The truth about electroconvulsive therapy (ECT) - Helen M. Farrell

譯者: Lilian Chiu 審譯者: Helen Chang

In 1982, a young nurse was suffering from severe, unrelenting depression.

1982 年，

一位年輕的護士飽受 嚴重且無情的憂鬱症之苦。

She couldn’t work, socialize,

她無法工作，無法社交，

or even concentrate well enough to read the newspaper.

甚至無法有足夠的專注力來看報紙。

One treatment changed everything.

一項治療改變了一切。

After two courses of electroconvulsive therapy, or ECT, her symptoms lifted.

兩次電痙攣治療（ECT）療程之後，

她的症狀改善了。

She went back to work, then on to graduate school, where she earned high grades.

她回去工作，接著去讀研究所， 得到很好的成績。

At first, she talked openly about her life changing treatment.

一開始，她會公開談論 這項改變她人生的治療。

But as she realized many people had an extremely negative impression of ECT,

但當她了解到許多人對於 ECT 有著極度負面的印象時，

she stopped sharing her experience.

她不再分享她的經驗。

ECT carried a deep stigma,

ECT 背負著很深的汙名，

leftover from a history that bears little resemblance to the modern procedure.

那是和現代做法大相逕庭的 一段歷史所遺留下來的汙名。

The therapy was first used in medicine in 1938.

1938 年，這項治療 初次被用在醫療上。

In its early years, doctors administered a strong electrical current to the brain,

在初期，醫生會讓 強力的電流通過大腦，

causing a whole-body seizure during which

造成整個全身性的發作， 在這個過程中，

patients might bite their tongues or even break bones.

病人可能會去咬舌頭， 或甚至發生骨折。

Modern ECT is very different.

現代的 ECT 非常不同。

While a patient is under general anesthesia,

病人在全身麻醉的狀況下，

electrodes deliver a series of mild electrical pulses to the brain.

電極會將一系列輕微的 電脈衝傳導到大腦。

This causes huge numbers of neurons to fire in unison:

這造成大量神經元同時發動：

a brief, controlled seizure.

短暫、在控制之下的癲癇發作。

A muscle relaxant keeps spasms from spreading to the rest of his body.

肌肉鬆弛劑會確保痙攣 不會散播到身體其他部位。

The only physical indication of the electricity flooding the brain

唯一顯示有電流通過大腦的身體指標

is a twitching foot.

是腳部的抽搐。

The treatment lasts for about a minute, and most patients are able

治療的時間大約一分鐘，

大部分的病人在療程後一小時 就能夠繼續正常的活動。

to resume normal activities about an hour after each session.

ECT is commonly used to treat severe cases of major depression or bipolar disorder

重度憂鬱症或是躁鬱症的病人

若對其他治療沒有反應，

in patients who haven’t responded to other therapies,

通常就會使用 ECT，

or who have had adverse reactions to medication.

或病人對藥物有不良 反應時也可以使用。

Half or more of those who undergo treatment experience an improvement

接受治療的人，有一半以上

症狀都有改善。

in their symptoms.

Most patients treated with ECT have two or three sessions per week for several weeks.

大部分接受 ECT 治療的病人

一週要做二或三次治療，持續數週。

Some begin to notice an improvement in their symptoms after just one session,

有人只做一次就已經 能發現症狀改善了，

while others take longer to respond.

其他人則要較長的時間才有反應。

Patients often continue less frequent treatments for several months to a year,

病人通常會減低頻率 但持續治療數個月至一年，

and some need occasional maintenance sessions for the rest of their lives.

有些人一生中都會偶爾 需要做維護治療。

Modern ECT is much safer than it used to be,

現代 ECT 比以前安全許多，

but patients can still experience side effects.

但對病人仍然可能會有副作用。

They may feel achy, fatigued, or nauseated right after treatment.

病人在治療後可能會 覺得疼痛、疲勞、噁心。

Some have trouble remembering what happened right before a session—

有些人會無法記住 在治療之前發生的事——

for example, what they had for dinner the previous evening.

比如，他們前一晚的晚餐吃什麼。

Rarely, they might have trouble remembering up to weeks and months before.

也有人無法記得數週 或數月前的事情，但非常罕見。

For most patients, this memory loss does improve over time.

大部分病人的記憶喪失狀況 會隨時間改善。

What's fascinating is that despite its proven track record,

很妙的是，儘管 ECT 過去的記錄已被證實有用，

we still don't know exactly why ECT works.

我們仍然不知道為什麼它會有用。

Neurons in the brain communicate via electrical signals,

大腦中的神經元 會透過電訊號來溝通，

which influence our brain chemistry, contributing to mood and behavior.

這些訊號會影響大腦的化學性質， 進而影響心情或行為。

The flood of electrical activity sparked by ECT alters that chemistry.

ECT 所造成的大量電活動 改變了那種化學性質。

For example, ECT triggers the release of certain neurotransmitters,

比如，ECT 會觸發 某些神經傳遞質的釋放，

molecules that help carry signals between neurons and influence mental health.

這些分子有助於在神經元之間 傳遞信號，並影響心理健康。

ECT also stimulates the flow of hormones that may help reduce symptoms of depression.

ECT 亦會刺激荷爾蒙流動， 可能會協助減輕憂鬱症的症狀。

Interestingly, ECT maintenance works better when paired with medication,

有趣的是，ECT 若能搭配藥物， 能維持更好的效果，

even in patients who were resistant to medication before.

即使病人過去有抗藥性也是一樣。

As we come to a better understanding of the brain,

隨著我們漸漸對大腦有更多了解，

we’ll likely be able to make ECT even more effective.

我們很有可能可以 讓 ECT 變得更有效。

In 1995, more than a decade after her first course of ECT,

1995 年，這位護士做了 第一次 ECT 療程後至少十年，

the nurse decided to publish an account of her experience.

她決定要將她的經驗 記述下來並出版。

Because of the stigma surrounding the treatment,

因為這項治療帶著汙名，

she worried that doing so might negatively impact

她很擔心做這件事可能會對 她的私生活和工作有負面的影響，

her personal and professional life,

but she knew ECT could make a difference for patients when all else failed.

但她知道 ECT 可以在其他做法 都行不通時為病人帶來轉機。

Though misperceptions about ECT persist,

雖然大家對 ECT 的 錯誤認知持續存在，

accounts like hers have helped make doctors and patients alike

她這樣的記述也已經 協助醫生和病人意識到

aware of the treatment’s life changing potential.

這項治療可能可以改變人生。