause neuropsychopharmacological changes in local areas of the brain, but there will be no side effects caused by drug therapy.
Today, doctors use anesthesia and muscle relaxation techniques to prevent muscle activity during ECT treatment, thus minimizing discomfort and injury.
This technique is also called [electroconvulsive therapy without convulsion] (MECT), and the typical course of treatment is usually set at 2-3 times a week for two weeks, sometimes for a longer time. Subsequent maintenance treatment is often through drugs, psychotherapy or low frequency MECT treatment.
What diseases can MECT treat?
In general, MECT therapy is suitable for severe depression, mania, and some forms of schizophrenia. It is also suitable for patients who do not respond to antidepressants, have serious side effects on drugs, or cannot take drugs safely due to their illness.
In addition, in life-threatening situations, MECT will also be recommended for patients with strong suicidal tendencies if the drug cannot take effect quickly, because it has faster curative effect than antidepressants.
Patients can feel good within one week after receiving MECT treatment. Compared with antidepressants that take at least two weeks to take effect, this treatment method can obviously save their lives.
At present, MECT treatment is only performed with the patient’s consent. Before treatment, doctors will comprehensively evaluate the patient’s physical and mental condition, taking into account the patient’s disease type, degree of pain, expected effect and prognosis if the treatment is not performed.
Now, MECT has proved to be a safe, effective and even life-saving treatment method. It has been approved by FDA for the only single treatment method for drug treatment of ineffective depression. In the past few decades, the treatment method of MECT has received a series of improvements. These improvements make modern MECT a medical technology method with both efficacy and safety.
Is MECT safe?
The most common side effect of MECT may be as prominent as its quick effect advantage, that is, it leads to amnesia, and [retrograde amnesia] is more prominent.
This kind of memory impairment has the most obvious effect on near memory, especially when it occurs in the months before MECT. It may also lead to anterograde amnesia, i.e. It is difficult to recall the newly acquired information after treatment, and it usually recovers within a few days to weeks after MECT interruption.
In addition, MECT may also affect the storage of new information, making it difficult for patients to remember what they have learned, but it will disappear within days to weeks after the end of MECT treatment.
What other physical methods can cure mental diseases?
Psychiatry is developing into a completely new field of treatment, including all kinds of brain electrical stimulation. It also builds bridges between basic neuroscience, neuroanatomy, neuroimaging and engineering. Various studies on the neurobiological effects of brain electrical stimulation also contribute to the further improvement and development of these new technologies.
Nowadays, the treatment of mental diseases includes drug therapy, non-drug somatic therapy (physical therapy) and psychotherapy. Non-drug somatic therapy includes some local electrical stimulation of the brain, but there are specific differences in traumatic and interventional methods.
In addition to MECT, vagus nerve stimulation (VNS) has been approved by FDA, which has been proved to be an effective treatment method by clinical studies, including transcranial magnetic stimulation (TMS). In addition, magnetic spasm therapy (MST), deep brain stimulation (DBS), transcranial direct electrical stimulation (tDCS) and other treatment methods are still under research and clinical trials.
1. Transcranial magnetic stimulation therapy
People have always wanted to use some equipment to change the function of the nervous system. This idea can be traced back to at least the early 19th century.
At that time, two psychiatrists proposed a patent for the use of electromagnetic equipment to treat depression and neurosis, which looks very similar to the equipment used today. In the 1880s, researchers invented a focused electromagnetic instrument, whose energy can induce induced currents in the spinal cord.
Then, they realized that this instrument can also directly and noninvasively stimulate the human brain.
Transcranial magnetic stimulation (TMS) is such a non-invasive stimulation.
TMS is probably the most interesting of all new technologies. Most clinical work focuses on TMS treatment of depression, and there are also studies carried out in patients with schizophrenia and anxiety disorders.
This technique does not require surgical craniotomy, nor does it need to cause spastic seizures, and its side effects are few.
Unlike ECT, It does not require anesthesia, No epileptic seizures, disorientation and cognitive impairment will be induced. Each treatment usually lasts for half an hour, 5 days a week, and the course of treatment is 2 to 4 weeks. The patient remains awake during the whole treatment process, and there are no other adverse reactions except occasional headache and scalp pain, so the outpatient can put into work immediately after the treatment.
2. Vagus nerve stimulation therapy
Vagus nerve stimulation (VNS) is similar to implantation of a cardiac pacemaker. Generators located under the skin send electrical signals to specific organs through implanted electrodes.
If TMS is non-invasive and focused, then VNS is in some ways opposite to TMS because it is invasive and requires permanent implantation of a device in the thoracic wall and a wire in the neck to stimulate the vagus nerve in the neck.
VNS is approved by FDA for the treatment of epilepsy and refractory depression. It is the best treatment choice for patients with chronic depression who are not suitable for most other treatment methods.
3. Treatment of magnetic spasm
Magnetic spasm therapy (MST) is a relatively novel treatment method, which achieves the therapeutic purpose by inducing epileptic seizures through high-dose transcranial magnetic stimulation.
MST also requires anesthesia, but compared with MECT, it can better control the stimulation location and the intensity of brain current, and can also locate the stimulation target in special brain regions, such as brain regions related to depression, thus reducing the diffusion of current to other brain regions.
Because of limiting the spread of stimuli, current does not reach the hippocampus of the limbic system, so MST may have less side effects of cognitive impairment than MECT. Because the efficacy of the two is equivalent and MST has fewer cognitive side effects, it can be used in patients who are not well treated with antidepressants and are intolerant to MECT.
Finally, it should be pointed out that almost all non-drug somatic therapy technologies will not be applied in treatment settings alone. The more common application of these treatment technologies is in combination with drug therapy or psychotherapy.