ECT Anonymous - Research Information - May 1999 - ECT - Research Information - May 1999

Written by Juli Lawrence

"There is also anecdotal (non-controlled) evidence that a greater incidence of ECT side effects might affect therapeutic response; e.g. in a circular distributed by Ectron, the largest UK manufacturer of ECT machines to psychiatric hospitals throughout the UK in December 1985, it is stated that Ectron's 'early generation' of 'constant current' ECT machines, which were designed to 'achieve minimal side effects,' had achieved 'inadequate clinical response' despite the fact that convulsions had been induced. They went on to say that their next generation of constant current machines, which would be designed to deliver more electrical energy (and therefore increase the risk of side effects) should 'ensure a good clinical response.' ...
...one study (Warren & Groome, 1984) which compared high energy pulse current and low energy pulse current with high energy sinusoidal current did not find any significant difference between the different waveforms in one aspect of memory function: 'acute general memory.'" (Dr. Graham Sheppard (Ticehurst House Hospital), 'A Critical Review of the Controlled real versus Sham ECT Studies in Depressive Illness,' 1988)

"An unjustified outcry concerning "side-effects" of ECT...arose, leading to a concentration on reducing "side-effects" which was at the expense of clinical effectiveness. Unfortunately, the development of constant current pulse-type stimuli...enhanced the problem, since they were more efficient in producing seizures with a much lower dosage and also reduced the side-effects. It was firmly believed that the clinical effect would always be present provided that a seizure was produced. It is now clear that a larger stimulus is necessary to ensure a good clinical response. (R. J. Russell (originator of 'Ectron'), 'Inadequate Seizures in ECT,' Brit J. Psychiat. (1988), 153)

Clearly ECT has dual features: shock and convulsions. A long running dispute exists about which of these should be claimed as the therapeutic agent, and also about which one causes the greatest cerebral damage:

"These cases show that irreversible cerebral damage can be caused by E.C.T. but leave unanswered the question of how much of the damage is due to the current and how much to the effect of the convulsion." (Maclay, 'Death Due to Treatment,' Proceedings of the Royal Society of Medicine, Vol. 46, Jan-Dec '53)

"[In the Forties] Wilcox discovered that the strength of an electrically induced grand mal seizure did not depend upon any more electricity than that required to induce the seizure. This meant that "adequate" convulsions could be induced with much lower dosages of electricity than had previously been used, and that the Cerletti-Bini devices were utilizing much more electricity than needed to induce such convulsions. Cerletti and Bini's device, then, was not an electroconvulsive device, but an electroshock device. ...
It remained only for the investigator to report that there was no possibility of administering EST without the damaging effects, as both the damage and the "therapeutic" effect appeared to be the result of suprathreshold dosages of electricity. But neither Wilcox, Freidman, nor Reiter made any such announcements. Rather than challenge colleagues who were damaging the brains of thousands of persons yearly, Wilcox and Reiter...allowed Impastato and colleagues to introduce the...Molac II, a Cerletti-Bini style SW AC device, capable of administering convulsions many times over seizure threshold. This was, in effect, the first deliberately designed...EST apparatus." (Douglas G. Cameron (World Association of Electroshock Survivors), 'ECT: Sham Statistics, the Myth of Convulsive Therapy, and the Case for Consumer Misinformation,' The Journal of Mind and Behaviour, 1994)

"Heath and Norman (1946) had suggested that a convulsion was not essential in order to gain benefit from electric therapy and that the benefits derived were due to hypothalamic stimulation." (Myre Sim (ed.), 'Guide to Psychiatry,' Churchill Livingstone, 1981)

Whatever the reasons, psychiatrists have been loath to admit it's the electricity that both 'works' and causes 'side effects':

"ECT is in no sense electrical treatment..., but only the use of an electrical stimulus...to set off an epileptiform disturbance in the brain; it is this disturbance which is therapeutic. ... We do not pit the mysterious force of electricity against (mysterious) mental illness, as a hostile lay public may believe.... So electroconvulsive therapy as a name has all the wrong associations and helps to perpetuate the bad image of the treatment. A more accurate name would be relaxant ictal therapy (RIT), which would be better for public relations." (John C. Cranmer (Institute of Psychiatry), 'The Truth About ECT,' Brit. J. Psychiat. (1988), 153 (Correspondence))

"After Ottosson's (1960) work, cognitive impairment was generally regarded as an effect of the electricity mainly, and the therapeutic benefit of ECT was attributed to the seizure. ... [However] many long-held assumptions were false and there is increasing evidence that...the degree to which electrical dose exceeds seizure threshold, and not the absolute dose administered, determines dosing effects on clinical outcome and the magnitude of cognitive deficits." (John Pippard, 'Audit of Electroconvulsive Treatment in two National Health Service Regions,' Brit. J. Psychiat. (1992), 160)

ECT is allegedly used primarily to treat depression … ¡ but the issue isn't as clear-cut as it might seem:

"...sham ECT involves all the procedures associated with real ECT except the passage of electricity through the head. ... ...the reported data at the end of the controlled phase of the [thirteen published] studies [reviewed] and subsequent follow-up data, as a body of evidence, does not...significantly indicate that real ECT is more effective than sham ECT in treating depressive illness." (Dr. Graham Sheppard, 'A Critical Review of the Controlled real versus Sham ECT Studies in Depressive Illness')

Perhaps a bit of a con is being perpetrated. Strangely, the authors of a study involving more than 2,500 first recipients of ECT inadvertently remark over-diagnosis of 'depression' in those patients sent for ECT:

"...depression (endogenous and neurotic) was heavily overrepresented in the ECT groups. ... The most striking difference between ECT and non-ECT first-hospitalization groups was the preponderance of depressed patients among the ECT population." (Babigian & Guttmacher, 'Epidemiologic Considerations in Electroconvulsive Therapy,' Arch. Gen. Psychiat., Vol. 41, March 1984)

"It is worth noticing that the action of E.C.T. cannot be purely on the factors, whatever they are, that are responsible for depression; for several patients in this series showed distinct improvement though they showed previously no trace of depression." (H. Collins and M. Bassett, 'The Effect of Electro-Convulsive Therapy on Initiative,' J. Ment. Sci., 1959)