March 24, 2000 (Washington) -- Electroconvulsive therapy (ECT), or "shock therapy," did not cause long-term memory loss or brain damage in adolescents who underwent the procedure for severe depression, according to a new study.
Shrouded in controversy but believed beneficial by many experts, ECT involves giving electrical shocks to the brain. It has been found to relieve severe depression and other mental illnesses, particularly in people who are not helped by medications. It is usually recommended when people have not improved after trying at least two different medications.
Physicians today take a number of precautions to ensure the procedure is performed safely. Patients are usually given a short-acting general anesthetic and a muscle relaxant before undergoing the treatment, which can be done in an outpatient center. In the past, patients could be hurt or suffered discomfort because they were awake during the procedure, which helped to create the poor image of ECT that many people still have today. And despite popular beliefs, many studies show people who have ECT do not suffer any long-term memory loss or other brain impairment.
The new study is one of few, if not the first, to look at the effect of ECT in teen-agers. The researchers combed through the records of five psychiatry departments in Paris for patients who were given ECT for a mood disorder before they were 19 years old. Only 20 such patients were found, and 10 participated in the study. These patients typically had a total of 10 treatments, which were performed two or three times a week. At least one year had elapsed since their last treatment. They were compared with 10 people who had not received ECT but were matched by sex, age, date and place of hospitalization, and diagnosis.
After being given more than six tests that measure brain functioning and memory, the researchers concluded that there were no significant differences between the teens who had ECT and those who didn't -- and that, intellectually, both had progressed normally for their age. Only one patient made serious complaints of memory loss and one had minor complaints, indicating memory loss could be a very rare occurrence. However, many experts believe this could be unrelated to the ECT, and could possibly be a side effect of anesthesia or a symptom of depression itself.
David Cohen, MD, the lead researcher, tells WebMD he was not surprised by the findings because they mimic studies in adults that also found few lingering effects on the brain after ECT. "We had an idea it should be like in adults. Adults usually do [retain] their memory. Sometimes they have spotty memory losses from the period immediately after the ECT." Cohen is chief of the department of child and adolescent psychiatry at the Groupe Hospitalier Pitiè-Salpètrière in Paris.
Cohen says fears about the use of ECT in youth "are not justified" and that some misunderstanding of the procedure comes from a lack of recognition of the severity of patients' illnesses. When it is used appropriately, the benefits are enormous, Cohen says. "When ECT works it is unbelievable; it is like a miracle. Most of them, they were like zombies before the treatment. Usually what they can do after the ECT is what they could do before they became ill."
He adds that in France, there are no restrictions on who can receive the treatments, in contrast to the U.S. Several states forbid the use of ECT for people under age 18.
"This is a problem, because I know of some extreme cases where patients should have had ECT and could not," Cohen says.
Several psychiatrists who reviewed the study for WebMD said it was instructive and well done. The study indicates that most of the time, the most effective treatment for the most severe form of depression is safe and does not cause brain damage, according to Alec Bodkin, MD, an assistant professor of psychiatry at Harvard School of Medicine. "It is important to be sure that the intuitively obvious thing is the case, which is that this is at least as safe in adolescents as in adults." Bodkin is also affiliated with McLean Hospital in Belmont, Mass.
Bodkin notes that the small study size indicates that in France, as well as in the U.S., ECT is underutilized in teens as well as adults. "ECT should be used more readily than it is. It works much more quickly and often more effectively than medications," says Bodkin. He adds that the procedure can be especially beneficial to teens, who often do not take their medications.
"I have had inpatients who were fiercely, fiercely ill, who were less than 20 years old, for whom ECT was necessary and who were helped by it," says Bodkin. "You cannot parent someone out of the need for ECT."
"This is the first good study that shows ECT in adolescents does not cause long-term memory problems," says Martin Szuba, MD, assistant professor of psychiatry at the University of Pennsylvania and director of the ECT program for the university's health system.
"ECT is grossly underutilized in adolescents," Szuba says. "Whether we like it or not, adolescents do develop severe depression and they do kill themselves, and there should be another treatment to offer them" beyond medications. "ECT can save lives."
Another physician had a more tepid response to the study. "They say that two out of 10 had [memory] complaints. ... That's about what you would expect in adults," says Mitchell S. Nobler, an assistant professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. "They are trying to say that it is safe because they did not find impairment [of their memories and thinking]."
But Nobler says that he would have preferred testing aimed at their recall prior to the ECT, which is more commonly impaired after ECT. He also feels that the researchers relied on the adolescents' recollection, which is not always reliable.
Cohen does make an important point, however. "In the article, we did not include the school evaluation we did, because of space, but the ECT and non-ECT groups had the same school evaluations. So they were able to continue their educations [after the treatment]."
- Electroconvulsive therapy (ECT), giving electrical shocks to the brain, is a quick and effective way to treat patients with severe depression who do not respond to medications.
- Adolescents who undergo the procedure do not experience any long-term memory loss or brain damage, according to a new study from Paris.
- Some experts say that ECT is underutilized, and several states in this country forbid the use of this therapy among adolescents.