ECT- Living Better Electrically

Cecil's Columns/Staff Reports
1

AH, Cecil. Finally a topic I have more than a modicum of information about.
As a healthcare provider (ghastly euphemism) I’ve assisted in administering Electro-Convulsive Therapy (ECT) to at least 60 patients in the past ten years. Probably 600 episodes. I do have an opinion about this technique and that is that when it works it works great and when it fails, well, life sucks.
I’ve seen patients curled in the fetal position, unable to relate to anything or anyone, blossom into persons again. I’ve also seen tragic failures where probably no therapy would have resulted in a happier outcome.
In all cases, I have never seen any deleterious effects from the therapy itself. Transient confusion (resolving in a couple hours) and loss of memory of the event (the ECT and a few minutes before) were the most common side effects. Anesthesia always controlled the flow of events and assured the safety of the patient. A quick acting barbiturate was given via an I.V. and when the patient was asleep a rapid onset, short action neuro-muscular paralyzing agent administered, usually succinylcholine. The patient is now asleep, essentially paralyzed, and completely monitored. The anesthesiologist assure adequate respirations via a resuscitation bag and 100% oxygen.
The ECT itself is unspectacular. A previously inflated blood pressure cuff on the ankle kept the paralyzing drug out of the foot so we can monitor the the peripheral seizure by watching the toes twitch. An electroencephalogram (EEG) allows us to monitor the central seizure by watching the brain wave patterns. The usual seizure lasts approx. one minute. If the seizure continues for longer that anticipated, drugs can be given that stop the impulses. A common goal is to give between 500 to 1000 seconds of treatment over time. The patient MUST be closely monitored for clinical effect; no improvement is often not a reason to terminate treatment early on in therapy.

Wordy, but I hope this dispels some rumors and misconceptions. ECT is not a panacea nor an evil, just a tool.

2

I know two people who have had the treatment. One did well, it seemed to have no effect on the other.

This hand, to tyrants ever sworn the fow, for freedom only deals the deadly blow, then sheathes in calm repose the vengful blade, for gentle peace in freedoms hallowed state. John Quincy Adams

3

Shouldn’t it be:

‘Better living through electricity’

Anyway, just what sort of things require a person to have such wonderful treatment Germ Boy? Also, can I get it done just by asking for it ?
thx

4

Not that I’m a doctor (or even a healthcare provider), but if you’re looking for a buzz or high I’d imagine you’d be disappointed.

Being used as a living electrical resister is seldom a pleasant experience. :slight_smile:

“I had a feeling that in Hell there would be mushrooms.” -The Secret of Monkey Island

5

I was wondering when folks were going to get around to the Reddy Kilowatt lines . . . I’m just glad somebody else went first.

I’ve known two people who had ECT . . . both highly intelligent, creative people who happened to have “nervous breakdowns.”

The first one, a former librarian with a master’s degree from Emory University, wound up with the approximate IQ of a 10 year old. She was so jolted from her experiences that she never recovered and lived the rest of her life as a perpetual child. She was sweet, she was innocent . . . and she lived like 50 years in that condition. It was too sad. In fact, it contributed to her demise; she let a stranger into her house, never dreaming that anybody would ever hurt her. He raped and killed her, but she was really killed all those years ago.

The second person I’ve known was a jazz pianist. Not only does he have no memory of his treatments, he has very little short term memory . . . or long term, for that matter. Which is an inconvenient thing for someone that made their living by playing stuff out of his head. I wish I had a penny for everytime I’ve played with him, gotten nearly through something . . .and he stops . . . and says, “I can’t remember the rest of it.” He can’t remember people’s names when he meets them, has “blanks” when he forgets things . . . It’s heartbreaking.

ECT probably helps as many folks as lobotomies and in the same fashion – you’re a better person in society’s eyes when you’re quiet. The reference to “One Flew Over the Cuckoo’s Nest” is most appropriate, see what happens to troublemakers?

ECT has been mostly discarded as a treatment but recently it has made a comeback, though I can’t imagine why. My guess is that people are desperate for a quick fix, a cure; treatment modalities like drug therapy and psychological couseling are not always helpful and take too long. I have also heard that insurance companies will actually PAY for ECT, mostly because it’s something they can do that’s quick, cheap, and easy.

And why would you WANT something like this?

your humble TubaDiva
who reminds you that there’s better ways than “shaking hands with Jesus.”

6

Mother Nature gave me two treatments for free. I do not look forward to a third. I may not be lucky enough to survive. I had not thought (?) to use this as an excuse for my strang behavior though. Humm I wonder if the police would… <-- 3¼¢

7

I don’t know about the rest of y’all; however, I’m still wondering about Germ Boy’s use of the terms “100% Oxygen” and “assure the patient’s safty” to describe a procedure which is basically electrocution

8

I think this thread is revealing in that the myth persists that ECT is inherently bad and that its use is somehow cruel. First, (ooo, those flames are close) it HAS been used inappropriately used in the past, for punitive purposes mostly. Second, its true mechanism of action is not completely understood (neither is the effect of aspirin for that matter) so its use could be labeled suspect. Third, it’s not the first line treatment for any disease.
All the patients I worked with had been in treatment for their mental difficulties for some time before the option of ECT was even broached; we didn’t even think of it until many other regimes (chemical) had been explored. This treatment ain’t for everybody.
COncerning the 2 “failures” outlined above, what other meds were, or are, the librarian and pianist on? What is their psychiatric disease? Are they currently in therapy? The questions abound.

Again, ECT is a tool. As such, the skill of its user is the greatest determinant of success.

9

You go first, okay?

As far as any prejudice I might have, well, I’ve seen such marvelous use of this tool I’m not likely to be pro-shock therapy any time soon. I saw real suffering (and in one case, real death) because of it and that’s no myth.

your humble TubaDiva

10

Death?!
Was this a case of gross malpractice, or does the legal waver cover a ride on Ol’ Smokey?

“I had a feeling that in Hell there would be mushrooms.” -The Secret of Monkey Island

11

“I saw real suffering (and in one case, real death) because of it and that’s no myth.”

I do not doubt your veracity. I am interested to know a least a couple details of this incident.

I am not beating a drum for ECT but do believe that peeling away the veil of mystery surrounding any procedure allows better decisions.

BTW, I would submit to ECT only after many other avenues had been traveled and turned out to be dead ends.

12

All things considered, this thread can go many pages in the effects and controversy surrounding ECT … and still be barely the outer layer of the “onion” of this topic.
What is perhaps topping the “bothersome” factor is somehow still hidden from public knowledge…

  • Such as who owns the company that makes the ECT machines, and the influence on the use of the procedure…

  • Also, the only state that requires tracing the statistics and patients is Texas… with numbers being thrown around that significantly misrepresent the success and the risks…

  • The profit and professional incentive in using non-surgical techniques to treat people.

-The statistically significant (extreme is a better word) rise in referrals for ECT when patients qualify for Medicare

-The very short term (less then a month) that “successful” treatments have relapsed into their illnesses

ON the flip side……

-Case studies of people who spent so many years (unsuccessfully) with drug and other therapies.
-Misrepresentation of memory and behavioral side effects by opponents of ECT

Personally---- I find this is the rare subject that I cannot have a discrete opinion on…

I was fascinated when I studied several chapters of “great and desperate cures” in December, ’98 , while researching the history of lobotomy . I agree with Unka Cecil’s recommendation of this book… it was very “eye opening”.

For those that are still paying off there Straight Dope bills at the local bookstore… or find Dr. Valenstein’s
Book very hard to find or order… a web site has acquired permission to post the book on his site for research and knowledge. web site has acquired permission to post the book on his site for research and knowledge. The following site also has several other mind boggling articles on this subject:

http://public.carleton.edu/~vestc/text/gdcindex.html

for a statistical look at ECT , here is another link that is good foo for thought.

http://www.usatoday.com/life/health/lhs188.htm

13

As a nursing student, I spent one horrendous day helping to give ECT treatments. The worst part, for me, was getting the consent form signed. Here’s this poor elderly woman souped up on God knows how many drugs and I’m trying to read her this form. She told me she didn’t want it done. I went and told the nurse, who talked to the woman for about five minutes and came back with the signed form. The old woman cried until the minute the paralytic took effect. She was a delusional mental patient; nobody took her seriously when she tried to protest. I wonder how many people are coerced into getting ECT?

14

Holly, your point is well made and important. But the bigger evil you refer to is the fact that patients (clients, customers, whatever) are coerced into treatments or regimens everyday in this country. That it was ECT that yout patient was forced into agreeing to is irrelevant. In my 20 years of practice I have always rigorously defended a person’s right to self determination. For any procedure where informed (key word) consent is required that has to be the overriding principle. I’ve known patients who have thoughtfully declined “lifesaving” treatments who have kept on living. I’ve also seen people who needed emergent treatments but because of an incapacity to make their needs known, have suffered while proper consent was obtained from a NOK. Your example is an egregious one and deserves to brought to light. A person on psychtropic meds must always be critically evaluated for their ability to make clear decisions.

Abuse is a part of the human condition and the caring professions are not immune. Please be bold and remember that at times you may be the only advocate that a patient has.

15

Okay folks, this is one I can actually field with some small knowledge. First a bit of background. I’m a neuropharmacologist who has specialized in the study of antidepressant treatments since 1983. Antidepressant drugs have been on the market since the mid-1950’s and ECT since the mid-1930’s. For the record, antidepressant treatments have been discovered either a) by accident or b) by copying effective treatments in a patentable way. Despite a boatload of work (my own included), we still don’t know exactly how ANY antidepressive treatment (psychotherapy, drug therapy, ECT or chocolate) works.

That said, antidepressants work at about the following rate: Psychotherapy - 50-60% (higher in some cases), Drug treatments - 60-70%, ECS - 90%. The down-side is that depression is a VERY dangerous disease. It accounts for about half of the cases of suicide and even in those patients who aren’t actively suicidal, it greatly increases risks for everything from immune dysfunction to heart disease and automobile accidents.
Unfortunately, antidepressant drugs, especially the 1st and 2nd generation can be very toxic. So much so that before the arrival of the 3rd generation serotonin reuptake inhibitors like Prozac or Paxil, it was condidered very risky to give a patient a large prescription because of the ease with which that prescription could be used to commit suicide. Luckily, The 3rd generation drugs are much less risky and much more tolerable to patients.

HOWEVER, like their predecessors, it take up to 6 weeks of continuous treatment at the correct dosage to produce a real antidepressant effect. Since the success rate is modest (60-70%) and inconsistent from drug to drug (i.e. some patients will respond to Prozac but not Paxil while others to Paxil but not Prozac), it can be discouraging to the patient if not downright dangerous (because of the risk of suicide during those 6 weeks) to use medication. In contrast, response to ECT is very rapid, taking 7-14 days to produce effects. Moreover, those effects are observed even in patients who are very unresponsive to drug therapy.

LASTLY, older people are much more likely to develop toxic responses to antidepressant drugs or be at risk of dangerous drug-drug interactions (e.g. with heart or blood pressure meds).

All that being said, ECT becomes the antidepressant treatment of choice for reasons such as: 1) speed of response; 2) failure to respond to 3 or more drug treatments or 3) toxic complications from drug-drug or drug-fetus effects. (This last accounts for the higher than usual use of ECT with Medicare patients since ECT is more often used in the elderly). ECT is NOT used as a punishment except by incompetent psychiatrists.

There is no doubt that ECS can produce memory problems in about 5-10% of patients. However, permanent damage is rare - less than 1%. Contrast that with toxic effects from medication or untreated depression that can run as high as 30% depending on who’s counting. And by the way, many of the horror stories that proliferate are either of the “urban legend” type or assume that the long term damage was produced by ECT (rather than the psychiatric disease itself, by the anesthesia used or by other drugs the patient is/was taking.

Sorry to be so long-winded but, I am after all, a professor – it’s what we do.

16

I’m a former teacher and registered nurse, totally and permanently disable by 13 out pt ECT’s I had in 1983. The damage ECT did to my brain is verified on numerous EEG’s. My disability is based upon this brain damage.

Less than a year prior to the ECT of 1983 I had graduated with honors as an RN at age 40. Withinin 6 months of the ECT I was officially diagnosed as “dementia”, “organic brain syndrome” and “diffuse encephlopathy”. The most profound damange is in the direct path of the electrical current, in the frontal and temporal lobes, as well as the limbic area of my brain.

Fifteen to twenty years of my life were simply “erased”. Only a few bits and pieces have returned. I have serious cognitive impairments, all verified as a result of the brain damage induced in the name of “therapy.”

I belong to a group of over 500 shock survivors, who have permanent memory loss and cognitive impairments due to their “therapy.” Many of former professionals were unable to work (at all) after ECT.

The death statistics from Texas, which have been compiled quarterly for nearly 6 years now, show a death rate of 1 out of 200. This means 1 of every 200 persons receiving ECT in Texas is dead within 14 days of their “treatment” or “therapy.”

California has kept records of memory loss for over ten years, and lists permanent meory loss as a complication (not temporary side effect) of ECT in alarming numbers.

I have spoken to approximately 200 shock survivors over the years, who have been disabled and devastated by ECT.

ECT took my past, my profession(s), my ability to work and learn, my musical abilities, who I was, and the mother of my children.

I call ECT evil, and a rape of the soul.

Anyone wanting more info on ECT will find it at www.ect.org or http://members.aol.com/wmacdo4301

17

What exactly does ROIZ mean by ‘‘misrepresentation’’ re:memory effects?
Also, as the primary author and llanfresh illustrate, the concept of being an ‘‘expert’’ in this subject basically boils down to knowing about the mechanics of the procedure as opposed to it’s effects even though claims are made to the contrary. This is directly comparable with a nazi deathcamp gas chamber administrator giving a description of the mechanics of dropping a canister of Zyklon B crystals in to the showerheads and then claiming to know what it is like to be asphixiated by the gas.

By definition the only people who can legitimately claim to know about the effects of ECT are those of us forced to have it. The effects upon my memory were not transient nor are they misrepresentative of the truth. The effects on memory are just the start, however. Other effects come into play. Facial recognition difficulties, right/left confusion, word and number dyslexia, etc, etc, etc.

Why take my word for it. reinforce your '‘expert’'status with a dose or ten for yourself. Until then do not ‘‘profess’’ (literally) to know what you are talking about.

18

Let me clarify a few things about my earlier comments.

First - I do not support “enforced consent” unless the patient is realistically dangerous to themselves or others. Nor do I suggest minimizing the potential side effects or complications. Both are negatives in deciding on electroconvulsive treatment. However, side effects and complications exist for ANY medical treatment - not the least of which includes antidepressant drug treatments. In either case, the negatives have to be considered WITH the possible/probable benefits.

That’s obviously a judgement call but, it’s one that has to be made by patients, family, patient advocates, physicians, etc. Like any other judgement call, there is the terrible possibility of being wrong - sometimes disasterously so. For most patients, however, the judgement to use ECT results in relief of depression without severe side effects.

I do not dispute the fact that ECT CAN and HAS resulted in severe memory damage for some patients. However, there is not a single medical treatment that does not have its horror stories – even antibiotic treatments have been known to kill people. Until we have better treatments, we have only two choices: abandon all potentially risky medical treatments (which ends up being the abandonment of ALL medical treatment) or accept, inform and try to reduce the known risks.

And by the way - Neither GermBoy nor I am trying to suggest that we know what your personal experience of ECT is or was like. I would trust your own assessment of that just as I would expect you to trust mine. Your bad experience makes ECT a bad choice for YOU. It does not make ECT a bad choice for everyone.

19

[[First - I do not support “enforced consent” unless the patient is realistically dangerous to themselves or others. ]]
Great expression – I assume they smile when they say that.

20

Ilamfresh- “I do not support…unless”, is about as meaningful as saying a Nazi does not support genocide unless you happen to be a Jew, a gypsy or homosexual. You either support the patient’s right to say “no” or you are a part of that abusive system. Since when has ECT been recently used in “third part risk” patients? Most of the shrinks I know now declare that the target group are depressives. There is a tiny, itsy, bitsty little difference between mainstream medicine and pschiatric care provision. In all other areas of medicine the patient, (with minors, the parents) decides if to take the risk. Some, indeed, decline medical intervention at the risk of their life, sometimes for religious reasons. Life at any cost, however, seems to be the theme for American psychiatrists, who just happen, by coincidence of course, to make a metaphorical “killing” out of the profits of exposing their patients to the risk of shock. Yes, antibiotics can kill. Thing is, unlike shock, there is statistical evidence that they save lives. Also, of course, no-one is forced to take antbiotics.