Does shock therapy work?

Many psychiatrists and patients are supporters of shock therapy because of the startlingly quick changes it usually produces.

Shock therapy lifts 70% to 95% of patients out of depression, according to most studies. That compares favorably with the most popular anti-depressants: Prozac (51%) and Zoloft (59%), according to a recent study of those drugs.

And shock therapy often seems to work on people who don't respond to drugs. It's also frequently used on high-risk patients - the elderly, those with AIDS, multiple sclerosis, Alzheimer's, pregnancy, even heart transplants - who should avoid anti-depressants because they could interact badly with other medications.

But, unlike drugs, shock therapy's benefits fade quickly.

Researchers have been unable to document any anti-depressant effect from shock that lasts longer than four weeks - a fact not disclosed to patients in educational literature or consent forms.

The standard measure of shock therapy's effectiveness is the Hamilton Depression Score. A severely depressed person would have a score of 30 or more; a nondepressed person, less than 10.

If, after shock, the depression score goes down, the shock is judged a success.

It's been proven repeatedly that shock therapy lowers the scores.

The American Psychiatric Association information sheet for patients says: "We know ECT works: 80% to 90% of depressed people who receive it respond favorably, making it the most effective treatment for severe depression.''

But the APA doesn't mention that this success disappears as quickly as it comes.

Two controlled studies have been done to track how long shock's effect lasts. The two studies compared depressed patients who were shocked with a similar group who had "fake shock'' - given anesthesia and muscle relaxants but not shocked.

The results:

In a 1980 study, shocked patients' depression scores were 26% lower than patients who received fake shock.

But one month later, there was no difference in depression scores between the two groups. A six-month follow-up also found no difference.

A 1984 study found shock patients were less depressed at two and four weeks than those receiving fake shock. But there was no difference at 12 weeks or 28 weeks.

No study has addressed the subject since. Shock researchers now consider it unethical to do studies with placebos (fake shock) on the grounds that it would be withholding treatment from a sick patient.

Shock therapy is strongly recommended to help suicidal patients.

Electroconvulsive Therapy, the textbook written by the owner of shock machine manufacturer Somatics Inc., says suicidal patients should be shocked as the first treatment, before drugs or other therapies. And a suicide threat is a common justification for giving forced shock to patients who don't want it, under court order, according to University of Kansas sociologist Carol Warren.

But the studies show shock therapy doesn't stop people from killing themselves.

A 1986 study involving 1,494 patients found no difference in suicide rates between shocked and non-shocked depressed patients. The study, published in Convulsive Therapy, then reviewed all previous studies on shock and suicide.

"A close examination of the literature does not support the commonly held belief that ECT exerts long-range protective effects against suicide,'' the study concludes.

By Dennis Cauchon, USA TODAY

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