Wed, Oct 13, 1999
ECT Document Reverberates Over the Internet Copyright

ę1999 The Disability News Service, Inc.
by Leye Jeannette Chrzanowski

When Joseph A. Rogers, the executive director of the Philadelphia-based Mental Health Consumer's Self Help Clearinghouse (MHCSHC), was asked to review a copy of a chapter in the U.S. Surgeon General's report on mental health labeled ¤draft,Ë he was shocked to read that electroconvulsive therapy (ECT) ¤is regarded as a safe and effective treatment for depression.

Generally, such reports from the surgeon general are regarded as state of the art research, and are frequently cited as authoritative sources in media reports and professional journals. According to Rogers, at least the ECT section of the draft report on mental health fails to measure up to previous surgeon general reports on smoking and nutrition.

Outraged by the contents of the draft, MHCSHC issued an Internet alert in late September, warning that ECT's efficacy and safety have not been confirmed as stated in the draft report. The alert urged people to contact the surgeon general because the report endorsing ECT would be published later this year if its contents remained unchallenged. The result? The alert garnered national and international media attention. The New York Times, the Newark Star Ledger and Reuters news agency published articles about the draft report, and the office of the surgeon general was swamped by faxes from angry advocates denouncing the endorsement of ECT.

¤I hope you understand that is not the surgeon general's draft report,Ë said Damon Thompson a spokesman for the office of the surgeon general, when interviewed on October 12. ¤It is one section of a small portion of proposed language that was given to a person for peer review,Ë asserted Thompson. ¤There is no report yet, and we're still very much in the process of reviewing and revising.Ë

¤You know what it's like when you turn on the light in a room full of cockroaches and they scurry for cover? That's what it's like,Ë says Rogers, who also questions the limited and questionable sources cited in the document.

The most frequently cited sources were Richard D. Weiner, M.D., Ph.D. and Andrew D. Krystal, M.D. Weiner heads Duke University Medical Center's Electroconvulsive Therapy Service and the American Psychiatric Association (APA) Task Force on ECT, which petitioned the Food and Drug Administration to lower its classification of ECT machines in 1982. Krystal, director of Duke's Sleep Disorder Center, received $150,036 in funding from the National Institutes of Mental Health (NIMH) in fiscal year 1998 to conduct research on improving ECT's effectiveness.

¤Clearly, the surgeon general's office simply did not do its homework, since there is a vast quantity of material that indicates that ECT is not safe,Ë states the MHCSHC alert.

Rogers further asserts that the committee members who prepared the document cite old recycled information and ignore numerous sources which contradict the position that ECT is safe. ¤They were asleep at the switch on putting out a cutting edge document for the surgeon general,Ë says Rogers. He adds the surgeon general should be angry at the committee for turning out ¤sloppy work.Ë

A NIMH fact sheet on depression posted on the federal agency's Internet Web site on April 13, 1999 also endorses ECT as ¤one of the most effectiveË treatments for depression. The fact sheet states:

¤Eighty to ninety percent of people with severe depression improve dramatically with ECT. ECT involves producing a seizure in the brain of a patient under general anesthesia by applying electrical stimulation to the brain through electrodes placed on the scalp.

Repeated treatments are necessary to achieve the most complete antidepressant response. Memory loss and other cognitive problems are common, yet typically short-lived side effects of ECT. Although some people report lasting difficulties, modern advances in ECT technique have greatly reduced the side effects of this treatment compared to earlier decades. NIMH research on ECT has found that the dose of electricity applied and the placement of electrodes (unilateral or bilateral) can influence the degree of depression relief and the severity of side effects.Ë

Yet, the above assertion that the side effects of ECT are short-lived, and that ECT is safe, as stated in the surgeon general's draft document, appear to contradict the Electroconvulsive Therapy Background Paper published in 1998 by U.S. Department of Health and Human Services (HHS). The paper states that in 1985 the National Institute of Mental Health Consensus Development Conference on ECT identified five priority research tasks, but thirteen years later, many were not completed.

¤While many studies of ECT have been undertaken since the 1985 Consensus Development Conference on ECT, the issues regarding brain damage and memory loss have not yet been fully explored or understood,Ë concludes the 1998 HHS document.