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CTV Mental Health Specialist
[Deborah Shiry: Shock therapy]
CTV, Canada
December 2002
Hear the words shock therapy and you might think of Hollywood movies depicting barbaric treatment of patients trapped in asylums. But shock therapy has come a long way.
And now as physicians look for more aggressive ways to help patients with a persistent mental illness, a growing number are returning to this controversial therapy.
The Canadian Psychiatric Association endorses shock therapy, recommending it "remain readily available as a treatment option". But critics, such as Barbara Everett of the Canadian Mental Health Association (CMHA), says shock is overused, under-regulated and should be a last resort.
"The idea of putting electric current through your brain is not considered a new millennium treatment. I think it's frightening for people and it's considered a backward kind of way of dealing with things," Everett says.
Critics aside, shock therapy is a first-line treatment for Doug Boyce. Boyce suffers from Parkinson's disease and depression and believes the controversial therapy has made a huge difference in his life.
"I definitely think these treatments have helped me," Boyce says. "Before I started treatments I was basically in a wheelchair."
Shock therapy is part of Boyce's routine. He's been getting the treatment every three weeks for the past five years. He says they've helped alleviate his Parkinson's symptoms of palsy and rigidity, and improved his mood.
The technical name for this treatment is electroconvulsive therapy, or ECT. Although it's been used since the 1930s, no one knows exactly how it works. What is known is that after being discredited as quack science for years, shock therapy is now back in vogue, up as much as 50 per cent in the last five years alone, according to some estimates.
Psychiatrist Douglas Grover estimates he's done nearly 15,000 ECT's during his career.
"I still marvel at the response rates that we get and it's very gratifying because it works so much faster than medication," Grover says.
According to Grover, while antidepressants can take up to two years to work, ECT is immediate and effective. It's for this reason that Grover believes shock is increasingly being considered as a first choice in the treatment of a wide variety of disorders.
Grover says, "ECT has jumped the queue so to speak and is considered much earlier in the treatment protocol now."
ECT a modern therapy
ECT is used as a treatment option for disorders including depression, anxiety, eating disorders and psychosis. And now ECT is also available for patients who suffer from Parkinson's.
"As we understand the biochemical mechanisms of ECT it should help Parkinson's disease," says Grover. He says about 50 per cent of people with Parkinson's develop depression.
"In my experience this works. It is truly a marvel for these terrible, terrible illnesses."
Grover says Hollywood has done a disservice to ECT with movies that show brain numbing procedures without anesthetic, and often without patient consent. "Many people are left with very graphic visual images of One Flew Over the Cuckoo's Nest in 1976 with Jack Nicholson, which really reflected ECT of 20 or 30 years before that."
But Grover insists ECT is now a modern therapy. "We've come a long way. We negotiate treatments with patients now. We try to get informed consent. We try to involve the families in the process," Grover says.
While no one knows for sure how shock works, psychiatrists believe the electrically-induced seizures are the critical component of ECT. It's thought that these grand mal seizures alter brain chemistry and elevate calming hormones like seratonin, dopamine and noradrenaline.
Side effects, such as memory loss, are common. But advocates insist lower doses and careful monitoring make the treatment safe. Not everyone agrees.
Everett, of the CMHA, calls ECT a radical treatment in need of more checks and balances.
"It is now utterly commonplace and I don't think the public knows that and its usage is on the rise and there are no studies that tell us who gets better as a result of it, who says they're not getting better as a result of it. There's no examination of the prescribing practices for ECT and we need to understand this particularly when it is such a controversial type of treatment," Everett says.
Everett also has some reservations about ECT being used as a first step in the fight against mental illness, saying it should be saved as a last resort.
"ECT to my mind resides in the area of a radical type of treatment," Everett says.