|
Page 2 of 3
Unlike water treatments or massages, shock therapy often had positive effects, particularly on the delusional and depressed. Bedridden patients who hadn't spoken in years suddenly sat up and talked. Suicidal patients were no longer in danger of harming themselves. But the benefits, however dramatic, were often fleeting, and often came at the expense of the patient's memory.
There were other problems. Up to 40% suffered broken bones or other injuries during seizures. Some had heart attacks. One in a thousand died.
In 1975, when the movie based on Ken Kesey's novel "One Flew Over the Cuckoo's Nest" gave the public its first look at the "wonder treatment," shock therapy was already a generation out of date, having suffered a dramatic reversal of fortune with the rise of psychopharmacology in the 1960s.
But at a handful of hospitals, ECT never went away. Instead, anesthesia, muscle relaxants and sophisticated new equipment turned it from the assaultive punishment of the past to a treatment about as dramatic as a dental procedure.
It's almost as safe. The mortality rate is now one in 20,000, the same as for the anesthesia alone. By comparison, 15 of every 100 people with severe depressions like Susan's ultimately commit suicide.
Eighty percent of those who have undergone the new ECT say they would do it again. Undoubtedly, some will. Even with antidepressant drugs, at least 20% will have relapses, often within six months. Mood disorders, said Rudorfer, "tend to be recurrent and relapsing illnesses, with episodes that come with increasing frequency as people go along."
The average patient hospitalized for depression at Columbia-Presbyterian Medical Center today is in his or her mid-50s and has already had four previous episodes, according to Dr. Harold Sackeim, chief of biological psychiatry.
Although ECT is remarkably effective as a treatment for depression, Sackeim said, it isn't a cure. It doesn't permanently affect underlying biological problems. Some hospitals now use additional treatments at regular intervals to ward off relapses. Studies of so-called "maintenance" ECT have yet to be done, but researchers say the idea makes sense.
"ECT is the only treatment we have in psychiatry that, once it works, we stop it," Sackeim said. "We don't do that with drugs." People who do stop taking antidepressant medicines relapse at similar rates, he said.
Of course, to most people, there's a big difference between an extra pill and an additional shock treatment. The social stigma that cost former Missouri Sen. Thomas Eagleton a shot at the Democratic vice presidency in 1972 lives on.
Dissatisfied former patients picket hospitals and lobby legislatures to limit access to ECT. Some blame their treatments for large, permanent gaps in their memories, and contend patients aren't adequately warned of the risks.
The movement has had some success. Berkeley, Calif., banned ECT in 1982, though a court overturned the ban six months later. Last year, Texas lawmakers made ECT off-limits to anyone under 16.
On the other side of the issue are the New England Journal of Medicine, the National Alliance for the Mentally Ill, the American Psychiatric Assn., and the doctors who study and administer ECT.
All maintain that state-of-the-art equipment has greatly reduced the impact on memory, limiting losses to the weeks right around the time of treatment. Though some gaps may be permanent, studies show most missing memories return within six months. Either way, they're the result not of any permanent brain damage but of temporary impairment in mechanisms that store short-term memory.
Understandably, people who have had ECT may be highly sensitized to normal forgetting, said Dr. Richard Weiner, director of the ECT program at Duke University Medical Center and chief of psychiatry at the Durham, N.C., Veterans Administration Medical Center.
"You and I forget things, but we don't worry about it. But if you had an acute period of organic amnesia, your perception and concern regarding your memory function might change."
Weiner also notes that some patients may have an unconscious need to forget, as evidenced by one highly educated woman who believed ECT had destroyed her mind. Under hypnosis, her abilities were proven intact.
For all that, Sackeim said, "The field has been way too defensive. Many in the anti-psychiatry movement were treated in the '40s and '50s. Some were treated badly, given high-intensity treatments and not careful enough monitoring of their cognitive states."
To minimize risks, most doctors limit patients to three treatments a week. And instead of a long wave of current, today's machines give only brief pulses.
Still, on the eve of her first treatment, Susan hardly slept.
Inside the brightly lit ECT suite the next morning, she prayed silently as the anesthesiologist inserted an IV needle in her arm and a nurse attached blood pressure, oxygen and heart monitors.
The doctor positioned electrodes on either side of her head, 1 inch up from the halfway point between the eye and ear. (Some doctors place both on the same side of the head, usually the right. Studies have shown this placement reduces memory loss, although it's also considered less effective.)
|
