A Shockingly Effective Treatment for Depression

The side effect of greatest concern is memory problems. In the same way that rebooting the computer can cause the loss of whatever the computer brain was working on at the time, so ECT commonly causes loss of memories around the time of the treatment. It is important to consider the context here. I have had patients tell me that this was not bothersome because they did not particularly want to recall the horrible feelings they had that led to the necessity of ECT.

On the other hand, the memory problems can extend further, leaving gaps in the period up to six months before ECT and up to two months after it. This effect is more pronounced in people undergoing a form of ECT called "bilateral" ECT, in which the electricity is run through the whole brain, than in the form called "unilateral," in which it is run only through the right side. For this reason, unilateral is the form generally used. For those who experience this memory loss, the memories generally return gradually, over a period of about six months.

Patients typically find they are able to compensate for memory gaps using strategies such as taking more written notes, or relying on friends or colleagues to remind them of things.

Many patients have described how memory difficulties are a price worth paying for relief from devastating and debilitating depression. Kitty Dukakis, wife of former presidential candidate Michael Dukakis, is among them. She relates how ECT changed her life for the better in her book "Shock: The Healing Power of Electroconvulsive Therapy."

The other important downside to ECT that patients need to be aware of is that while it restores many patients to wellness, it does not necessarily keep them well. There is a need for continuing treatment to give people the best possible chance of staying depression-free.

One study showed that either putting patients back on antidepressant medications, or continuing to do occasional ECT treatments (called "maintenance" ECT), led to two-thirds of patients staying well over the next six months. The rate of wellness over that period in patients with no treatment was only 16 percent.

ECT is far from perfect, but it is the most effective treatment we have for serious depression. I wish you could see the bright and optimistic looks on the faces of the three women whom we brought back from the brink this month.

Dr. James Potash is an associate professor of psychiatry and co-director of the Mood Disorders Program at the Johns Hopkins School of Medicine in Baltimore. If you have questions or comments, please e-mail at moods@jhu.edu. To participate in our genetic and clinical studies, call 1-877-MOODS-JH.

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