Electroshock Therapy Gets a Makeover

Despite udpates to the procedure, ECT still stirs debate in the medical world.


July 20, 2007 — -- Amy, a New York resident, had her first electroshock treatment at the age of 72 … and despite the stigma that electroshock is a brutal, outdated procedure for treating psychiatric health, she said it's been a miracle for her.

And it's probably more common than most people believe.

"I started 10 years ago when I was very depressed. I was diagnosed as bipolar. I took medicine -- Prozac, a whole slew of them -- but they didn't help," she said. "Then a psychiatrist told one of my friends that I should have ECT. My friends told me to get ECT. It was the only solution, I couldn't go on the way I was. After ECT, everyone told me it was a miracle."

Amy, who asked that her last name not be used, is now 82 and continues to receive electroshock therapy regularly.

Although she admits that after each procedure she has a headache and her memory is temporarily "a little bit off," she insists that ECT has been a success for her.

"I know there's a lot of negative. I think it's a rather painless procedure. It's wonderful," she said. "If medicine doesn't work, then yes, I would recommend it to someone else."

Since its terrifying depiction in the movie "One Flew Over the Cuckoo's Nest," electroshock, or electroconvulsive therapy (ECT) has changed dramatically. According to doctors who use it, the administration of the anesthetic, changes in the type of electricity used and the way seizures are triggered have transformed the procedure, making it safer and more effective.

The latest clinically available form of ECT, called ultrabrief pulse unilateral, uses a briefer stimulus that lasts for .25 to .3 milliseconds, according to Dr. Sarah Lisanby at the New York State Psychiatric Institute. The difference in the type of electricity used allows doctors to induce seizures with lower amounts of electricity then was previously possible.

"It does away with lifelong memory loss," said Dr. Harold Sackheim, a leading proponent of ECT and chief of the department of biological psychiatry at the New York State Psychiatric Institute. "If there is any memory loss, it's markedly reduced."

Although there are no national reporting requirements for the number of procedures performed, experts estimate that approximately 100,000 patients a year in the United States and several million worldwide receive ECT.

According to Dr. Mustafa Husain, the director of the Geriatric Psychiatry Training Program at the University of Texas Southwestern Medical Center, the newer version of ECT is becoming the standard in practice, particularly at academic medical centers and clinics due to its relatively low amount of adverse effects on the brain.

"We started the new ECT almost a year ago. All of our equipment is now ultrabrief pulse," he said.

Despite support from many well-respected physicians, ECT is still controversial. Critics view the procedure as a dangerous game of Russian roulette that should be banned.

"You hear from people who succeed. You don't hear from people who lost wedding or childbirth memories," said David Oaks, director of MindFreeedom, a nonprofit organization focused on human rights campaigns in mental health.

Dr. Peter Breggin, founder of the International Center for the Study of Psychiatry and Psychology, is a staunch opponent of the practice.

"If you were in your kitchen, touched your stove and got a convulsion, you would be in the hospital. It would be treated as an emergency. You might even be given anti-seizure medication to ensure that you do not get another convulsion," Breggin said. "Psychiatry is the only place where you damage the brain and call it a cure."

Because unilateral ECT is a shock to the nondominant, nonverbal side of the brain, controls a person's intuition, creativity and emotions, Breggin said patients may have a harder time explaining the side effects they might experience.

"So people when damaged on the nonverbal side can't tell you about it. It's a ruse," Breggin insisted. "Ultrabrief pulse unilateral is still damaging the brain, but it's less obvious. It cures by creating a delirium in which the patient is incapable of normal human emotion."

John Breeding, an Austin, Texas, psychologist, is alarmed by the state of the industry.

"The shock industry is the Enron of mental health. If they're honest, and you ask them, 'How does shock work,' they'll say they don't really know," Breeding said.

Oaks agreed.

"They look at a problem as physical -- drug, drug, drug, drug, drug -- then they'll try shock. The system is so oriented toward this medical model approach. Relapse rate is enormous, so what's their answer? Maintenance shock," he said. "What has happened in the industry is that research has discounted people's memories."

ECT experts recognize the controversial history of the procedure and acknowledge the stigma attached to it.

"The stigma affects providers and patients. The treatment is perceived by the public as brutal," Sackheim said. "Undoubtedly people don't receive the treatment, because they're afraid of it. In some cases it's quite tragic because they may not live."

ECT proponents hope that the newer form of ECT will encourage more people to seek the procedure to cure their depression.

"Finding ways to make ECT safer, beneficial, lowers barriers to accessing the efficacy of this procedure," said Dr. Lisanby.

Doctors who use ECT are the first to admit that the complete cure for severe depression still eludes them.

"ECT can be rapidly effective in treating [depression] but always needs maintenance treatment to maintain effects," Lisanby said.

Don Weitz, co-founder of the Coalition Against Psychiatric Assault, a group that opposes the use of ECT, said that the American public is in the dark about its use as a treatment.

"Most people think it no longer exists. When I meet people in the street, they say, 'You're kidding!' And it's increasingly for elderly women," Weitz said. "Two-thirds of people who get ECT are women. This is not a treatment. It always causes brain damage and it targets women."