Electroconvulsive Therapy Overview

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
Popolos should help shed some light on the issue:

All about ECT

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 & move on to lightning bolts, electric eels & 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 or severe depression than any other form of
treatment. It can be life-saving & 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 & pregnant women who suffer from depression or
mania. A patient who is very intent on suicide, & 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 & 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, & with modifications in
technique it bears little relationship to the unmodified treatments of the

The patient is put to sleep with a very short-acting barbiturate, & then the
drug succinycholine is administered to temporarily paralyze the muscles so
they do not contract during the treatment & cause fractures. An electrode is
placed above the temple of the nondominant side of the brain, & 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 & producing a seizure.
Because the patient is anesthetized & his body is totally relaxed by the
succinycholine, he sleeps peacefully while an electroencephalogram (EEG)
monitors the seizure activity & an electrocardiogram (EKG) monitors the heart
rhythm. The current is applied for one second or less, & the patient
breathes pure oxygen through a mask. The duration of a clincally effective
siezure ranges from 30 seconds to sometimes longer than a minute, & the
patient wakes up 10 to 15 minutes later.
Upon awakening, a patient may experience a brief period of confusion,
headache or muscle stiffness, but these symptoms typically ease in a matter
of 20 to 60 minutes. During the few seconds following the ECT stimulus there
may be temporary drop in blood pressure. This may be followed by a marked
increase in heart rate, which may then lead to a rise in blood pressure.
Heart rhythm disturbances, not unusual during the period of time, generally
subside without complications. A patient with a history of high blood
pressure or other cardiovascular problems should have a cardiology
consultation first.

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

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 & persist for a few
days following treatment, but that patients return to normal within a month.
A 1985 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
& shameful, & 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, & whether they would do it
again. Of the patients interviewed, 54% considered a trip to the dentist more
distressing, many praised the treatment, & 81% said they would agree to have
ECT again. Those are comforting statistics about a treatment that has an ugly
name & ugly connotations but beautiful & 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 effective 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, 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.

Dr. Demitri Papolos
Montefiore Medical Center

Dr. D.P. Devanand
Dr. Harold Sackeim
NY Psychiatric Institute
722 West 168th St.
NY NY 10032

Dr. Max Fink
State University of NY
at Stony Brook

Dr. Shep Kanter
Dr. Fox
Gracie Square Hospital

Dr. John Markowitz
Payne Whitney Hospital

Dr. Mathew Smith
NY University Hospital

Dr. Bruce Klutchko
NY University Hospital

Dr. Ana Fels
NY Hospital
Cornell Medical Center
Payne Whitney Clinic
525 East 68th St.
NY NY 100214

This article was posted by D.J. Jaffe on behalf of the Alliance for the
Mentally Ill/Friends and Advocates of the Mentally Ill, a NYC Chapter of the
National Alliance for the Mentally Ill. AMI/FAMI is located at 381 Park
Avenue South, NY NY 10016. Call (212) 684-3264 for more information. Your
support is appreciated.



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