A Shockingly Effective Treatment for Depression

Jan. 29, 2008 — -- I have been taking care of many severely ill patients with depression and bipolar disorder over the past month, patients hospitalized on the mood disorders service at Johns Hopkins Hospital. Three of these patients have had outstanding responses to ECT, or electroconvulsive therapy, also known as "shock" therapy.

Two of them came in hopeless, intensely miserable, and preoccupied with ending their lives, while the third came in with a depression so severe that it shut her down entirely — she was mute, not able to respond to my questions or even recognize that I was in the room with her.

The three of them all look happy and cheerful now, and feel very grateful for having been made well again.

The challenges that their depressions created in their lives — disruption at work and school, and damaged family and social relationships — now seem surmountable, given their new energy and confidence.

While in the minds of some patients and their families ECT remains scary and controversial, the reality is that it is the most effective treatment for clinical depression, and it is a well-studied, safe medical procedure.

I know it looks cruel and punitive as it is depicted in the 1975 movie "One Flew Over the Cuckoo's Nest," but that's Hollywood — that's fiction — rather than an accurate rendering of ECT as we use it in psychiatry today.

The most important thing to know about ECT is that it works 75 percent to 80 percent of the time in treating people with depression, while any given antidepressant medication works about 60 percent of the time.

As with most of our treatments in psychiatry, we do not know precisely how ECT works, though we have some clues.

We know that ECT causes a seizure — an electrical storm — in the brain, and that this seizure is necessary for ECT to have its therapeutic effect. The seizure seems to reboot the emotional machinery of the brain, in the same way that pressing Ctrl-Alt-Delete on the computer can sometimes provide a fresh start when the digital computer brain is stuck.