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Insulin Shock Therapy – History and Risks

Insulin shock therapy is a historical psychiatric procedure in which high doses of insulin were used to induce hypoglycemic coma. It is now considered obsolete and is no longer practiced.

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Things worth knowing about "Insulin Shock Therapy"

Insulin shock therapy is a historical psychiatric procedure in which high doses of insulin were used to induce hypoglycemic coma. It is now considered obsolete and is no longer practiced.

What Is Insulin Shock Therapy?

Insulin shock therapy (also known as insulin coma therapy or the Sakel cure) is a historical psychiatric treatment used primarily from the 1930s to the 1960s. The procedure involved administering high doses of insulin to patients in order to induce a hypoglycemic shock -- a state of extreme low blood sugar leading to unconsciousness or coma. The method was developed by the Austrian-American physician Manfred Sakel and was mainly used to treat schizophrenia.

Historical Background

Manfred Sakel first introduced the technique around 1927 for the treatment of morphine withdrawal and began reporting its use in schizophrenia in 1933. Over the following decades, the therapy spread to psychiatric institutions worldwide. Sakel claimed high remission rates, which contributed to its rapid adoption. For a period, insulin shock therapy was considered a standard treatment for schizophrenia and was routinely administered in many countries.

Procedure

The treatment was carried out on an inpatient basis under close medical supervision. The typical procedure was as follows:

A fasting patient received a high dose of insulin by injection in the morning.
The resulting severe drop in blood sugar (hypoglycemia) caused the patient to lose consciousness and enter an artificially induced coma.
After a defined period -- usually 30 to 60 minutes -- the comatose state was terminated by administering glucose (dextrose).
A full treatment course typically comprised 20 to 60 such sessions over several weeks.

Supposed Mechanism and Treatment Goal

The precise mechanism of action was never scientifically established. Hypotheses included a neuroplasticity-enhancing effect of hypoglycemia, as well as autonomic and hormonal changes. However, no clearly defined neurobiological mechanism was ever demonstrated. The stated therapeutic goal was to reduce psychotic symptoms such as hallucinations, delusions, and thought disorders in patients with schizophrenia.

Risks and Side Effects

Insulin shock therapy carried significant health risks:

Death: The mortality rate was estimated at approximately 1 to 2 percent.
Irreversible brain damage: Prolonged hypoglycemic episodes could result in permanent neurological injury.
Cardiovascular complications: Cardiac arrhythmias and circulatory failure were possible outcomes.
Seizures: Epileptiform convulsions occurred during the shock state.
Psychological trauma: Many patients found the treatment extremely distressing and traumatizing.

Scientific Criticism and Discontinuation

The scientific basis of insulin shock therapy was questioned from an early stage. A pivotal moment came in 1957 with the publication of a controlled study by British psychiatrist Harold Bourne, followed by research by Ackner and colleagues, which demonstrated that the method offered no therapeutic advantage over deep sedation without insulin. With the introduction of effective antipsychotic medications -- particularly chlorpromazine in the mid-1950s -- insulin shock therapy rapidly fell out of use. It is no longer practiced anywhere in the world and is now regarded as a historically obsolete and ethically problematic procedure.

Significance in the History of Psychiatry

Insulin shock therapy stands as a defining example of an era in psychiatry when treatments were applied without adequate scientific evidence and often without the informed consent of patients. Its history has played a significant role in shaping modern ethical standards in medical research and clinical practice, including requirements for informed consent and rigorous clinical evaluation of new therapies.

Distinction from Electroconvulsive Therapy

Insulin shock therapy should not be confused with electroconvulsive therapy (ECT), which was also developed in the 1930s and involves inducing controlled seizures through brief electrical impulses. ECT -- in a highly refined and regulated modern form -- continues to be used today for certain severe psychiatric conditions such as treatment-resistant depression and is scientifically recognized as an effective intervention.

References

Ackner, B., Harris, A., Oldham, A. J. (1957): Insulin treatment of schizophrenia -- a controlled study. The Lancet, 269(6969), 607--611.
Shorter, E. (1997): A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. John Wiley & Sons.
Braslow, J. T. (1997): Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. University of California Press.

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