In 1982, a young nurse was suffering from severe, unrelenting depression. She couldn’t work, socialize, or even concentrate well enough to read the newspaper.
Godine 1982, mlada medicinska sestra je bolovala od teške, nepopustljive depresije. Nije mogla da radi, da se druži, čak ni da se dovoljno koncentriše da bi čitala novine.
One treatment changed everything. After two courses of electroconvulsive therapy, or ECT, her symptoms lifted. She went back to work, then on to graduate school, where she earned high grades. At first, she talked openly about her life changing treatment. But as she realized many people had an extremely negative impression of ECT, she stopped sharing her experience.
Jedan tretman je sve promenio. Nakon dva ciklusa elektrokonvulzivne terapije, ili EKT, njeni simptomi su se povukli. Vratila se na posao, a zatim na postdiplomske studije, na kojima je dobila visoke ocene. U početku je otvoreno govorila o tretmanu koji joj je promenio život. Ali pošto je shvatila da mnogi ljudi imaju izuzetno negativan utisak o EKT, prestala je da iznosi svoje iskustvo.
ECT carried a deep stigma, leftover from a history that bears little resemblance to the modern procedure. The therapy was first used in medicine in 1938. In its early years, doctors administered a strong electrical current to the brain, causing a whole-body seizure during which patients might bite their tongues or even break bones. Modern ECT is very different. While a patient is under general anesthesia, electrodes deliver a series of mild electrical pulses to the brain. This causes huge numbers of neurons to fire in unison: a brief, controlled seizure. A muscle relaxant keeps spasms from spreading to the rest of his body. The only physical indication of the electricity flooding the brain is a twitching foot. The treatment lasts for about a minute, and most patients are able to resume normal activities about an hour after each session.
EKT je nosila duboku stigmu, što je ostalo iz istorije sa kojom moderna procedura nema mnogo sličnosti. Ova terapija je prvi put korišćena u medicini 1938. godine. Prvih godina, doktori su primenjivali jaku električnu struju na mozak, čime bi izazvali grčenje celog tela za vreme koga bi pacijenti mogli odgristi jezik ili čak polomiti kosti. Moderna EKT je veoma drugačija. Dok je pacijent pod opštom anestezijom, elektrode daju niz blagih električnih impulsa u mozak. To uzrokuje istovremenu aktivaciju ogromnog broja neurona - kratki, kontrolisani napad. Mišićni relaksant sprečava da se grčevi prošire na ostatak tela. Jedini fizički pokazatelj električne energije koja preplavljuje mozak je stopalo koje se trza. Tretman traje oko minut, i većina pacijenata je u stanju da nastavi sa normalnim aktivnostima oko sat vremena nakon svake sesije.
ECT is commonly used to treat severe cases of major depression or bipolar disorder in patients who haven’t responded to other therapies, or who have had adverse reactions to medication. Half or more of those who undergo treatment experience an improvement in their symptoms.
EKT se obično koristi za lečenje teških slučajeva depresije ili bipolarnog poremećaja kod pacijenata koji nisu reagovali na druge terapije ili koji su imali neželjene reakcije na lekove. Polovina i više onih koji prođu tretman dožive poboljšanje simptoma.
Most patients treated with ECT have two or three sessions per week for several weeks. Some begin to notice an improvement in their symptoms after just one session, while others take longer to respond. Patients often continue less frequent treatments for several months to a year, and some need occasional maintenance sessions for the rest of their lives.
Većina pacijenata koji se leče EKT-om imaju dva ili tri tretmana nedeljno tokom nekoliko sedmica. Neki počnu da primećuju poboljšanje simptoma nakon samo jednog tretmana, dok drugima treba više vremena da reaguju. Pacijenti često nastave sa manje učestalim tretmanima tokom nekoliko meseci do godinu dana, a nekima su potrebni povremeni tretmani radi održavanja stanja do kraja života.
Modern ECT is much safer than it used to be, but patients can still experience side effects. They may feel achy, fatigued, or nauseated right after treatment. Some have trouble remembering what happened right before a session— for example, what they had for dinner the previous evening. Rarely, they might have trouble remembering up to weeks and months before. For most patients, this memory loss does improve over time.
Savremena EKT je mnogo bezbednija nego pre, ali pacijenti ipak mogu imati nuspojave. Mogu osećati bolove, umor ili mučninu odmah nakon tretmana. Neki imaju problema da se sete šta se desilo neposredno pre sesije - na primer, šta su večerali prethodne večeri. U retkim slučajevima mogu imati problema da se sete stvari od pre više nedelja i meseci. Kod većine pacijenata se vremenom poboljša ovaj gubitak pamćenja.
What's fascinating is that despite its proven track record, we still don't know exactly why ECT works. Neurons in the brain communicate via electrical signals, which influence our brain chemistry, contributing to mood and behavior. The flood of electrical activity sparked by ECT alters that chemistry. For example, ECT triggers the release of certain neurotransmitters, molecules that help carry signals between neurons and influence mental health. ECT also stimulates the flow of hormones that may help reduce symptoms of depression. Interestingly, ECT maintenance works better when paired with medication, even in patients who were resistant to medication before. As we come to a better understanding of the brain, we’ll likely be able to make ECT even more effective.
Fascinatno je to što, iako je njen uspeh dokazan, i dalje ne znamo tačno zašto EKT deluje. Neuroni u mozgu komuniciraju putem električnih signala koji utiču na hemiju u našem mozgu, čime doprinose raspoloženju i ponašanju. Bujica električnih aktivnosti izazvana EKT-om menja tu hemiju. Na primer, EKT pokreće oslobađanje određenih neurotransmitera, molekula koji pomažu u prenosu signala između neurona i utiču na mentalno zdravlje. EKT takođe stimuliše protok hormona koji mogu pomoći u smanjenju simptoma depresije. Zanimljivo je da održavanje EKT-om bolje deluje u kombinaciji sa lekovima, čak i kod pacijenata koji su ranije bili otporni na lekove. Kako budemo dolazili do boljeg razumevanja mozga, verovatno ćemo moći da učinimo EKT još delotvornijom.
In 1995, more than a decade after her first course of ECT, the nurse decided to publish an account of her experience. Because of the stigma surrounding the treatment, she worried that doing so might negatively impact her personal and professional life, but she knew ECT could make a difference for patients when all else failed. Though misperceptions about ECT persist, accounts like hers have helped make doctors and patients alike aware of the treatment’s life changing potential.
Godine 1995, više od decenije nakon svog prvog lečenja EKT-om, bolničarka je odlučila da objavi svoje iskustvo. Usled stigme koja okružuje tretman, brinula je da bi to moglo negativno uticati na njen lični i profesionalni život, ali znala je da EKT može biti od značaja za pacijente kod kojih ništa nije uspelo. Mada pogrešne predstave o EKT i dalje postoje, ispričana iskustva poput njenog su pomogla da doktori, kao i pacijenti, postanu svesni potencijala ovog tretmana da promeni život.