Treatment considered part of the psychiatric arsenal

by Jim Mosher
The Enterprise

Kenora psychiatrist Crosbie Watler acknowledges electroconvulsive therapy (ECT) was appropriately used in the past, but that's no reason to turn away from its demonstrated therapeutic benefits.

"As we use it today, ECT is a very safe, very effective and very well-researched treatment, " Watler, chief of psychiatry at Lake in the Woods Hospital, said. "There are some demons in the closet from decades ago, but we shouldn't throw the baby out with the bath water."

Dr. Watler says ECT is used at the Kenora hospital because it can provide "a prompt, life-saving" treatment for people who are in the throes of extreme depression; those who are suicidal, in particular.

"ECT is a mainstream treatment in psychiatry," Watler said. "In the '50s, '60s and '70s, it was used inappropriately. But over the last 15 years the indicators for ECT have been extremely well stated."

People at extreme risk of self-harm and those suffering extreme forms of mania are among the candidates for the electrical therapy.

"There's not been a single documented case, with the way ECT is used currently, of brain damage," the Kenora psychiatrist said, noting past ECT therapy was performed without oxygenation (supplying oxygen to the brain) and with greater electrical current.

Treatments are now administered under general anaesthetic.

Patients also receive a muscle relaxant to eliminate or reduce muscle spasms and convulsions, such as accompanied past treatments.

Watler is not alone in his profession. Psychiatric associations in Canada and the United States endorse the treatment, even though both groups acknowledge no one fully understands why ECT is effective.

"The mechanism of action of ECT remains uncertain, as do the mechanisms of action of antidepressant medications," says Dr. John Lipsey, associate professor of psychiatry at Johns Hopkins University School of Medicine in Baltimore. "However, ECT remains an effective and often lifesaving treatment for the most severely ill psychiatric patients. Eventually, it will be replaced by more specific physical treatments so that induction of a generalized seizure will no longer be necessary. In the meantime, the continued careful use of ECT in selected cases is imperative to save lives and alleviate suffering."

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