Shock Therapy
Called `barbaric' by some, a `miracle' cure
by others, it is being used more and more to treat depression
By Jamie Talan
Newsday
4-10-90
SUSAN WITTE remembers looking at her children and wondering when they grew
up. She recalls looking at pictures from a fun-filled vacation and wondering
when she was away. And she still wonders about her husband . . . has it
really been 23 years of marriage?
Susan Witte has lost six years of her life.
The 42-year-old North Valley Stream woman says the memories, both good and
bad, were wiped out when psychiatrists passed electric currents through
her brain to pull her from the depths of a depression.
"The doctors said that my memory would return in four weeks," Witte said
of her treatment with electroconvulsive therapy (ECT). "It just kept getting
worse. It never came back." And, she says, the treatments did not alleviate
her depression.
Thousands of patients who receive what is popularly known as shock therapy
complain of its problems, such as loss of memory. But thousands of others
swear by the treatment that has rapidly expanded to an estimated 100,000
people a year.
Since it was discovered more than 50 years ago, ECT has split the psychiatric
community. Some doctors argue that it is a barbaric throwback to a time
when there were no drugs available to treat depression and radical surgery,
even lobotomies, were mistakenly believed to be the only cure. Other psychiatrists
contend that using quick, high-voltage bursts of electricity is usually
safer, faster and more effective in treating suicidal depression than are
most drugs.
"Some of my colleagues would rather spend years, even decades, administering
mind-altering drugs, most with disturbing side effects, even though studies
have shown that thirty percent of patients do not respond to medications,"
said Dr. Max Fink of the Health Science Center at the State University of
New York at Stony Brook. An ECT expert, Fink edits the only journal devoted
to research on shock therapy.
"They still believe that there are no alternatives," the psychiatrist said.
"If any of us could find a better way to treat patients, we would. At the
present time, there is nothing that beats ECT."
But there are equally outspoken doctors who have built their careers on
fighting shock therapy. They are armed with decades of studies that they
say prove the dangerousness of the technique.
"ECT is a barbaric assault on the brain," said Dr. Peter Breggin, a Maryland
psychiatrist who opposes the treatment. Breggin is often called as a witness
in ECT malpractice cases. "It damages the brain. ECT patients don't know
whether they are coming or going." Animal studies clearly show that zapping
the brain with electricity damages cells, he argues.
Breggin is also one of the leading opponents of a recent task force report
by the American Psychiatric Association that backs ECT as a primary therapy
for some cases of severe depression and mania.
The report, released in December, recommends that the 29,000 U.S. psychiatrists
learn the technique and offer it as an alternative to drug therapy. The
six researchers who worked on the report concluded that ECT was safe and
effective when used appropriately. ECT, the report concluded, "should not
be seen as a `last resort' therapy. Such a view may well deprive patients
of effective treatment."
Perhaps the only thing both sides agree on is that the technology of ECT
has steadily improved.
ECT dates from 1938 when psychiatrist Ugo Cerletti, practicing in Italy,
applied electrified tongs to the temples of a schizophrenic patient. He
and others argued that epileptics had seizures but were free of schizophrenia,
so perhaps inducing seizures in non-epileptics would relieve the symptoms
of schizophrenia.
European psychiatrists began inducing seizures by giving toxic doses of
camphor or Metrazol. Cerletti's electric technique was convenient and seemingly
safer. By 1948, about 85 percent of U.S. hospitals surveyed said they used
chemically or electrically induced shock on mental patients. In time, psychiatrists
began to see that the electric technique worked best for people seriously
depressed and on the verge of suicide.
NO ONE REALLY knows how ECT works, only that it causes a seizure in the
brain that seems to alleviate many of the symptoms of severe depression
and mania. It is also being used experimentally to treat schizophrenia,
Alzheimer's and Parkinson's diseases. Psychiatrists agree that modern ECT,
administered with muscle relaxants and anesthesia, has come a long way from
the days when an electric shock jarred the whole body into convulsions,
often resulting in broken bones.
Researchers at the National Institute of Mental Health estimate that during
any six-month period about 10 million people suffer depression. An episode
can last weeks or months, and the likelihood of a future bout is high. Researchers
now suspect that some forms of depression are caused by brain chemicals
gone awry.
Drug therapy is still considered the best treatment for most people with
depression. Some people can't tolerate the side effects, which can include
blurred vision, dry mouth, urinary retention, constipation, rapid heart
beat, hypotension, sedation and sexual difficulty.
Researchers say that 70 percent of patients respond to antidepressant medications,
but it may take several weeks, even months, for people to begin to feel
better. ECT, which is saved for only the most severe cases of depression
or mania, is said to work quickly, often after the first treatment. Dr.
Herbert Fox of Gracie Square Hospital in Manhattan said that studies have
shown that it is effective 80 to 90 percent of the time.
Some doctors estimate that 100,000 Americans a year receive ECT treatments.
Modern-day therapy calls for a series of six to 12 treatments, doctors say,
compared to dozens, even hundreds, of shock sessions decades ago.
But ECT is not an easy solution, nor is it a cure. It provides temporary
relief from life-threatening mental illnesses, Fox said. It is a type of
surgery, and any surgery has its limits and dangers. During the procedure,
electrodes are placed on the head and chest to record changes in heart rate
and brain waves. Electrodes are also placed on the scalp to elicit a seizure.
Before electricity surges through the brain, patients are given an IV barbiturate
to sleep and a relaxant to calm the body's hundreds of muscles. The bolt
of electricity lasts seconds, just long enough to produce a seizure. The
anesthetic wears off in minutes, and the patient resumes normal activity
within two hours of treatment.
The majority of ECT cases are carried out in a hospital, but more and more
patients are receiving shock treatments on an out-patient basis.
Julie, 32, of Queens, has spent most of her adult life fighting severe bouts
of depression. She has seen six doctors in as many years. She was given
antidepressants, antipsychotics, even lithium, but the side effects were
always so harsh that she was forced to stop. She was falling so deep into
her sadness that she felt that it would only be a matter of time before
she was evicted from her apartment.
"I was so emotionally dull that I was unable to connect with other people,"
said Julie, who asked that her last name not be used. "I felt so weak that
I did not have the strength to look for yet another doctor." So Julie, who
was working her way through a master's degree in social work, decided to
look into electroshock therapy. Her mother also suffered from severe depressions
and found relief from shocks to her brain.
"I read about all the side effects, and they did not sound as bad as the
ones I was experiencing on the medications," Julie said. Some of her complaints:
severe dry mouth, dulled thinking and concentration, and anxiety. Lithium
left her with disfiguring acne. She was a persistent patient. She worked
at a psychiatric hospital and did not want to take time off to get better.
She found the answer at an out-patient clinic at Gracie Square.
There she worked with psychiatrists on a treatment schedule that would allow
her to continue work and college. She travels to the hospital once a month
for ECT treatment.
"It's a miracle. Years ago, I would have been institutionalized for a couple
of years," Julie said, pointing out that her depression has lifted. "I am
doing a lot better than most people who have never suffered depression."
Fox and others say they worry that ECT is fast becoming a treatment for
the rich or, like Julie, at least the adequately insured. Private hospitals
are buying up ECT machines, Fox said, while state hospitals are relying
more heavily on drugs to treat their patients.
New York State, which operates 33 hospitals, is looking into whether it
should provide more ECT. According to Dr. John Oldham, the acting chief
of the state's Office of Mental Health, "We can't be sure whether it should
be used more or less. I would say that there are a few state facilities
where it is not readily available and that it can be a problem for patients."
But making it available may also cause problems. Dr. Richard Frances, a
professor of clinical psychiatry at the University of Medicine and Dentistry
of New Jersey, said that patients' most common complaints are confusion
and memory lapses.
"These problems can be very frightening to people," Frances said. "There
is a temporary period of memory loss during the time people are getting
ECT."
While some patients complain of lifelong memory lapses, studies on the structure
of the brain have not shown any evidence of such permanent memory loss.
Dr. Matthew Rudorfer of the National Institute of Mental Health says that
he has done PET (positron emission tomography) scans on a few patients and
so far has found no brain chemical differences between those who received
ECT and those who did not. In other studies, researchers have induced repeated
seizures in rats and were unable to detect any damage to the stimulated
area. Other animal studies conducted using MRI (magnetic resonance imaging)
scans - these devices reveal structural abnormalities - also found no changes
before or after ECT.
IN ADDITION to memory problems, some patients complain of side effects including
headaches, nausea, muscle aches or soreness, weakness, drowsiness, anorexia
and missed menstrual periods, said Harold Sackeim, an ECT researcher at
Columbia University College of Physicians and Surgeons.
More than two years after Long Island's Witte had ECT to treat her chronic
sadness, she says she is still having problems. While some of her memories
returned after her shock treatment, others from several years before the
therapy have not. After her hospital stay, she says, she had no idea how
to find her own house. She did not know the neighborhood foodstore where
she had shopped for a decade. Family vacations were snapshots of empty weeks.
Friends, family and a long-time psychologist have helped Witte put the pieces
of her lost life back together.
"The treatment has profoundly changed her," husband William said. "She has
had to get to know me and the children all over again."
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