Called "barbaric" by some, a "miracle" cure by others, it is being used more and more to treat depression

SUSAN WITTE remembers looking at her children and wondering when they grew up. She recalls looking at pictures from a fun-filled vacation and wondering when she was away. And she still wonders about her husband . . . has it really been 23 years of marriage?

Susan Witte has lost six years of her life.

The 42-year-old North Valley Stream woman says the memories, both good and bad, were wiped out when psychiatrists passed electric currents through her brain to pull her from the depths of a depression.

"The doctors said that my memory would return in four weeks," Witte said of her treatment with electroconvulsive therapy (ECT). "It just kept getting worse. It never came back." And, she says, the ECT treatments did not alleviate her depression.

Thousands of patients who receive what is popularly known as shock therapy complain of its problems, such as loss of memory. But thousands of others swear by the treatment that has rapidly expanded to an estimated 100,000 people a year.

Since it was discovered more than 50 years ago, ECT has split the psychiatric community. Some doctors argue that it is a barbaric throwback to a time when there were no drugs available to treat depression and radical surgery, even lobotomies, were mistakenly believed to be the only cure. Other psychiatrists contend that using quick, high-voltage bursts of electricity is usually safer, faster and more effective in treating suicidal depression than are most drugs.

"Some of my colleagues would rather spend years, even decades, administering mind-altering drugs, most with disturbing side effects, even though studies have shown that thirty percent of patients do not respond to medications," said Dr. Max Fink of the Health Science Center at the State University of New York at Stony Brook. An ECT expert, Fink edits the only journal devoted to research on shock therapy.

"They still believe that there are no alternatives," the psychiatrist said. "If any of us could find a better way to treat patients, we would. At the present time, there is nothing that beats ECT."

But there are equally outspoken doctors who have built their careers on fighting shock therapy. They are armed with decades of studies that they say prove the dangerousness of the technique.

"ECT is a barbaric assault on the brain," said Dr. Peter Breggin, a Maryland psychiatrist who opposes the treatment. Breggin is often called as a witness in ECT malpractice cases. "It damages the brain. ECT patients don't know whether they are coming or going." Animal studies clearly show that zapping the brain with electricity damages cells, he argues.

Breggin is also one of the leading opponents of a recent task force report by the American Psychiatric Association that backs ECT as a primary therapy for some cases of severe depression and mania.

The report, released in December, recommends that the 29,000 U.S. psychiatrists learn the technique and offer it as an alternative to drug therapy. The six researchers who worked on the report concluded that ECT was safe and effective when used appropriately. ECT, the report concluded, "should not be seen as a `last resort' therapy. Such a view may well deprive patients of effective treatment."

Perhaps the only thing both sides agree on is that the technology of ECT has steadily improved.

ECT dates from 1938 when psychiatrist Ugo Cerletti, practicing in Italy, applied electrified tongs to the temples of a schizophrenic patient. He and others argued that epileptics had seizures but were free of schizophrenia, so perhaps inducing seizures in non-epileptics would relieve the symptoms of schizophrenia.

European psychiatrists began inducing seizures by giving toxic doses of camphor or Metrazol. Cerletti's electric technique was convenient and seemingly safer. By 1948, about 85 percent of U.S. hospitals surveyed said they used chemically or electrically induced shock on mental patients. In time, psychiatrists began to see that the electric technique worked best for people seriously depressed and on the verge of suicide.

NO ONE REALLY knows how ECT works, only that it causes a seizure in the brain that seems to alleviate many of the symptoms of severe depression and mania. It is also being used experimentally to treat schizophrenia, Alzheimer's and Parkinson's diseases. Psychiatrists agree that modern ECT, administered with muscle relaxants and anesthesia, has come a long way from the days when an electric shock jarred the whole body into convulsions, often resulting in broken bones.

Researchers at the National Institute of Mental Health estimate that during any six-month period about 10 million people suffer depression. An episode can last weeks or months, and the likelihood of a future bout is high. Researchers now suspect that some forms of depression are caused by brain chemicals gone awry.

Drug therapy is still considered the best treatment for most people with depression. Some people can't tolerate the side effects, which can include blurred vision, dry mouth, urinary retention, constipation, rapid heart beat, hypotension, sedation and sexual difficulty.

Researchers say that 70 percent of patients respond to antidepressant medications, but it may take several weeks, even months, for people to begin to feel better. ECT, which is saved for only the most severe cases of depression or mania, is said to work quickly, often after the first treatment. Dr. Herbert Fox of Gracie Square Hospital in Manhattan said that studies have shown that it is effective 80 to 90 percent of the time.

Some doctors estimate that 100,000 Americans a year receive ECT treatments. Modern-day therapy calls for a series of six to 12 treatments, doctors say, compared to dozens, even hundreds, of shock sessions decades ago.

But ECT is not an easy solution, nor is it a cure. It provides temporary relief from life-threatening mental illnesses, Fox said. It is a type of surgery, and any surgery has its limits and dangers. During the procedure, electrodes are placed on the head and chest to record changes in heart rate and brain waves. Electrodes are also placed on the scalp to elicit a seizure.