TAKING THE SHOCK OUT OF ELECTROSHOCK

by Joannie Schrof Fischer
US News & World Report, January 24, 2000

At age 63, the native New Yorker knows she has a wonderful life. After all, she has a sweetheart of a husband, gorgeous grandkids, and a pack o fun-loving friends. That's why, after months of medication failed to stop her suicidal thoughts, she asked her husband to drive her to Hillside Hospital on Long Island. There, last Thursday at 10 a.m. she was put to sleep and given a dose a electroconvulsive therapy, or ECT. Five minutes later, she woke up from the anesthesia and from her persistent comalike depression. "Thirty years ago, I was afraid to get ECT," she recalls. "This time, I begged for it."

The procedure she feared a generation ago and the one she's eager for today are hardly the same treatment. More than 100,000 patients receive ECT each year and according to this month's American Journal of Psychiatry, the latest refinements of ECT are producing consistent and dramatic results. Yet despite her appreciation, despite the surgeon general's recent endorsement of the therapy, and despite the fact that no other depression treatment has ever beaten ECT's 70 percent to 90 percent success rate, this patient will not give her name. 'You should see the look in people's eyes when I tell them," she says. "They think I'm a freak, like Frankenstein, so I've learned to keep it a secret."

In some ways, Jack Nicholson is to blame. His 1975 portrayal of a patient subjected to a 1940s form of ECT in One Flew Over the Cuckoo's Nest created an enduring image that is graphic, compelling -- and misleading. For instance, Nicholson's character, Randle McMurphy, was awake; today's patients receive a short-acting sedative and sleep. McMurphy was held down by a half-dozen men in white coats while he convulsed violently; now, patients take a muscle relaxant and lie mostly still. Large white mitts sent jolts of electricity coursing through MeMurphy's body; today, quarter-size patches deliver a current of between 0.5 and 0.9 amps, far less than, say, the 20 amps in a typical living room socket. The average patient today receives between six and 12 sessions of ECT.

But even though modem ECT is a far cry from the barbarism of a half century ago, the controversy lives on. Although a recent Mayo Clinic study found that 91 percent of ECT patients say they are glad to have received it, a small but vocal group of patients claim that ECT has robbed them of their memories. Because of such bad publicity over the years, many medical centers have dropped ECT entirely. Today, few public or rural hospitals offer the treatment, and many doctors-in-training never even learn how to perform the procedure.

Memory loss. That is not to say that all concerns are unfounded. Like many treatments, says Columbia University's Harold Sackeim, ECT can have untoward side effects-especially memory loss, which is usually temporary, but not always. To this day Larry Wilson, a 54-year-old retired banker, has no recollection of the birthday bash his wife threw for him two years ago. But he says he doesn't mind: "The side effects of Prozac, like sexual dysfunction and nausea, seem worse to me than forgetting a few things." Sackeim and others are searching for ways to eliminate such side effects altogether. Until that happens, ECT will remain a treatment only to be used after psychotherapy and drugs have failed to alleviate a life-threatening depression.

Even though it's commonly called shock therapy, it's not the electricity that is therapeutic in ECT but the seizure-a rapid firing of neurons in the brain. If scientists can find a safer way to trigger those seizures, they can do away with the electricity. Some are trying to develop extremely powerful magnets that could be focused like a laser beam on particular groups of brain cells. Others are experimenting with a new technique called Vagus Nerve Stimulation, in which a tiny pacemakerlike device stimulates a nerve running through the neck to the brain. Texan Joanne Tesoriero is trying VNS now, even though a recent course of ECT successfully rid her of suicidal impulses. "I have no doubt that ECT saved my life, but I quit because I couldn't quite stomach the idea of it," she concedes. "I know it's silly, but I'm haunted by the sense that it's this primitive, inhuman thing."