- Also called:
- insulin coma therapy
- Key People:
- Manfred J. Sakel
- Related Topics:
- psychiatric treatment
insulin shock therapy
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What is insulin shock therapy?
Insulin shock therapy was a psychiatric treatment where patients received increasing doses of insulin to induce hypoglycemia and coma, based on the incorrect idea that this could "jolt" them out of psychosis.
Polish psychiatrist Manfred Sakel conceived the therapy in the 1920s after noticing mental clarity in a morphine-addicted patient who had accidentally received too much insulin. Despite lacking scientific support, the treatment gained popularity worldwide but was largely discredited by the 1960s due to the introduction of antipsychotic drugs, the intense care needed, and safety concerns.
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Why was insulin shock therapy used in psychiatry?
In psychiatry, insulin shock therapy was employed based on the hypothesis that hypoglycemia-induced coma could potentially alleviate patients' psychoses. Polish psychiatrist Manfred Sakel conceived the idea in the 1920s, after observing a patient's mental clarity improve after an accidental insulin overdose.
Despite lacking scientific support, the treatment gained popularity, involving daily insulin injections to induce hour-long unconsciousness, followed by glucose injections to awaken patients. This was repeated over weeks or months, with increasing insulin doses to deepen the coma. Constant monitoring was needed due to the risk of hypoglycemic episodes and seizures. Following treatment, many patients became obese and some developed brain damage, which was sometimes mistaken for improvement. The treatment also sometimes resulted in death; estimates of the fatality rate of insulin shock therapy vary from 1 to nearly 5 percent. By the 1950s, its use declined due to the introduction of antipsychotic drugs, the intensive care needed, and the lack of evidence supporting its effectiveness or safety.
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How did insulin shock therapy work?
Insulin shock therapy, pioneered by Manfred Sakel in the 1920s, involved injecting patients with increasing doses of insulin to induce hypoglycemia, which would result in a coma. The treatment was based on the incorrect theory that coma could "jolt" patients out of psychosis.
Sakel's technique required near-daily insulin injections to maintain unconsciousness for over an hour, followed by glucose injections to restore consciousness. This pattern was repeated for months, even up to a year, to deepen the comatose state. Though considered effective by some, the treatment lacked scientific support and carried significant risks, including brain damage and a fatality rate between 1 and 5 percent. By the 1950s, insulin shock therapy's popularity waned due to the introduction of antipsychotic drugs and concerns over its safety and effectiveness.
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What types of mental illnesses were treated with insulin shock therapy?
Insulin shock therapy involved injecting patients with increasing doses of insulin to induce hypoglycemia and coma, based on the incorrect idea that this could "jolt" them out of their psychoses.
Insulin shock therapy was considered effective in treating schizophrenia. It was more effective with schizophrenic patients whose illness had lasted less than two years and in the treatment of paranoid and catatonic schizophrenia than in the hebephrenic types.
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What risks or side effects were associated with insulin shock therapy?
Insulin shock therapy involved significant risks and side effects. During treatment, patients were at high risk of hypoglycemic episodes and seizures, necessitating constant monitoring. Following the full course of therapy, many patients became obese due to repeated glucose injections.
Brain damage was another serious concern, sometimes misinterpreted as improvement. The treatment also carried a risk of death, with fatality rates estimated between 1 to nearly 5 percent.
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Why is insulin shock therapy no longer commonly used today?
Insulin shock therapy, a psychiatric treatment involving high doses of insulin to induce hypoglycemia and coma, was based on the idea that coma could "jolt" patients out of psychoses. Despite lacking scientific evidence, it gained popularity after psychiatrist Manfred Sakel's accidental discovery in the 1920s.
By the 1950s, insulin shock therapy was falling out of favor and was largely discredited by the 1960s. Several factors contributed to its decline, including the intensive care required for patients, the introduction of antipsychotic drugs, and a lack of evidence supporting its effectiveness and safety. Moreover, many patients developed brain damage, and the treatment sometimes resulted in death.
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insulin shock therapy, form of psychiatric treatment in which patients were given increasingly large doses of insulin in order to induce hypoglycemia (low blood glucose) and coma. Insulin shock therapy was based on the notion that hypoglycemia-induced coma could basically “jolt” patients out of their psychoses. The approach was largely discredited by the 1960s and is no longer used.
The idea for insulin shock therapy was conceived in the 1920s by Polish psychiatrist Manfred Sakel, who accidentally administered too much insulin to a patient with a morphine addiction, triggering convulsions and coma in the patient. After regaining consciousness, the patient experienced an improvement in mental clarity and reduced symptoms of drug withdrawal. The incident led Sakel to conclude that insulin, given in doses sufficient to induce coma, could potentially rid patients of mental health conditions. Sakel began testing his theory in patients with schizophrenia in the late 1920s, administering the drug in doses high enough to not only induce unconsciousness but also sometimes trigger convulsions, which he considered to be beneficial in certain cases. In 1933 he published the results of his trials.
Despite a lack of scientific evidence to support the effectiveness or safety of insulin shock therapy, the treatment quickly became popular and was adopted by psychiatrists in countries worldwide, including Canada, China, Korea, the United Kingdom, and the United States. The approach introduced by Sakel, known as “Sakel’s technique,” entailed almost daily injections of insulin to induce unconsciousness that lasted an hour or longer. Patients were brought back to a waking state with an injection of glucose. This treatment pattern was repeated six days a week over the course of months and, in some instances, a year or more, with steady increases in insulin dose to produce deeper states of coma. Some patients experienced as many as 50 or 60 episodes of unconsciousness over the duration of therapy.
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Patients experienced various effects during and after insulin shock therapy. Immediately following injection, patients exhibited a range of symptoms, including pallor, sweating, and restlessness, followed by deep sleep and finally coma. Patients were at high risk of hypoglycemic episodes and seizures when not receiving treatment, necessitating constant monitoring by nursing staff, and, following completion of the full course of therapy, patients were obese, owing to the effects of repeated glucose injections. Many patients also developed brain damage, which sometimes was erroneously perceived by psychiatrists as an improvement in mental condition. Treatment also sometimes resulted in death; estimates of the fatality rate of insulin shock therapy vary from 1 to nearly 5 percent.
Insulin shock therapy was considered by its proponents to be highly effective in the treatment of schizophrenia; however, in many cases schizophrenic patients were selected for therapy because they were considered to be so ill that any change in their mental state—including changes that today are considered hallmarks of brain damage—could be claimed as an improvement. By the 1950s, however, insulin shock therapy was rapidly falling out of use. The intense care necessary for patients undergoing therapy, the introduction of antipsychotic drugs, and a lack of evidence to support its effectiveness or safety were major factors in its decline.