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October 23, 2006
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Electroshock therapy still around, and some say it works.
From: State (Columbia, SC) | Date: October 20, 2006
Byline: Linda H. Lamb
COLUMBIA, S.C. _ It's a humid, overcast morning when Marcia Hudson heads to the hospital for a treatment most people would be surprised to know still exists.
Reclining on a gurney with white cloths tucked around her, she will be rolled into a bright room at Palmetto Health Baptist hospital. She will chat with the doctors and nurses attending her. She will be sedated and have electrodes attached near her temples.
When she's asleep, a doctor will press a button and for a fraction of a second, an electrical stimulus will pass into her brain.
Yes, electroconvulsive therapy or ECT _ formerly known as electroshock _ does still exist. About 100,000 patients will have these treatments in the United States this year.
If you're already picturing a horror movie, or "One Flew Over the Cuckoo's Nest," you might be surprised to know Hudson calls ECT "a blessing" that helped her conquer crippling depression when nothing else worked.
"I was feeling hopeless, totally hopeless," said Hudson, 62, of Laurens County, S.C. While struggling in the aftermath of her stepson's suicide, she became immobilized by sadness and anxiety.
"I just could not function," she said. "I felt numb, I couldn't think, couldn't put one foot ahead of another."
The antidepressant medications that help many people were not helping her, and she felt that talk therapy was a dead end. That's why she sought out ECT early this year.
Despite some resulting problems with her short-term memory, she credits the treatments with helping her feel balanced and creative again.
"I think it's an option that people don't know about," she said.
Doctors who use ECT say that for some people _ especially older patients who are severely depressed _ it's an option that can save lives. They say the treatments have changed significantly over the years thanks to improved techniques, smaller jolts of electricity and the use of anesthesia and muscle-relaxing medications.
There's even a new celebrity testimonial to the benefits of ECT: Kitty Dukakis, wife of the former Democratic presidential candidate, has written a book about how ECT saved her from decades of depression ("Shock: The healing power of electroconvulsive therapy").
But that doesn't mean the subject is no longer controversial.
Juli Lawrence, 46, says ECT did not cure the depression she developed while dealing with job troubles and a difficult divorce. Worst of all, she said she's still trying to cope with cognitive problems following the treatments, which she had in 1994.
"The one thing that really stands out is that some of my math abilities have disappeared," she said. "Math has always been something I loved and I was exceptional at."
Now she can't balance her checkbook, said Lawrence, who lives on Long Island, N.Y., and operates a Web site critical of ECT (www.ect.org).
Another former ECT patient, Andy Behrman, was bemused to find himself an ECT poster boy after writing a 1999 New York Times essay about how it helped him regain control of a life ravaged by bipolar illness. When he wrote a verbally hyperactive book about his experiences, he titled it "Electroboy: A Memoir of Mania."
Behrman credits ECT with breaking his manic cycle. He'd been living in fast-forward, hopping planes from his Manhattan home to London or Tokyo on a whim, spending money like crazy and eventually getting into legal trouble. Now, at 44, he lives in Los Angeles and is happily working on a movie based on his book.
Electroconvulsive therapy "was a last resort for me _ 37 medications had failed me," he said. But his 19 ECT treatments caused confusion and memory lapses he found frightening and humiliating.
"Electroboy" said he doubts he would have ECT again.
NOT THE FIRST OPTION
On the other hand, who wants to cherish memories of being paralyzed in dark depression, or being obsessed with thoughts of suicide? Up to 15 percent of seriously depressed people end up killing themselves, according to the National Institutes of Health.
Some patients say brief periods of confusion, even memory gaps that persist for years, are a worthwhile tradeoff for the ability to go back to living their lives.
"The people who are selected for ECT today are those who are significantly, suicidally depressed," said Dr. Kenneth Huggins, a psychiatrist who administers treatments for Hudson and others at Palmetto Health Baptist.
"We don't take a person who is depressed and give them ECT to start with," he said.
Typically, Huggins said, doctors will try various medications and therapies for patients who are sad, anxious or depressed. ECT might be considered if patients seem perilously close to suicide, have a serious reaction to medication, or are so ravaged by depression that they cannot take care of themselves.
"ECT has saved my life a few times in the last three years," said Kathleen Kain, 48, of Columbia, S.C.
"Psychiatric medications are great, but my body can't tolerate them because I get severe side effects," she said.
Kain, trained as an engineering scientist, has struggled with bipolar illness for years and currently is on disability. She said she has attempted suicide half a dozen times. She thinks "horror stories" about ECT keep patients from trying it.
Another Columbia woman, who asked that her name not be used, said she fears she would be stigmatized in her government job if people knew she had had electroconvulsive therapy.
But the treatments jolted her out of two decades of depression, she said.
"About four years ago, I just kind of lost it," she said. "I called my doctor and said, `Get me a room at the hospital; I'm on my way.'
"After 10 days in the hospital, I came home and I sat on the couch for two and a half months. I just stared at the TV. I didn't go anyplace but the doctor. I withdrew."
She had tried medications, group therapy and psychoanalysis. Finally, she agreed to try ECT. Now she is back at work, coping with some short-term memory loss by making notes to herself.
"I did that before, but I do it more now," she said with a laugh.
"The fatigue is gone; (I) can think ... it's like all of a sudden, a light went on."
Huggins, who teaches a course on electroconvulsive therapy at the University of South Carolina School of Medicine, said ECT was developed in the 1930s.
Doctors had observed that when epileptics had seizures, or when people had fever-related seizures, depression symptoms often improved. They tried triggering seizures with electric current for a similar effect.
"Your brain is an electrical organ in delicate balance," Huggins said, adding that it's not clear why ECT may help depressed patients. He thinks the best theory is that the stimulus triggers release of brain chemical that functions as a powerful antidepressant.
According to the 1999 Surgeon General's Report on Mental Health, no controlled study has shown any other treatment to be superior to ECT for depression. However, it fell out of favor for several reasons, Huggins said.
One is that before psychiatric drugs, ECT was tried for all kinds of mental disorders _ and in most cases, it didn't help.
Also, patients suffered serious memory loss and brutal seizures. Some patients convulsed so violently that they broke bones, Huggins said.
Actor Jack Nicholson in the Oscar-winning, 1975 "Cuckoo's Nest" grimaces painfully during an electroshock treatment.
"He did a great job. That is exactly the way it looked, back in the '50s," Huggins said.
View the film carefully and you'll notice Nicholson's character is affected little by his ECT. But at the end of the movie, he's had a surgical procedure called a lobotomy that leaves him completely senseless. Interestingly, people remember that horrifying image and associate it with ECT.
"That was probably one of the most influential movies in the history of psychiatry," said Dr. Milton J. Foust Jr. of the Medical University of South Carolina.
Besides the two Palmetto Health hospitals in Columbia, MUSC in Charleston is the only other place in South Carolina where ECT is administered. Foust said negative media portrayals of ECT run counter to his observations at MUSC, especially of gravely depressed, older patients. "Those kind of patients respond exquisitely well to ECT," often showing great improvement after only a few treatments, he said.
The brief pulse of electrical current is as little as one-third as powerful as what was used decades ago. With the use of anesthesia and muscle relaxants, the only sign of a seizure might be a slightly twitching hand or toe and the printout of an EEG (electroencephalogram, which measures brain activity).
Resulting memory loss "typically is not going to have any serious effect on the person's ability to function," said Foust, an assistant professor of psychiatry.
The National Institute of Mental Health says lasting memory problems are less troublesome than in the past, but advises patients to weigh the benefits and risks carefully before having ECT.
Patients usually receive eight to 12 treatments, two or three a week. Initially some receive the treatments while hospitalized. Hudson and Kain receive outpatient "maintenance" treatments.
More than 100 patients receive ECT in Charleston each year, about 225 a year at Palmetto Health Baptist and 60 at Palmetto Health Richland.
DECLINE AND COMEBACK
Use of ECT declined with the emergence of anti-psychotic drugs and antidepressants in the 1950s. According to medical journals, the treatment has made a bit of a comeback in recent years. But positive accounts of ECT have been controversial, such as Martha Manning's 1994 book "Undercurrents: A therapist's reckoning with her own depression."
"Nobody bats an eye when electricity is delivered to a stalled heart. ... But try talking about the same thing with the brain, and it's no miracle," Manning wrote. "Suddenly, words like torture and mind control populate the descriptions."
Some experts believe other forms of brain stimulation will replace ECT to treat the 15-20 percent of depressed people who do not respond to medications and psychotherapy.
Proto, the magazine of Harvard University-connected Massachusetts General Hospital, recently touted "less shocking alternatives" of vagus nerve stimulation, transcranial magnetic stimulation and deep brain stimulation. It proclaimed cheerily that these treatments are "sure signs that electroconvulsive therapy has flown the cuckoo's nest."
But Dr. Mark George, a renowned brain researcher at MUSC, noted that two of those techniques involve surgery and none of them are widely available. Though very promising, they are not appropriate for an emergency in which a depressed person is not eating or is suicidal, he said.
George said research is being done at MUSC and elsewhere to try to bypass or limit the cognitive problems of ECT _ for example, to deliver energy inducing a seizure without passing through the part of the brain that affects memory.
"I don't think ECT will ever fall into disuse, not in the next 10 to 15 years, for sure," George said.
"ECT, with all its problems, is still a lifesaver."
Electroconvulsive therapy, or ECT, formerly was called electroshock or shock treatment.
For most patients, medications for mental illness are more likely to
be used than
Studies show ECT can be highly effective for severe depression, some psychotic states and mania.
A brief pulse of electric current passed through one or two electrodes causes a generalized brain seizure.
Possible risks from ECT include confusion, memory loss, headache, hypotension (a type of low blood pressure), rapid heartbeat and allergic reaction to anesthesia.
Cost of a typical course of ECT (eight to 12 treatments) is about $10,000 to $17,000, usually covered by insurance.
To view a video presentation of one woman's experience with ECT, visit www.mayoclinic.com/health/electroconvulsivetherapy/MH00022.
SOURCES: Surgeon General's report, National Institutes of Health
(c) 2006, The State (Columbia, S.C.).
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Bipolar disorder - as the name implies - involves two distinct set of symptoms. One set throws the individual down into the depths of a massive depression. The other places the individual who suffers with bipolar disorder at the top of a peak manic episode.
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