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"These are people who are so severely ill that without the treatment they would almost certainly die of the illness much faster and more certainly than with the risks," says Rabheru.
"Where someone actually comes in at death's door, and you give them a couple of ECTs, they start to eat, they start to drink, they become a lot less suicidal."
But he acknowledges it's more hazardous to older patients.
"The risks are definitely greater," says Rabheru, whose institution provided 79 per cent of its ECT treatments to patients over the age of 65 in 1999-2000, the last year for which statistics are available.
"Because they're more frail. Their cardiovascular systems are compromised, their respiratory systems are compromised. So the risks are definitely higher, no question about it. And there are people who have cognitive impairment, who have cardiac problems as a result of anesthesia."
Dr. Lee Coleman, a psychiatrist and author based in Berkeley, Calif., says "risk-benefit" analyses of ECT overstate the benefits and underestimate the hazards.
"What they never talk about is the people who commit suicide because they're afraid of the treatment that is about to be forced upon them. That definitely happens," says Coleman in a phone interview.
In a 1999 Journal of Clinical Psychiatry article, Dr. Harold Sackeim, a leading advocate of the treatment in the U.S., wrote: "Little, if any, evidence supports a long-term positive effect of ECT on suicide rates."
Keith Welch, a former president of the patients' council at the Queen Street Mental Health Centre in Toronto, now part of the CAMH, says he suffered a series of strokes and several years of memory loss after receiving ECT in the 1970s.
He feels that elderly patients are being damaged by ECT.
"When the seniors first go in, they're very active. Maybe a little upset, you know, because it could be a family problem, something like that. Then, maybe a month later, they're walking around like zombies. They don't know what's going on, Some of them can't even change their clothes after they get shock treatments," says Welch, 59.
"I always stop and figure, you know, someday I'm going to be as old as them too. What if the same thing happens to me?"
Don Weitz, 71, who has actively campaigned against ECT for years, notes that more older women than men receive the therapy in Ontario.
"Elderly women are such easy targets," he says.
"When part of the medical profession targets an age group of 60-plus, it's a form of elder abuse," says Weitz, an ex-insulin shock patient who lives in Toronto.
"The reason the elderly get so much ECT is because they are less likely to refuse. People as they get older generally automatically do what the doctor says without question. 'Shock docs' can make hundreds of dollars a day just by pressing a button."
Dr. David Conn, head of psychiatry at the Baycrest Centre for Geriatric Care in Toronto, says any notion that psychiatrists give ECT to the elderly to make money is incorrect.
"From a physician's perspective, you've got to get up early in the morning to give the treatments, and I'd prefer to stay in bed," says Conn, who adds that ECT is a "lifesaving" treatment for elderly people who suffer from suicidal depression but who are unable to tolerate antidepressant medication.
"There's no great advantage to physicians giving the treatment except that if you want your patients well, it works."
Treatments are usually administered in the morning because patients have to fast beforehand.
In December 2000, Dr. Jaime Paredes made headlines with his concerns about increased use of ECT at Riverview Hospital in Port Coquitlam, B.C., after doctors began receiving an extra $62 or so per treatment from the provincial health-care plan.
At the time, Riverview spokesman Alastair Gordon defended the increase, saying that the institution was receiving referrals from other hospitals and there was growing medical acceptance of ECT as a "treatment of choice for geriatric patients suffering from depression."
A review panel commissioned by former health minister Corky Evans found that ECT "delivery" at the hospital was of high quality, but the lack of a detailed database on outcomes meant there was no way to evaluate the results, or to determine why the number of treatments had jumped so dramatically.
Paredes resigned under pressure from his position as president of Riverview's medical staff in December 2001.
"The medical plan is impressed with an administrator who shortens patients' hospital stay and even if an ECT patient is readmitted fairly soon, he counts as a new admission, rather than the same patient having a long stay," Paredes said in an interview.
Earlier this year, Riverview was in the news again when Michael Matthews, a 70-year-old patient who had received 130 ECT treatments over a three-year period, made the front page of the Vancouver Sun.
"I don't like it. They hurt, I don't want it," Matthews told a reporter for the Sun, which ran a close-up photo of Matthews' head which was covered in cuts and bruises from a fall he said was caused by ECT-induced confusion.
The B.C. Public Guardian and Trustee's office and the B.C. Provincial Health Services Authority have both launched probes into Matthews' ECT treatments.
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