Debate Rages Over Safety of ECT, or Shock Therapy, Used on Elderly

Written by Tom Lyons

TOM LYONS
Canadian Press
Saturday, September 28, 2002

TORONTO (CP) - Marianne Ueberschar checked herself in to the city's Centre for Addiction and Mental Health two years ago suffering from suicidal depression.

Like many older women entering psychiatric wards in Canada, Ueberschar, now 69, was offered electroconvulsive shock therapy, or ECT. She refused, and fought a legal battle with the institution to prevent it from administering the treatment.

"I said I don't want my brains fried, thank you very much," says Ueberschar, who was discharged five months later without having been hooked up to electrodes to induce a generalized seizure.

(Please see below for: In early years of ECT, most doctors didn't use it on seniors.)

Invented in the late 1930s, the treatment for mental disorders involves passing an electric current through the brain.

It has its supporters and detractors.

ECT is endorsed by the Canadian Psychiatric Association, the American Psychiatric Association, the American Medical Association, the U.S. Surgeon General, and the U.S. National Institute for Mental Health, or NIMH.

According to an article posted on the Toronto mental health centre's Web site, people have no substantial reason to fear the procedure because it doesn't cause "structural brain damage" and it has "come a long way from its first unmodified use in 1938, when it was administered without anesthesia and muscle relaxant."

A vocal minority of doctors, however, says the treatment is inherently unsafe for the elderly.

"It causes them to have memory problems when they've already got memory problems to start with. It causes increased cardiovascular risks. It causes falls which can lead to death when they break their hips," says Dr. Peter Breggin, a psychiatrist and author, speaking on the phone from his office in Bethesda, Md.

"It is ridiculous to give a brain-damaging treatment to people who are already having cognitive difficulties due to an aging brain."

The topic has also provoked a great deal of debate in New York State over the past year. In March, a standing committee of the New York Assembly released the results of a year long review that concluded elderly people were more likely to receive ECT.

Permanent cognitive deficits, memory loss, and premature death were among the increased risks from ECT faced by older people, said the report, which called for special safeguards for the elderly.

"The use of this controversial method of treatment is deeply disturbing, particularly when you consider that its use results in damage to the brain and lapses in memory," said Assemblyman Felix Ortiz, who is preparing a bill which would provide more protection for the elderly.

"The use seems almost ironic when you consider how many children and grandchildren wish there was a way they could save the memories of their parents and grandparents from diseases such as Alzheimer's."

ECT fell out of favour in the 1960s and '70s in the U.S., as psychiatrists increasingly turned to antidepressant medication, but has gradually made a comeback.

The American Psychiatric Association notes in its 2001 Task Force report that elderly people became the primary recipients of ECT across the U.S. in the 1980s.

"Individuals aged 65 and over received ECT at a higher rate than any other age group. Indeed, the overall increase in the use of ECT between 1980 and 1986 was fully attributable to its greater use in elderly patients," states the report.

"Further evidence for increased use of ECT in the elderly comes from a survey of Medicare Part B claims data between the years 1987 and 1992."

The Canadian Psychiatric Association hasn't published a comprehensive national survey of ECT use on the elderly, but partial statistics from several provinces suggest a similar situation in Canada.

About 13 per cent of the population here is over 65.

In British Columbia, people 65 years of age and over comprised 44 per cent of the 835 patients receiving ECT in 2001.

In Ontario, patients 65 and over accounted for 28 per cent of the 13,162 ECT treatments given in general hospitals and community psychiatric hospitals in 2000-01, and 40 per cent of the 2,983 ECT treatments given in provincial psychiatric hospitals in 1999-2000.

In Quebec last year, 2,861 of the 7,925 ECTs administered (about 36 per cent) were to people over age 65.

Figures from Nova Scotia for 2001-02 show a total of 408 ECT treatments, including 91 on people over 65.

Dr. Kiran Rabheru, the head of the geriatric psychiatry at the Regional Mental Health Centre of London, Ont., says the treatment is often safer for elderly depressed people than antidepressant medication or no treatment at all.