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Paredes, who was Matthews' doctor for several years before his ECT treatments began, says numerous elderly ECT recipients at Riverview are suffering from the same type of ECT-induced mental deterioration plaguing his former patient.
"There are many, many others. And nobody wants to talk (about) them. Because the relatives are always concerned that they're going to be blamed for allowing this to happen. And the patients, most of the time they are not in a condition to talk at all," says Paredes, who adds that he is not opposed to the appropriate use of ECT.
Dr. Nirmal Kang, the head of ECT services at Riverview, declined to discuss the Matthews case due to confidentiality, but he defended his hospital's ECT safety record in a telephone interview.
"From 1996, God forbid, we haven't had a single fatality related to ECT complications," said Kang.
That ECT can cause death from medical complications is conceded by proponents, but the frequency of ECT fatalities is hotly disputed.
Sackeim, an APA Task Force member and NIMH researcher, says elderly people have only a "somewhat higher" death rate than the APA's general mortality estimate of one in every 10,000 ECT patients, or 0.01 per cent.
"Just in general, the rate of mortality in ECT is low," says Sackeim from his office at the New York Institute of Psychiatry.
Opponents of ECT, like Dr. John Breeding, a Texas psychologist, say the actual death rate among elderly electroshock recipients is closer to one in 200 patients, or 0.5 per cent, judging from the number of post-ECT pathology reports filed in the 1990s in his state, the only jurisdiction in North America requiring the reporting of all deaths occurring within 14 days of ECT.
The current CPA position paper on ECT cites a general treatment complications rate for all ages of one in 1,400 treatments, or 0.07 per cent.
And the APA report says "reports of stroke (either hemorrhagic of ischemic) during or shortly after ECT are surprisingly rare."
Opponents say this overlooks strokes which occur as long-term complications in the elderly, as detailed in a 1994 case report by Dr. Patricia Blackburn, and disregards other types of ECT-related brain damage in older people, such as atrophy of the frontal lobes, found in a 1981 CAT scan study of 41 elderly patients by Dr. S.P. Calloway and a 2002 MRI study by Dr. P.J. Shah.
"(It's) a big lie ECT doesn't cause brain damage," Dr. John Friedberg, a California neurologist, told New York Assembly hearings on ECT in May of last year.
"One picture will refute that," he said, referring to an MRI scan published in the November 1991 issue of Neurology of a 69-year-old woman who suffered an intracerebral hemorrhage after ECT.
The 2001 APA report does include a reference to the woman's brain scan but the sample patient information booklet appended to the report nevertheless says "brain scans after ECT have shown no injury to the brain."
Dr. Barry Martin, head of ECT services at the CAMH in Toronto and a peer reviewer of the 2001 APA report, said it would be a "waste of time" to respond to the opponents' arguments because Breggin and Friedberg suffer from a "lack of credibility."
"The 'other side' is so inflammatory and out of touch with the realistic benefit of this treatment that it interferes with people getting effective treatment," Martin said. "Frightens people and their families unduly."
He said transient memory loss is well worth the price to someone who recovers from depression after undergoing ECT.
"The memory loss usually recovers over a period of weeks to several months," he said.
"There may be some permanent loss for some events both before and after the treatment. But for the ability to learn and retain new information, the actual memory mechanism recovers fully. If it didn't, ECT would not be allowed in treatment."
And Rabheru has noted some financial benefits to the health-care system.
"With the current economic constraints, governments and third party payers are under constant pressure to reduce expensive inpatient stays to a minimum, but also to provide optimum quality of psychiatric care," he wrote in a June 1997 article in the Canadian Journal of Psychiatry.
"C/MECT has been clearly shown to reduce inpatient stays in numerous studies."
C/MECT is continuation or maintenance ECT, and consists of ongoing treatments after the original course of six to 12 treatments is completed.
A report commissioned at arm's length by Health Canada, the provinces and territories, and released in January 2001, says government should become involved.
The study by Dr. Kimberly McEwan and Dr. Elliot Goldner of the University of British Columbia department of psychiatry recommended that health authorities begin measuring the percentage of ECT recipients who suffer strokes, heart attacks, respiratory problems and other recognized complications of the treatment.
Meanwhile, back in New York state, the standing committee's report has urged the U.S. Food and Drug Administration to conduct an independent medical safety investigation of ECT machines.
"The FDA has never tested ECT devices to ensure their safety," the report noted.
On May 30, the New York Assembly passed a resolution calling for an FDA investigation.
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