A white-gowned man is lying in a room full of doctors. One applies a cold salve to his temples. He demands that they let him go, but they pin him down and gag his mouth. One attaches electrodes to his head. Another flips a switch — and suddenly the man is writhing and convulsing like a fish out of water, his face contorted with pain. The doors to the room open an hour later. The man stumbles out with vacant eyes. He no longer remembers or feels anything.

This is the public's typical perception of electroconvulsive therapy (ECT), a treatment for people with severe depression, bipolar disorder, and catatonia. The name of the treatment (with the words electric and convulsive) conjures images of people writhing in pain. Furthermore, popular movies such as "One Flew Over the Cuckoo's Nest" have also generated stigma towards ECT through graphic, negative depictions. Many people believe that ECT is harmful, but the truth is that ECT has become a relatively safe and effective treatment for mental disorders. Before the treatment, patients are administered a general anesthetic, which, besides ensuring that the patient does not flail around, also prevents the patient from feeling any pain. In recent years, doctors have run simulations with computational models of the brain to determine electrode placements and electrical outputs that cause minimal side effects. Most side effects, such as memory loss, typically fade within a few months. On the contrary, since depression impairs memory, memory may even improve after treatment!

ECT is typically used as a last resort treatment for individuals who have exhausted other treatments. It is also used for populations unable to take medication, such as pregnant women. ECT was created in the 1930s when an Italian neurologist named Ugo Cerletti noticed that patients in psych wards who suffered from both epilepsy and depression experienced elevated moods after a seizure. To replicate this phenomenon, Cerletti induced seizures with electricity under the assumption that therapeutic effects would follow. As crazy as this premise is, studies show that ECT works: over 60% of patients with depression experience remission (the reduction or disappearance of a disease) after treatment. 

Although doctors have been shocking people's brains to treat mental disorders for nearly a century, ECT is still not fully understood. Various hypotheses have been proposed for its mechanism of action, the most popular of which is the neuroplasticity hypothesis. Neuroplasticity is the ability of the brain to form new connections between neurons. Studies have shown that depression is related to low brain neuroplasticity and that brain neuroplasticity is enhanced after an ECT-induced seizure, much as if the brain is trying to counteract the disruption caused by the seizure. With this enhanced neuroplasticity, the brain rewires its neural circuits, thereby becoming better equipped to handle mental disorders. 

In recent years, new treatments such as magnetic seizure therapy (MST) and transcranial electric stimulation therapy (TEST) with fewer side effects than ECT have been developed. MST induces seizures through magnetic waves rather than electric currents, and TEST administers electric currents without inducing seizures. Whereas ECT induces a widespread seizure across the brain, MST uses a lower overall electrical output and targets more specific areas. In ECT, it is difficult to attribute side effects to either the electrical stimulus or the seizure because both happen at the same time. By studying TEST and MST, scientists can determine the individual effects of the electrical stimulus and the seizure. 

Researchers at USC's Keck School of Medicine have also started utilizing AI to improve transcranial magnetic stimulation (TMS), which generates a magnetic field to induce an electrical current in the brain without causing a seizure. By analyzing brain scans from a database of over 60,000 patients with depression, researchers hope to identify patterns that signify whether or not a patient will be responsive to the treatment. They also hope to use AI to determine which regions of the brain need to be stimulated for treatment to be effective.

As technology advances, we will have more tools to treat mental disorders. Gone are the days where we were fumbling in the dark, attempting remedies without understanding why they work.