Shock Therapy: No Longer So Shocking
ECT as Depression Treatment Is Neither Curse nor Cure
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Why Consider ECT?
Even so, why would anybody risk ECT? It's easy to justify for patients who are so extremely depressed they can't feed themselves. But ECT also offers hope to patients whose lives have been ruined by moderate-to-severe depression.
"Most commonly, it's someone who is clearly miserable and nonfunctional socially and occupationally," McCall says. "They are not threatening to kill themselves today. They are eating. But their life is a wreck. They cannot work, they cannot do anything to keep the house clean, they are not bathing, they are not changing their clothes. And if the patient has failed to respond to three or four medications and psychotherapy, something has to be done. And that something is ECT."
Many patients get low-dose ECT every other week, says William McDonald, MD, director of the Fuqua Center for Late Life Depression and chief of geriatric psychiatry at Atlanta's Emory University. It's called maintenance ECT.
"Keeping people well is what we are trying to do," McDonald tells WebMD. "What ECT does well is put people in remission -- not just response, but remission -- at very high rates. You are talking about 70% to 80% remission. And these patients are a very difficult-to-treat group. This is really positive."
Patients Say ECT Improves Life Quality
McCall and colleagues at New York's Columbia University looked at 283 depressed patients treated with ECT. Using standardized questionnaires, they asked them whether the patients' lives were better or worse after ECT.
"The findings were mixed. But after treatment, 87% said ECT improved their quality of life," McCall says. "Six months out, 78% rated their quality of life as improved. At that time point the memory loss had cleared up."
McDonald says the study findings support his own experience in treating patients with ECT.
"McCall is pointing out that when people get ECT over time, their quality of life improves," he says. "People actually start feeling better about themselves. It's not just that their psychiatric depression score goes down -- they are better able to function in society and in life."
ECT isn't anything like a perfect treatment. But McDonald says patients travel several hours to get the every-other-week treatment. Clearly, it's extremely valuable to them.
McCall says there doesn't seem to be any upper limit on how many ECT treatments a person can have. But as the number starts to get high, McDonald says, doctors worry about whether there will be cumulative effects.
There's a lot of research into alternative treatment strategies. Eventually, McDonald predicts, science will come up with appropriate treatments for many of the very different kinds of depression.
"What is really happening in psychiatry is neuroimaging, and being able to type people from brain scans and genetic testing," he says. "Psychiatry is moving on this. When psychiatry uses these tools to identify which treatment works best for which subtype of depression, it will be a huge move forward."