The body electric

Sep. 28, 2006
The State

The body electric
What’s more shocking — that electroconvulsive therapy is still around, or that some doctors and patients say it really works?
By LINDA H. LAMB

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. 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, including more than 385 in South Carolina.

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.

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.

STILL CONTROVERSIAL

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.

“I don’t know any patient who hasn’t suffered from some pretty serious confusion and memory loss,” he said.

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.

“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, 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.”

‘CUCKOO’S NEST’

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 the state 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.”

Reach Lamb at (803) 771-8454.

ABOUT ECT

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 ECT.

• 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

Comments (7)

TomasOctober 4th, 2006 at 2:16 pm

_All_ subjects interviewed in this article, including those testifying of positive experiences in sum, testify of persisting short-term memory loss and/or persisting long-term memory loss and/or persisting other cognitive deficits. And I thought doctors _knew_ any side-effects were mild and transitory, considering how insisting they are theirs is the electroshock truth.

I am a little tired of this story on the origins of shock therapies being repeated over and over. In reality, the Hungarian physician Ladislaus von Meduna developed metrazol shock therapy (inducing convulsions chemically) on the basis of his theory of epilepsy and schizophrenia being opposed. Ugo Cerletti, later, convinced metrazol shocks were useful in the treatment of schizophrenia, developed electroshock collaborating with Lucio Bini.

http://www.cerebromente.org.br/n04/historia/shock_i.htm

Martha HeltonOctober 4th, 2006 at 8:15 pm

I am currently undergoing ECT treatments and will have my 12th one Friday. From the very first treatment, I felt wonderful, with no trace of depression left. I do have some slight memory loss but consider this fine because I feel so great and CREATIVE!!!!

I have struggled on and off for over 20 years with depression and antidepressants and this has given me a new lease on life!!!!

October 3, 2006

renee whiteApril 25th, 2007 at 9:16 am

I have not felt this good in years!!! So i don’t remember the last two and a half months. well i have a few memories.They are a little scary too.I only had seven ect treatments about four weeks ago. It has taken a few weeks for me to come out of the fog but i’m out which is all that matters!I don’t want to die any more and i’m out of the bed.I can’t believe it!!! GOD HAS ANSWERED MY PRAYERS!!!!!I don’t know if ect will work for everyone i just know so far it has for me.

Debbie MoatsMay 4th, 2007 at 9:54 pm

Thank God for the ECT treatments. I’ve had a struggle with depression for awhile but I had enough. I was going to end my life. Had been on so many meds for depression. I had four healthy boys, a wonderful husband, a nice home, bills were paid, family, freinds and a job. Depression is from both sides of the family. What a curse! I was so desperated. Had heard terrifing stories about shock treatments. After just two tratments I was feeling better. Yes, I don’t remember a month of my life but that was the time I was so depressed that I don’t want to remember. I give all the praise and glory to my God for directing me to the treatments. Unless you have been there, you don’t understand. If you want to die, what do you have to lose anyway? Try it.

jenny schmitzSeptember 10th, 2007 at 9:42 pm

We have all had problems and surely !! Dr.kellner has had it worse off than all of us. Why else would someone single handly destroy someone’s life for a cocktail party conversation??
I imagine he must wake up in the morning, thank God for MECTA, shine his shoes, polish his glasses , invision faulty brain waves, and sail through the day. If he’s lucky, he’s found a non-compliant patient who refuses the straps involved in moving you to the next floor up. Then, and only then, does he have the perfect speciman to conduct electricity through their body in the name of crime, or saint hood.
Charles, you are quite the crusader. I’m sure you are proud of your sacrifices in life. What a trooper you are!!!!

linda leeOctober 14th, 2007 at 6:09 pm

my sister has had problems for over 40yrs it all started when she abused diet meds she is on so many pills now i cant count even a diet pill that her dr gives her well in the last 3yrs ect about every 2 weeks they seem to be distroing her as soon as she starts to feel better its time to go back she cant even get out of bed for over a week i think she would be better of with out them and to have her meds re grouped her family dr has even said the same thing it seems to me a break down every couple yrs is etter than all this toucher all it dose is make her relive the things years ago that she has problems with dealing with she isnt suicidal

Feryal JubranMay 25th, 2008 at 8:47 pm

This could be entirely unrelated but this has been going on for nearly 3 years. I ended a relationship over 2 and a half years ago. Since then, I have been subjected to hell. I don’t understand how he can send electric charges to my body. It is like he is trying to stimulate me and gets upset and goes cucko when I don’t move. He watches me while at work and home.

This is so painful. Could he have put something on me or my home. I read that this can cause seizures. Plase help, the police are clueless.

(Phone number removed – please don’t post your home info online!…Juli)

Living through Hell

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