The Positives and Negatives of Shock Therapy
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"While it is not a trivial procedure, what people don't understand is that the procedure is done under general anesthesia, and patients are unconscious," he says. "They are given muscle relaxants, so it can be hard to tell a patient is even having a seizure."
Glass says the study shows the importance of prescribing drug therapy after ECT and how it contributes to the overall effectiveness of the procedure.
"What the study shows is that in people who receive ECT, almost everyone will relapse unless they receive aggressive drug therapy," says lead researcher Harold A. Sackeim, PhD, chief of the department of biologic psychiatry at the New York State Psychiatric Institute in New York City.
In the study, 290 patients who completed ECT treatment received either the tricyclic antidepressant Pamelor, a combination of Pamelor and lithium, or an inactive placebo pill. Eighty-four percent of the patients who received the placebo had a recurrence of depression, while 60% of the patients on Pamelor alone had a recurrence. Only 39% of patients who received the lithium/Pamelor combo had a return of severe depression, according to the study.
Sackeim believes relapse after ECT can be cut even further by continuing ECT treatments beyond the standard three-week cycle, tapering the treatments as time goes on. Starting patients on medication at the time of ECT can also help, though he notes that patients should not receive lithium simultaneously with ECT.
ECT practitioners who reviewed the JAMA article say the recommendation makes sense.
"ECT is the only treatment in psychiatry that we give until the patient stops showing symptoms, even though we have known for 65 years that that doesn't work very well," says Max Fink, MD, professor emeritus of psychiatry and neurology at the State University of New York in Stony Brook.
It is reasonable for patients to continue to receive ECT once a week for as long as six months, Fink tells WebMD, in combination with antidepressant medication.
Today, Swan counts herself lucky to be receiving aggressive drug therapy for her bipolar disorder. A volunteer for the National Alliance for the Mentally Ill in Cuyahoga County, Ohio, Swan urges patients to know as much about ECT as possible -- especially side effects like amnesia -- and to consult more than one physician before undergoing the treatment.
"It's a very important decision and not something you jump into because you feel like it," she tells WebMD. "You need to be an educated consumer."