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Shock Therapy: No Longer So Shocking

ECT as Depression Treatment Is Neither Curse nor Cure

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Feb. 15, 2006 - Shocking news: Shock therapy for depression isn't evil.

Shock therapy makes many of us -- and many mental health professionals -- think of Jack Nicholson being zapped into oblivion in the movie One Flew over the Cuckoo's Nest. Even the real name for the treatment is scary. ECT: electroconvulsive therapy. How can this be good?

The answer, a new study shows, is that ECT can restore quality of life to people devastated by severe depression. Study leader W. Vaughn McCall, MD, leads the department of psychiatry and behavioral medicine at Wake Forest University School of Medicine.

"To take a universal, damning approach to ECT -- to say it ruins everybody's life -- is just not supported by this data," McCall. "The majority of patients in our study said they were better off after ECT. That is the importance of this study. It refutes global claims that this is a life-destroying treatment."

The study appears in the February issue of the Journal of Affective Disorders.

ECT: The Not-So-Shocking Truth

McCall says ECT is not a cure for depression. Its effects wear off. He'd never use it unless psychotherapy and medication failed to bring a patient back from the depths of depression. He's quick to point out the treatment's shortcomings.

"There are a lot of reasons not to do ECT. But people think it is painful, bone breaking, and brain damaging. That is not the case," McCall says. "The reason to be concerned is that it is costly. It is a hassle -- you can't do it at home. And it is not permanent. Even if you get a great result, it may not stick."

And, McCall is quick to point out, there is short-term learning difficulty and permanent memory loss.

"The patient may be left with some permanent memory loss of the time immediately before treatment," he says. "You will not forget your name, growing up, or getting married. But you may forget what happened at Thanksgiving. For example, when counseling patients getting ready to take a two-to-three week course of ECT on March 1, I'd tell them they might have difficulty learning new things for a few weeks. And they may have memory loss for early March, February, and January."

There are rare cases, McCall says, where patients say that ECT erased most of their memory. But if this really does occur, it's never been seen in a research study.

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."

Show Sources

SOURCES: McCall, W.V. Journal of Affective Disorders, February 2006; vol 90: pp 269-274. W. Vaughn McCall, MD, professor and chairman, department of psychiatry and behavioral medicine, Wake Forest University School of Medicine, Winston-Salem, N.C. William McDonald, MD, director, Fuqua Center for Late Life Depression; chief, division of geriatric psychiatry, Emory University School of Medicine, Atlanta.
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