Electro-convulsive therapy for depression?

A friend of mine has been struggling with depression for many years. Six years ago, it reached the stage that it disabled him and he sought treatment. Unable to work, he is on disability, which means he has to fight for treatment, struggle to get good medication, as well as figure out a way to survive on the little bit per month he gets. (Under $1000 monthly.)

After 6 years of therapy, averaging 1 session a month, being on at least 6 different medications and combinations there of, having been assigned 7 government psychologists – 4 of which have left social services – 2 psychiatrists, one of which retired and another whom he has never met, and having many frustrating battles with the disability and social service system, he is tired of not getting much better.

While he has made progress, he is not able to work and seems to have reached a point where he is ‘leveled’ off. He doesn’t get worse but he doesn’t get better. He takes 60 mg Paxil daily, which has some side affects – including knocking out his sex life for 5 years. He misses that. It takes intense stimulation for him to get aroused, which he often feels is not worth the effort. Then again, being depressed, he is reclusive and no longer has girl friends.

He is considering Electro-convulsive therapy as a potential last resort.

For you who don’t know what it is, the treatment has been around for ages, is controversial in the psychiatric community, seen on horror shows and has been modified and improved over the years.

It still basically is the following: A large amount of electrical current is shot from one side of the brain to the other, scrambling up everything in-between, causing moderate to severe convulsions physically. The results are hopefully to jangle the areas of the brain that have ‘learned’ mental illness of certain forms into ‘forgetting’ how to be ill.

If it works, the depression decreases, becomes far less severe and with regular conventional treatment, can be cured quickly. There is often temporary loss of memory after each treatment. Often, the program requires several treatments of ECT, during which the patient can develop functional amnesia, lasting anywhere from days to months.

The process, as I know of it, consists of the patient being hospitalized in a medical hospital. Before treatment, they are lightly sedated. Then, in the treatment room, they are placed on a table and secured with padded straps, an anesthetic injection is given to put the person in twilight sleep. A vynal mouth piece with an airway is placed in the mouth, adhesive contacts placed on the temples and connected to a machine similar to a cardiac shock device. Then jolts of variable power and duration are administered with Dr and nurses and emergency medical supplies standing by. The patient goes into convulsions lasting a few minutes. Afterwards, the patient is returned to his room to recover and will get another treatment usually the next day.

There is no guarantee that the desired results will be achieved.

Anyone here know about ECT? Had any? What do you think about them? I don’t know much, except that most psychiatrists don’t like them, but the treatment is approved by the medical and psychiatric community. Some people swear by them, some do not.

I don’t know what to tell him. I cannot offer an educated opinion.

I don’t care what those doctors say, ECT may still be practiced but it is highly controversial. It has often produced the opposite result. I know only one person who has been subjected to it. I didn’t know her before, but she sure didn’t seem cured to me. She told me she had nightmares about being in the hospital.
But then, she wasn’t really willingly in there at the time.

I would personally never have anything like that done to me, no matter how bad I felt. Electrocution is a very crude method of psychiatry and everyone I know in the psychiatric profession is opposed to it in most or all cases.

For the record, I am currently studying the social sciences (including psychology) and have been treated for depression my self. If your friend feels he has no other choice, I guess it beats suicide. But I have learned to be wary of doctors who are quick on the AC/DC switch. Tell him to think it through and read up on it from reliable sources.

— G. Raven

I think one of my uncles (whom I don’t know very well) is currently having this done. He has been severely depressed throughout most of his life (he’s 50), with the occasional manic episode, and has made a number of suicide attempts starting in his teens, the most recent of which was this past Thanksgiving. Living so far from my family, and never having been close to him (he’s very solitary), I haven’t really had any progress reports on his condition. I will ask, though, and see what my mom can tell me.

I’m currently doing an MA in psych, and taking an abnormal psych course. Here are some snippets from the recommended course text book by G. Davison and J. Neale. This edition is hot off the press and presumably has the latest opinions and info.

(From Chapter 10, Mood Disorders: Biological Therapies for Depression and Mania)

P.S. Although I study in Scotland, this text is American.

I have never had ECT, but I work as a chaplain in a psychiatric hospital so I interact very closely with severely depressed people all day. This is a leading and highly regarded hospital in a major urban area.

I have seen well over a hundred patients who have received ECT. By my rough estimation, maybe ninety percent report some improvement in their mental state. The remainder report no change at all. I have never encountered anyone who feels that it made them worse. The side effects and dangers are very often mild compared to what happens when people have to take large amounts of psychotropic drugs.

The process itself is extremely humane and totally painless. I witnessed one treatment, with a patient that was so terrified that he would not submit without my presence. It was nothing at all like One Flew Over the Cuckoo’s Nest. This particular patient quickly improved and wondered what all the fuss was about. It is usually given at my hospital twice a week, on Mondays and Wednesdays. There are several different procedures which can be done, and the psychatrists that I know are very careful in finding the best one for the patients and informing them of the potential risks. Consent by the patient is required and the treatments can be discontinued at any time.

The memory loss is not nearly as bad as often stated. It is limited to the days or perhaps weeks prior to the treatment, and is not total. In any case, the person is generally forgetting only times when they were extremely miserable, so it’s no great loss.

I don’t know where the idea that it is controversial or that most psychiatrists oppose it comes from. I read an article in Atlantic Monthly last month that pretty well demolished the anti-ECT forces, stating that most of the organized anti-ECT PR and lobbying is actually done by front organizations of the Church of Scientology, teamed up with fringe psychiatrists and patients who continued to worsen even with (although not because) of ECT and are looking for a scapegoat. Here it is: http://www.theatlantic.com/issues/2001/02/smith.htm

I was really horrified by the whole concept when I started working at the psych hospital. But after seeing people sharply improve from ECT, I had to change my mind. Giving people electrical shocks may not sound like the most precise science, but then again, neither is pumping someone with mind altering chemicals until hopefully something clicks.

I talked to my mom and she says my uncle has not had this done yet; right now they’ve been experimenting with medications and dosages to see if they can treat him effectively that way. However, she used to volunteer at Sheppard Pratt (in Baltimore) and has seen the procedure done several times. She says there’s nothing alarming about the procedure; the patient is unconscious and given a muscle relaxant. There is only very minor twitching (I think she said they monitor the big toe?). I don’t know that she talked to the patients after the procedure had been done. She may e-mail me more about it; if she does, I’ll post it.

Just found this link for ECT On-Line:
http://www.priory.com/psych/ectol.htm

As one of the SDers who suffers a major depressive disorder (there are quite a few of us), I found your post interesting.

The fact that your friend is considering a “last resort” option to deal with his depression raises some concerns. It could well indicate that his depression is no longer being managed by medication and that despite appearances to the contrary, his condition is actually getting worse.

I would certainly recommend that his condition is re-assessed ASAP (this should be done routinely anyway). If your friend is sliding towards another depressive episode, he may not have the energy to ensure he gets the best medical care available. This is one area in which you might be able to help.

Paxil is a selective serotonin reuptake inhibitor (SSRI), and while the SSRIs are effective in managing depressive disorders for very many people, they don’t work for everyone and they don’t always work when prescribed as a “stand alone” medication. One of the reasons why continual assessment and review by a competent practitioner is so important in the treatment of depressive disorders is because appropriate treatment is such an individual thing.

One problem with longterm, major depressions is that treatment can become habitualised rather than being subjected to constant review. Clearly your friend is not happy with the degree of improvement in his condition, and this is something he really needs to discuss with his treatment providers. It could be that his expectations of what medication can achieve are unrealistic (anti-depressants are not, as is often thought, “happy pills”), or it could be that indications of a decline are being missed. Either way, his care providers need to be aware of how he is feeling. People who suffer extreme depressive episodes often fail to mention feelings which seem “minor” or “trivial” to them (when compared to their worst feelings), sometimes because they’ve lived with those feelings so long that they perceive them as “normal” and sometimes because they seem insignificant compared to other symptoms. This is where a good friend such as yourself can be a real help. You may notice subtle changes in your friend’s thinking which he does not.

Ultimately, ECT may be the appropriate form of treatment for your friend, but I would certainly encourage you to assist him in getting his case reviewed by more than one practitioner before contemplating that course of action. There is a huge difference between mental health care in general and good mental health care, and it may be that your friend has yet to experience the latter.

For a rather, uh, spirited discussion on the subject from a two years ago, check out ECT- Living Better Electrically"

I know someone who had this treatment.
She has been on and off treatment for many yeras. Nothing seemed to be working this time. She was hospitalized for 2 weeks and had about 10 treatments. Memory loss was very short term (like she couldn’t remember what she had for breakfast the morning of treatment)As I understand ECT it is a short term solution. It gets you some rapid improvement, but still must be backed up by other methods.
She is still in treatment, but has not deteriorated to that level again in 4 years.

You’ve heard from the psych people and from the “friends of”, so let me offer my experience as someone who has actually undergone ECT.

About 10 years ago, I suffered a major depressive episode, so bad that I tried to commit suicide twice. After trying virtually every pyschotropic drug on the market at that time, and not having much success, my doctor recommended ECT. I was hospitalized for a month, and had treatments 3 times a week. It was not a horror show. I was given medication prior to the procedure so I was unconscious during the actual treatment. The only residual effect was a killer headache, and I was given medication for that as well. My memory of the time I was actually in the hospital is a little scrambled, but other than that there were no ill effects.

So here’s the major question: Did it work? I would have to say yes it did. As it turns out, my actual diagnosis is not major depressive disorder, but bipolar instead. It takes a while to tell the two apart sometimes. I wouldn’t take ECT as a first treatment option, but it did turn my life around at a time when nothing else seems to be working.

I hope your friend gets the treatment he needs as well.