Electroconvulsive Shock Therapy (ECT): What do you think?

There is a major controversy in the mental health field over the use of ECT in the treatment of mental illness. If you are a mental health professional it would be great to hear your opinion, but I'm much more interested in the takes of those outside the field.

Focus: What have you heard about ECT? What do you think about the procedure? Do you think it could help? If so, whom? Should such a radical therapy simply be abolished? Would you consider ECT for yourself? If so, where would you need to be in your life to engage in such treatment?

This topic might be relevant for those who weighed in on the "Right to Die" topic a few weeks back. I'll do my best to chime in on the myths vs. facts after enough people have commented.

 

I don't have enough information to know.

We don't know much about the brain or how it works, relatively speaking. To me, it seems that all the tools we have for affecting how it works are the bluntest of instruments. Asking what I think about ECT is like asking what I think of using a clawhammer for cardiovascular surgery. Even the drugs aren't great, but as far as I can tell you can stop taking them and a few weeks later you'll be back to how you were before. We also seem to have a slightly better idea of how neurotransmitters work and what they are for than other aspects of the brain.

 

I have heard it is mainly for people who have depression so severe it is untreatable with medications and they are a danger to themselves. I don't know enough about the procedure itself (other than what I've seen in movies) to comment on how it's done. I have heard second hand reports, someone who knew someone whose son, daughter, aunt had it done but never had any follow up whether it helped or not. I don't think it should be abolished because, again, I don't know enough about how it's done/works. As far as considering having it done myself, it would have to be in the context of me being suicidal. In that case I would imagine friends or relatives would step in somewhat, along with psychiatrists and caregivers, to make that decision for me.

 

This thread could not be more timely for me.

My mother - update here - (<a class="postlink-local" href="http://www.theidiotboard.composting.php?mode=quote&f=3&p=108288" onclick="window.open(this.href);return false;">posting.php?mode=quote&f=3&p=108288</a>) underwent ECT back in the late sixties. She had long had mental issues, and after I was born the postpartum stress sent her over the edge and she was committed.

So while grandma was caring for me over the first few months of my life, they lit dear old mom up like a Christmas tree. Aside from terrifying her, and possibly causing pain, these treatments did nothing to address her problems. From what my family tells me, she may have actually been worse off afterwards.

To address this from a scientific point of view, I fail to see how inducing temporary alterations in brain function can be useful for long term mental illness. Unless such treatments permanently alter chemical or electrical processes in the brain, which, as I understand, they do not, then they don't address the basic causes of mental illness, and are simply a dramatic treatment for minimal benefit.

 

I've always understood ECT as an archaic and blunt tool that has about as much chance of screwing up the brain or having no notable effect, as it does to actually improve the targeted issue. It beats cutting out chunks of brain, but it doesn't seem to be much more effective. This is based on what I learned on high school psychology in addition to idly browsing about it online, so I'm not exactly a scholar on the subject. That said, in an ideal world it would be something that could be improved with better understanding of the brain, something we don't have just yet. Frylock made a good point, in that the drugs seem to be have only a temporary effect. ECT on the other hand, seems to me like shocking parts of an extremely complex supercomputer that happens to have free will and a personality...not something that can be replaced if you fuck something up.

There are reports of people decades ago being forced to undergo ECT in hospitals. This is where my comparison to a lobotomy comes in. In theory, it's a great idea, but again, we just don't know enough about how exactly our brain works to go around using electric impulses on it.

 

ECT is the equivalent of hitting the TV when the reception is bad in hope it starts to work again. The problem is, you can't buy a new brain. That's basically my impression of it.

I know that the brain is basically a bunch of fat suspended in a load of chemicals. I know that chemistry can be altered with electricity. What I don't understand is how this is supposed to alleviate the problems. It would have to transform chemicals you have too much into chemicals you have too few of. The resulting composition of chemicals then also has to be stable so that it does not easily change back. The shocks have to create a new chemical equilibrium. I simply don't see that happening. Not to mention that heating up the brain like that can't be healthy.

I think treatment by drugs are far more potent and sensible. This is follows obviously from my assumption that a chemical imbalance is the problem in these kind of diseases. If that proves to be wrong then we should have look at ECT. Else it simply does not make sense.

 

Like Misanthrope's mother, my grandmother underwent several ECT sessions in the 60's. She was clinically depressed most of her adult life. From what I understand she came back from her ECT "visits" even more depressed, anxious, and wouldn't tell anyone what actually happened in those hospitals. I'm pretty sure was mistreated/abused while she was there. Anyway, as a little girl I'd ask her about growing up back in the day, and she had no childhood memories. She was lucid and alert, but she couldn't remember certain things that even people with Alzheimer's remember. Everyone in my family/her therapist believes it was a side-effect from ECT.

We don't know enough about the brain to start zapping people.

 

As most of you know, I spent some time as a patient in a psychiatric hospital a few years ago (an experience that left me appalled and outraged as to how mental health facilities operate, treatment--or lack thereof--provided, disregard for patient's rights, etc., but that's a story for a different thread).

Another patient, Randy, and I were transferred into this facility together after spending the weekend in psychiatric lockdown of the county hospital (we both had our psychotic episodes over the weekend, and that's where they bring you). He had substance abuse issues, and anger issues among other things. After 4 days of "not responding to treatment" (the only treatment provided was a steady diet of lithium and other psychopharmaceuticals and two group sessions per day on very broad topics like "decision-making"), his psychiatrist on staff was having him transferred to the state mental hospital in Austin for ECT, supposedly to help erase painful memories that were at the root of his maladaptive behaviors. At least that was the way he explained that that was how it was explained to him.

I was shocked. I really didn't think such an intervention was still being used. I haven't done any research on it, so I'm not up on the neuroscience that supports it's use, for what particular SMIs, or its efficacy. Like most people, I've only seen it as TV and films have portrayed it: negatively (same way most media portrays mental illness in general, which contributes to the societal stigma, but again, that's for another thread). But one would think that, sending electrical current directly into the brain would be a last resort measure when all other therapeutic interventions failed, and from what I witnessed, that wasn't the case with Randy. A few days of pharmacotherapy and group sessions that didn't even come close to exploring what his problems were, let alone what they stemmed from, isn't really exhausting all the options.

 

My knowledge on ECT comes from pop culture, movies, and impressions I've developed without ANY medical background.

Still...

If medication, alcohol, marijuana, etc can and do alter brain function and the "thought process" why couldn't ECT do the same thing. Obviously cranking up the meter and having a go like they did in the 60's isn't the way to go but what about a low voltage(?) session every morning. If our mind is mostly a bunch of electrical pulses disrupting or steering them could certainly be beneficial.

Furthermore if meditation can work why couldn't this?

In general I think our understanding of how the mind works is far behind our knowledge of other areas of the body. Too many variables in what makes a person tick. I say experiment and figure it out. There are too many people anyways.

 

From what I've heard from medical professionals (please do not quote me on this because, although the people I was talking to have medical degrees, we had this discussion at a party where alcohol was served) it is helpful for some people. It is also nothing like how they show it in the movies. You have to sign a lot of papers in order to get this treatment, and it's not something that is done lightly.

 

Carrie Fisher (most known as Princess Leia but also one of the most sucessfull "script doctors" in Hollywood) suffers from Bi-Polar disorder and has of late been publically discussing her use of the modern version of this procedure. She claims it causes short-term memory loss, but that it effectively extracts her from depression. She described that on the occasions when her mind becomes "cement-like" -- and she is unable to unlock her mind from whatever is consuming her-- this procedure breaks things apart so that she can function.

Apparently the modern method is very different, with simple films attached to two places on the patient's head which are used to administer the shocks.

[By the way, she also discusses this, to a small degree, in her one-woman show on HBO, "Wishful Drinking" which I highly recommend.]

 

I imagine a very complex chemical reaction, a very involved piece of machinery that produces an advanced, complex and subtle supply of something good. And I imagine that generations in the future, after an apocalypse has destroyed the civilization and pool of knowledge that lead to the creation of such things - the involved piece of machinery is found, still working, more or less, and producing the advanced, complex and subtle supply of something good - but with occasional backfires.

Now I imagine the Octopus/Orangutan hybrid that has risen to dominance as the intelligent species on the planet trying to fix the problem, but hooking some jumper leads up to the inputs of this sucker, and a bank of car batteries to the other end of the jumper leads, to see what happens.

Maybe nothing bad has happened yet. Maybe what happens is good. Maybe it's even an improvement and fixes some of the backfires. Maybe the metrics that the Octogutan people have available says everything is awesome, as they beat their sticks on leather drums and pray to the fire god to bless their producer of good things.

But those primitives, pumping dangerous levels of electricity through a a complicated piece of machinery to influence a complex chemical reaction that they don't understand - have no idea what they're doing. They're children with flame throwers in the Louvre. Regardless of how positive the results to date, within their limited powers of observation - it still seems like a really fucking bad idea.

I guess it helps some people. I'm just glad I'm not in a situation where I have to decide if it's worth trying it on myself.

 

My opinion is probably biased because all I've heard about ECT has been negative. I took a few psychology classes in high school and college, and they usually briefed on the topic of ECT. I remember looking at dozens of cases discussing mild to severe short and long term memory damage, but I don't remember once hearing/reading about any significant recovery from the treatment. I'm not saying it doesn't happen, but my classes avoided it if it does. So based on what I've seen I'm adamantly against the procedure and it sounds about as useful as trepanning.

 

I've done a 6 week psychiatry rotation as part of my med school, and have seen ECT work absolute wonders in veterans so depressed they could not leave their beds. After couple cycles they were walking around, smiling, and ready for discharge. The only side effect the patients encountered was transient confusion.

For the people claiming we don't know enough about how it works, hence we should stop using it. By that rationale we'd have to throw out basically not only every psych med, but also things like antimalarials.

I'm going to shut up now, because like Dr. Rob, I want to see what you guys know/think about the procedure before I or someone else blabs out how it looks like, how long it takes, etc.

 

Here's an article from a few years ago by Daphne Merkin on her experience with chronic depression (http://www.nytimes.com/2009/05/10/magazine/10Depression-t.html). Her doctor recommends ECT after anti-depressants prove ineffective, but she avoids the treatment even when she's hospitalized after months of suicidal thoughts. I highly suggest you read the entire piece; it's the most harrowing thing you'll read all week.

From what I've heard, ECT can be useful for the worst cases of depression. I have a shrink acquaintance who said "One Flew Over The Cuckoos Nest" scared the general public into thinking that ECT is a barbaric relic of the bad old days of psychiatry, but, in fact, it's often effective.

 

There was a law and order SVU episode that revolved around pretty much this topic - and culminated in Jack asking the detractor (a former patient who'd been through ECT after depression and suicide attempts) if it was his contention that ECT was ineffective as a medical treatment, and then if after receiving ECT if he had ever attempted suicide again.

The clear point was hey, we might not understand it - but clearly it works. But ECT is essentially slapping the side of the television to clean up the picture. It may well work - but we have no idea what we're doing and we risk accidentally smashing the screen every time we try it. I understand it's use as a last resort alternative to taking the patient out and putting them out of their misery. But I'm still really glad it's not something I need to make a decision about in relation to my own care.

 

So is defibrillation when you do it to the heart. Yet every public place has AEDs (Automated External Defibrillators), and when I pass out in the mall, it is not only totally OK but actually recommended for a total untrained stranger to attach pads to me and zap my heart with electricity multiple times.

The idea of defibrillation is to shock the system, terminate whatever abnormal rhythm there is, and hope the heart can restore its own normal rhythm. Some people need it just once, and others need permanent implantable defibrillators that shock them every time the heart goes funky, aka implantable cardioverter-defibrillators. When ICDs were first introduced, people were laughing, and it took over a decade to give the researchers a chance. None of you brought this up as an analogy to ECT, because defibrillation is now widely accepted and not controversial. Hell, lay people can do it in emergencies.

Apply it to the brain, if you claim there is an abnormal rhythm/conduction loop/something, why can't we just zap it, with hopes that the brain will reset and restore its own normal activity?

*Yes, I do realize I am clearly biased, and that we do not know enough about the brain...yet.

 

My only opinion of ECT is that it's something that comes after drugs run their course. And pretty much all I care about is drugs, and if there's something other than drugs, I'd soon be out of a job.

Nonetheless, there is an interesting aspect of ECT. Short-term memory loss. If memory serves (and this comes from me reading random articles when I was in high school), there are some people whose depression has been specifically treated by ablating their short-term memory using ECT.

<a class="postlink" href="http://www.slate.com/id/2127351/" onclick="window.open(this.href);return false;">http://www.slate.com/id/2127351/</a>

An interesting prospect.

The list of drugs we don't quite understand is impressive. Everything from newer agents like statins to old stand-bys like tylenol and hydrochlorothiazide are, in their own ways, mysteries. And nevermind the placebo effect.