Monday, July 14, 2008


ECT (electroconvulsive therapy) is a hospital procedure in which the patient undergoes general anesthesia, after which an electric current is passed through the brain using externally-applied electrodes. In order for the treatment to work, a generalized seizure must be induced by the current.

This treatment arouses a lot of strong feeling and controversy in the public.

In my opinion, ECT can be almost miraculous in how well it works. There are a few instances in my career in which I have watched someone who had languished in a severe depressive state for months, wasting away, despite the intense caring efforts of family, nursing, perhaps many other types of treatment -- in these cases it appeared that the person was about to die from malnutrition. Sometimes it was believed that these individuals were in fact dying of "natural causes" or were simply elderly and terminally ill.

I can remember instances of clinical situations like this in which ECT caused the person to have a complete recovery from such a state. Truly miraculous. And no complaint of ECT-induced side-effects either.

ECT is used only for very treatment-resistant depression nowadays. It can also work particularly well for individuals who have depression with psychotic features (i.e. they have symptoms such as hallucinations or delusions with their depression). It can also work well to treat severe manic states.

Unfortunately, individuals in the treatment-resistant depressed group less frequently respond to any new therapy (though it is important to continue the search until something is found that works!). So when ECT is used in a treatment-resistant population, even ECT may not work. The people who have had ECT yet remain unwell may feel worse still. It is much like cardiac disease (in fact cardiology is one of the other branches of medicine in which a radically effective treatment, such as cardioversion, involves a carefully applied electric current passing through human tissue)--in chronic cardiac disease, the disease may worsen despite best efforts. The best treatment may not work, and the patient may even do worse afterwards. Likewise, with ECT, sometimes it does not work.

Yet the evidence does show that it has an important role in treating severe, resistant depression. It can sometimes work miraculously well. It is not without side-effects, but a careful look at the evidence will show that sustained measurable cognitive side-effects are uncommon. A recent article demonstrated some possible cognitive side-effects attributed to ECT in bipolar patients. Yet these side-effects were subtle, and quantitatively far less severe than the symptoms of the primary mental illness.

Ironically, ECT is also an anti-seizure treatment. ECT treatments cause the brain to subsequently be more resistant to having a seizure. It is sometimes used to treat seizure disorders. It is ironic this way. People need to acquaint themselves with what the research shows on this subject, and not assume in advance that an invasive treatment such as ECT must cause tissue damage. There is even some evidence that ECT treatments promote the growth of new nervous system tissue, rather than cause tissue destruction. Once again, I invite the reader to study the evidence. There is certainly no one who has an agenda to profit from giving or promoting ECT (independent of it being an actual helpful treatment), so I can't see any reason for bias in the evidence; ECT equipment is not expensive, there are no huge drug companies at play here, there is no one earning a fortune giving ECT, and there are long waits for patients needing anesthesia or psychiatric care for other reasons.

I do not mean to celebrate ECT as a perfect treatment. It certainly is not. But I think it has been demonized in the public, perhaps causing many people to rule out a therapeutic possibility that can be remarkably effective, often life-saving.

1 comment:

Anonymous said...

I've had ECT and it certainly is demonized by the public. It was life saving and definitely worth the side effects.