Elektrokonvulsiv behandling ved alvorlig depresjon – i konflikt med den hippokratiske eden?

Electroconvulsive treatment (ECT) often is described as particularly effective with severe depression. We argue that available placebo-controlled evidence does not support this contention, instead showing marginal effects of ECT at treatment end and the absence of positive long term effects. In contrast, the literature on neuropsychological effects suggests that ECT weakens cognitive functions, in particular memory, for weeks or months in most participants. Neurophysiologically, ECT lowers the regional activation level and slows down neural firing in the frontal and temporal lobes (deceleration). ECT also blocks long term potentiation necessary for memory formation, and it activates the hypothalamus-pituitary-adrenal stress axis. The frontotemporal deceleration following ECT empirically is associated with changes in the patients’ behavior viewed as «therapeutic response» by clinicians, such as improved appetite and sleep. Increased «doses» of ECT are associated with a stronger «therapeutic response» as well as with gradually increased neurophysiological deficits and memory problems. It may appear that the response to ECT seen in the clinic reflects the neurophysiological deficits that the treatment incurs, indicating a violation of the Hippocratic oath – first, do no harm