If your doctor suggests electroconvulsive therapy, or ECT, for you or a loved one, forget the movie One Flew Over the Cuckoo's Nest and the lobotomizing stereotype of shock therapy. Today ECT is far safer and more precise than in the past. For some people with severe depression, it may even be the most effective form of therapy, not merely a treatment of last resort.
During ECT, patients receive a series of electrical currents to the brain that induce a 30- to 60-second generalized seizure. Patients are under general anesthesia. The anesthesia may contribute to the short-term memory loss patients experience after ECT.
Changing perceptions based on evidence
"Ten years ago I would have to broach ECT with patients," says Corey Greenwald, MD, a psychiatrist in Atlanta who performs many ECT procedures per year. "Today people are broaching it with me."
These changing perceptions are in part due to a series of positive studies in recent years. In one, 78% of 283 severely depressed people reported a significant reduction of symptoms and a better quality of life six months after ECT.
While only some of those patients experienced complete remission, they were all measurably better off.
"Electroconvulsive therapy remains one of the most effective treatments we have to treat depression," says Mark Frye, MD, director of the Mood Disorder Program at the Mayo Clinic, in Rochester, Minn. "Response rates for ECT are consistently higher than response rates generally reported in clinical trials for antidepressant medications. This observation is doubly impressive knowing that patients who today receive ECT typically have failed two or more antidepressant medication trials."
Feeling a "gradual lifting"
Some patients who have tried ECT say they are proof that the studies are not a fluke. Jim Hawkins, 78, of Rockville, Maryland, saw a number of psychiatrists for his crippling depression but remained in such despair he elected to have ECT. "It saved my life. I had 12 treatmentsthree times a week, four weeks total. After the 12th, I woke up the next day and the was sun shining. It felt good. Suddenly I felt like I was over the depression."
Rather than feeling lobotomized, patients like Jeff, 40, of New York City, say they feel like themselves afterward.
"The effects of ECT weren't immediate. It took a few weeks of gradual lifting of the fog," he says. "Eventually it dawned on me that I was well enough to realize that I didn't want to be a sick person anymore and that there was a life to get back to."
"They say it causes short-term memory loss, but I can't think of too many things on the slate that were wiped indelibly off as a result of the treatment. It may sound sappy, but at some profound level I regained the understanding that I could be the person I was meant to be."
ECT is scary and not always successful
Kathleen Brannon, 48, found the experience frightening, especially the short-term memory loss. "They completely knock you out and paralyze your muscles, so contractions don't break bones and stuff. It's not a small thingit's a very intimidating and frightening process, especially at first. The first few times, it's very scary because when you wake up, you don't know your name, where you are, your family. It's like your mind has been erased. And that lasts for a while, up to a day before it starts gradually coming back to you."
For Joseph, 55, another New Yorker with severe depression who gave ECT a try a decade ago, the results were not good. "It was like nothing to me. I felt nothing, and I didn't get better at all." Surprisingly he doesn't regret the decision. "When you are suffering so much, you are willing to try anything. I was willing to take the chance that it might work."