All
about ECT
Written by D.J. Jaffe, NYC Chapter of
the National Alliance for the Mentally Ill from information in Overcoming
Depression by Dr. Demitris Papolos.
Electroconvulsive therapy has
received some bad press as a result of what the treatment used to be. Yet
"ECT has a higher success rate for severe depression than any other form
of treatment." It has also been shown to be an effective form of treatment
for schizophrenia accompanied by catatonia, extreme depression, mania, or other
affective components. The following excerpt on its use in depression from Overcoming
Depression by Dr. Demitris Papolos
should help shed some light on the issue.
There's been a resurgence of interest in ECT because it has
evolved into a safe option, one that works. But for a public influenced by Ken Kesey's “One Flew Over the Cuckoo's Nest,” whose
associations with ECT start with the electric chair and move on to lightning
bolts, electric eels and third rails, it makes for queasy conversation. For all
of us - let's replace a few of the myths with facts.
ECT has a higher success rate for severe depression than any
other form of treatment. It can be life-saving and produce dramatic results. It
is particularly useful for people who suffer from psychotic depressions or
intractable mania, people who cannot take antidepressants due to problems of
health or lack of response and pregnant women who suffer from depression or
mania. A patient who is very intent on suicide, and who would not wait 3 weeks
for an antidepressant to work, would be a good candidate for ECT because it
works more rapidly. In fact, suicide attempts are relatively rare after ECT.
ECT is usually given 3 times a week. A patient may require
as few as 3 or 4 treatments or as many as 12 to 15. Once the family and patient
consider that the patient is more or less back to his normal level of
functioning, it is usual for the patient to have 1 or 2 additional treatments
in order to prevent relapse. Today the method is painless, and with
modifications in technique it bears little relationship to the unmodified
treatments of the 1940s.
The patient is put to sleep with a very short-acting
barbiturate, and then the drug succinycholine is
administered to temporarily paralyze the muscles so they do not contract during
the treatment and cause fractures. An electrode is placed above the temple of
the non-dominant side of the brain, and a second in the middle of the forehead
(this is called unilateral ECT); or one electrode is placed above each temple
(this is called bilateral ECT). A very small current is passed through the
brain, activating it and producing a seizure. Because the patient is
anesthetized and his body is totally relaxed by the succinycholine,
he sleeps peacefully while an electroencephalogram (EEG) monitors the seizure
activity and an electrocardiogram (EKG) monitors the heart rhythm. The current
is applied for one second or less, and the patient breathes pure oxygen through
a mask. The duration of a clinically effective seizure ranges from 30 seconds
to sometimes longer than a minute, and the patient wakes
up
Because as many as 20 to 50 percent of the people who
respond well to a course of ECT relapse within 6 months, a maintenance
treatment of antidepressants, lithium or ECT at monthly or 6 week intervals
might be advisable.
Short-term memory loss has always been a concern to patients
who receive ECT, but several studies conclude that patients who received
unilateral ECT performed better on attention/memory tests than those who
received bilateral ECT. However, there is a question as to whether unilateral
is as effective. Experts agree that changes in memory function do occur and
persist for a few days following treatment, but that patients return to normal
within a month. A National Institute of Mental Health (NIMH) Consensus
Conference concluded that while some memory loss is frequent after ECT, it is
estimated that one-half of 1 percent of ECT patients suffer severe loss. Memory
problems usually clear within 7 months of treatment, although there may be a
persistent memory deficit for the period immediately surrounding the treatment.
How distressing is ECT to Patients?
While there are certainly patients
who perceive the treatment as terrifying and shameful, and some who report
distress about persistent memory loss, many speak positively of the benefits.
An article entitled "Are Patients Shocked by ECT?" reported on
interviews with 72 consecutive patients treated with ECT. The patients were
asked whether they were frightened or angered by the experience, how they looked
back at the treatment, and whether they would do it again. Of the patients
interviewed, 54% considered a trip to the dentist more distressing, many
praised the treatment, and 81% said they would agree to have ECT again. Those
are comforting statistics about a treatment that has an ugly name and ugly
connotations but beautiful and even life-saving results.
Why is there a resurgent interest in
ECT
The scientific evidence regarding
the efficacy of the treatment has been firmly established in the professional
literature. In addition, decades old studies showing
brain cell death have been refuted in recent studies (but some anti-ECT activists
still quote them). However, ECT is like all other treatments.
Doctors often underplay the
potential side-effects. In addition, it is sometimes prescribed for conditions
it is not medically appropriate for. And like other treatments, the effectiveness
is not always permanent. Like with medicines, ECT is not used once and you are
better forever. Maintenance ECT may be required.
Unfortunately, some well-intentioned activists who received
ECT inappropriately; were erroneously told the effects were always permanent;
and/or suffered side effects (ex. memory loss) that their doctors did not
explain. Some of these activists have attacked the treatment itself when it is
really the doctor who delivered the treatment who was at fault. NAMI's official
policy is that while it does not endorse particular forms of treatment, it
believes informed individuals with neurobiological disorders have the right to
receive NIMH approved treatments like ECT from properly trained practitioners.
NAMI opposes actions intended to limit this right.
For more information about mental illness, CALL:
NAMI of Greater
(312) 563-0445
Website:
www.namigc.org