ECT debate: A danger, or effective therapy?
Source: TELEGRAM & GAZETTE, WORCESTER, MA, USA
original article with photos:
WORCESTER — Imagine a commercial for a treatment for major depression that sounded like this:
“When nothing else works to treat your depression — when you or a loved one has reached your breaking point — there is another choice: A doctor can purposefully induce a seizure with an electric shock to your brain. Contrary to what you might have thought, electroconvulsive therapy — shock therapy — has never gone away. It lifts depression in 80 percent of patients. Side effects include temporary confusion and short-term memory loss, headaches and nausea. In rare cases, sustained memory loss occurs. There is a 1 to 2 percent chance of death, mainly due to complications with anesthesia.
“When nothing else works, ECT can help.”
Electroconvulsive therapy, or ECT, has been around since the 1940s, and was the first medical treatment used to treat many mental disorders. Doctors don't know exactly how or why it works, but they theorize that the shock stimulates the brain's production of chemicals such as serotonin, norepinephrine and dopamine. ECT has proven effective for lifting major depression in 75 percent to 80 percent of patients, according to a study published in the December 2001 issue of the Journal of ECT. It also has proven effective in reducing schizophrenia in 40 percent to 80 percent of patients, according to a study published in 1985 in Convulsive Therapy. Both the U.S. Surgeon General and the National Institutes of Health have said ECT treatment is superior to drugs for lifting major depression.
The opponents of ECT — former patients, Scientologists, and a national movement called MindFreedom International that opposes many types of psychological drugs as well — say ECT causes brain damage. Some opponents say ECT should be outlawed.
ECT treatments are conducted at UMass Memorial Medical Center and St. Vincent Hospital in Worcester, and at Harrington Memorial Hospital in Southbridge. Last year, ECT treatments were administered 1,376 times at UMass Memorial, and 300 to 500 times at St. Vincent. Harrington Memorial, which restarted its ECT program last October, conducted 45 treatments in 2008. Marlboro Hospital shuttered its ECT program last November, after a doctor left for UMass, a Marlboro Hospital spokeswoman said.
Dr. Tatyana Shteinlukht, head of the ECT program at UMass Memorial Medical Center — University Campus, said the hospital has increased its ECT treatments in the two years she has led the ECT program, from three or four patients per week to six patients per day, five days a week. She said the hospital has a backlog of patients seeking ECT treatment.
“There are people who love it, and there are people who hate it,” said Dr. Shteinlukht, who has been an ECT practitioner for 20 years. “The best part about it is that recovery can be very quick, quicker than with a drug treatment.” She said there are side effects, most notably confusion and memory loss, but the confusion fades very quickly and memory loss is often temporary.
When asked why patients might fear ECT, she answered, “It's a medical procedure, you have to go to a hospital, you have to go under general anesthesia. I think it's the fear of the unknown. I think some people imagine the worst.”
Many people are surprised to hear that ECT still exists as a psychiatric treatment, given its perception in popular culture.
The lasting image of ECT is Jack Nicholson's character, flailing violently, receiving a shock treatment in the 1975 film “One Flew Over the Cuckoo's Nest.” Even then, that version of ECT already was a decade or two out of date.
Today, here's how the procedure works:
A patient is put under general anesthesia and given powerful muscle relaxants. A set of electrodes is placed on the patient's head. A short burst of electricity courses through the brain, setting off a grand mal seizure. Because of the muscle relaxants, the only noticeable effect on the patient during the procedure is a twitch in the toe. Each treatment costs about $1,000, and is covered by public and private health insurance plans.
For some patients, a few treatments are all they need. For others, ECT treatments are administered sporadically, over time. These are called “maintenance treatments.”
“ECT will get you out of depression a lot quicker than many drugs,” said Dr. Serge Botsaris, acting director of psychiatry at St. Vincent Hospital. “It's not trying the same type of medications over and over again.”
ECT has helped many people with depression. Kitty Dukakis, wife of former Massachusetts Gov. Michael Dukakis, swears that ECT is the only thing that broke the cycle of despondency and alcoholism that dogged her for years. She continues to go back to Massachusetts General Hospital for maintenance ECT treatments, more than eight years after her first treatment.
“It might be as simple as shocking me back into balance,” she wrote in her 2006 book, “Shock, The Healing Power of Electroconvulsive Therapy,” written with former Boston Globe reporter Larry Tye. “I hate the word ‘shock' because it scares so many people away, conjuring up memories of ECT's darkest days and embellished images of ‘One Flew Over the Cuckoo's Nest.' But shocking or jolting sure sounds like what is happening to me, whether or not it is scientifically accurate.”
Many others who have been helped are less able to speak publicly. The husband of a local woman who fell into bouts of depression said ECT has helped her immensely. He asked that neither his name, nor his wife's name, be used in the story, because of the double stigma associated with mental illness and shock therapy.
“For people for whom medicine does not do it, this is a godsend,” he said. “You can live a normal life, and get regular treatments, no different than dialysis or insulin.”
He said his wife has had some side effects, mainly temporary memory loss.
“It's a day, max, maybe less,” he said. “It is unfortunate that society still looks on this (treatment) so negatively.”
To opponents, though, ECT is a barbaric technique still forced on some patients without their consent.
“Flooding your head with electricity is kind of like banging your head against the wall,” said Oryx Cohen, a Worcester resident who is co-founder of The Freedom Center in Northampton, an activist group that advocates for people who have been mistreated in the mental health system. “I don't think it's any more effective than banging your head against a wall, actually.”
Cheryl Stevens counts herself among ECT's victims. The Worcester native and graduate of the College of the Holy Cross, who has a medical degree but is not a practicing physician, fell into a deep depression 20 years ago in New York. She was hospitalized and considered killing herself. She received several rounds of ECT treatment after she was told that drug regimens failed.
The ECT treatment, she said, has had lasting negative impacts on her memory, on her ability to recognize faces, and on her IQ.
“I have pictures of me performing surgery in what was then Zaire, and those memories are just gone,” said Ms. Stevens, an addiction counselor. “I've had trouble remembering friends' names. I've lost whole chunks of memories.”
Ms. Stevens said she believes that she suffered brain damage as a result of her ECT treatments. She said the psychotropic drugs that she was given for her mental disorders also may be to blame for her cognitive problems. She also noted that she attempted suicide after an ECT treatment.
“People who are most vulnerable are not given the information they need,” she said. “The whole thing (ECT treatment) is just dangerous and should be outlawed.”
(click link at top to see photos in original article):
Dr. Tatyana Shteinlukht, left, head of the ECT program at UMass Memorial Medical Center — University Campus, and Dr. J. Lance Lichtor of the UMass Memorial's Department of Anesthesia. (T&G Staff Photos / TOM RETTIG)
The machine used to administer electroconvulsive therapy at UMass Memorial Medical Center - University Campus.
There are people who love it, and there are people who hate it
-- Dr. Tatyana Shteinlukht, UMASS MEMORIAL MEDICAL CENTER
The history: Electroconvulsive therapy, or ECT, has been around since the 1940s, and was the first medical treatment used to treat many mental disorders.
The results: ECT has proven effective for lifting major depression in 75 percent to 80 percent of patients.
The reality: Many people are surprised to hear that ECT still exists as a psychiatric treatment, given its perception in popular culture.
The quote: 'ECT will get you out of depression a lot quicker than many drugs. It's not trying the same type of medications over and over again.' - Dr. Serge Botsaris, acting director of psychiatry at St. Vincent Hospital
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IMPORTANT: First and only comment on their web page is from shock supporter WHO DECRIES THE USE OF FORCED ELECTROSHOCK IN MASSACHUSETTS!!!
I work at Psychiatric Hospital in Belmont MA. We have an ECT unit here on the campus. Although there are people who oppose these treatments, they do in fact work. The technicians at the unit have starting exploring the use of ECT with early alzheimers and dementia and have found this to be an affective treatment as well. The only issue I have morally about ECT is that a large amount of people are court ordered in the state of Massachusetts to have 10-15 ECT treatments, this I have an issue with. I believe any medical procedure needs to be an individuals personal decision and not that of the court system. But for people who suffer from Major Depressive Disorder, Mania as part of Bi-Polar this can be a life saver. This is not the electro-shock therapy of 40 years ago, with short term memory loss for a limited amount of time I believe that ECT helps more than it hinders. - MsC
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