Shock Therapy

Because he knew I had undergone shock therapy, an acquaintance in the bipolar community, who has also had shock therapy, gave my name to a reporter from my local newspaper. When she called to ask if she could interview me, I agreed, and the resulting article follows below. I think she did a really good job covering this subject. Image Source

Controversial shock therapy back for severe depression

By Laura Ungar

Andrea lay nervously on a table in a psychiatric hospital, desperate for doctors to lift her disabling depression. But she feared how they would do it — by shocking her brain to spark a convulsion. It was her first dose of electroconvulsive therapy, a controversial treatment once known as electroshock that’s making a comeback.

About 100,000 Americans a year get ECT, a number that has more than tripled since dipping to 30,000 in the 1980s. That was a low point for the treatment after a growing anti-psychiatry movement in the 1960s contended it caused brain damage and was inhuman, and those ideas were reinforced in the influential 1975 film “One Flew Over the Cuckoo’s Nest.”

“ECT has had something of a rebirth,” said Dr. David Casey, vice chairman of the Department of Psychiatry at the University of Louisville and one of about 10 ECT practitioners in Louisville and Lexington. “It is used primarily for people with very severe depression who have not responded to other therapies…” such as medications. “And it does work for a very large number of people.”

Andrea got 16 treatments between October 2008 and February 2009, which she said relieved her depression. But they also impaired her memory for more than a year, so she couldn’t find familiar places or remember what she had read in a book. “It did help me, but it took a long time to get my life back to normal,” said Andrea, 40, of Louisville. “I think it should only be used in the worst situations.”

In 2007, the American Psychiatric Association released a position statement deeming ECT safe and effective when done correctly on the right patients, such as those with severe, treatment-resistant depression and catatonia.

One high-profile patient is Kitty Dukakis, wife of former presidential candidate Michael Dukakis, who gets ECT once a month. “I have not had a depression like the ones I had every eight or nine months,” said Dukakis who co-authored a 2006 book called “Shock” with Larry Tye, a former Courier-Journal reporter. “I feel energized most of the time. In general I enjoy life.”

Dr. Stephen Taylor, who has given ECT to almost 150 people at Our Lady of Peace in the past three years, said 80 percent of depressed patients in studies achieve remission by the end of their treatment. Drug studies don’t use remission as a measure, he said, but only about 60 percent to 70 percent show improvement with antidepressants.
But some doctors remain fiercely opposed to ECT. Dr. Peter Breggin of Ithaca, N.Y., for instance, contends it causes brain damage, with memory loss being only the most visible sign. “This came out of the same era as the lobotomy,” said Breggin, author of the book “Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex.” “Shock is just a closed-head lobotomy.”

Driven by depression

Andrea isn’t the first in her family to get ECT. She said her 95-year-old grandmother got it after suffering post-partum depression in the 1940s, the first decade the treatment was used in America. "She felt like she got better,” Andrea said.

Andrea, who recalls suffering deep sadness as early as age 5, was a 19-year-old student and soccer player at Indiana University when she attempted suicide with over-the-counter sleeping pills and vodka. She was hospitalized and eventually diagnosed as having bipolar disorder.

Andrea said she was prescribed medications, but they didn’t always help and she didn’t always take them. Still, she managed to become a competitive bicycle racer, graduate college, and find success in a series of jobs. She eventually earned a master’s degree in education and worked as a special education teacher. But in her mind, she said, chaos reigned. She was manic three-quarters of the time and depressed the rest of the time. Stress made everything worse.

One of her lowest points came when she was 38 and so depressed she could barely heat up soup, pour a box of cereal or talk. She said she felt isolated and recalled sitting in her psychiatrists’ office one day “just shaking and crying. I felt totally hopeless.” The doctor suggested outpatient ECT. “At the time I just agreed to it,” she said, adding that she was told about side effects and signed a written consent. “When I had thought about, it seemed drastic and scary.”

Andrea, who isn’t married and has no children, arrived early with her parents at Ten Broeck Hospital, now called The Brook Hospital-KMI. She and other patients were led from a first-floor waiting room into the basement for treatment by Dr. Thomas Burke. While she was under anesthesia, Burke applied electricity through two electrodes on her scalp. Most treatments were bilateral — on both temples — which some doctors consider more effective but more likely to cause memory problems.

Andrea got 88.7 joules of electricity, a level that varies by patient from about 10 to 100 joules, with about 10 percent entering the brain, according to Taylor. Defibrillators can jolt a heart with 300 joules. Patients typically get three ECT treatments a week for a total of six to 12. Andrea got more than usual, and it was covered by insurance, as it usually is when other treatments fail. “It worked very well,” Burke said.

Disagreement on impact

Doctors don’t know exactly how ECT combats mental illness, but theorize that treatment changes brain chemistry and may help restore brain matter lost in treatment-resistant depression. Opponents allude to something far more sinister.

Breggin said ECT causes high blood pressure and heat damage in the brain and 30 seconds of brain death, and likened the results of a few treatments to what happens after a concussion. He said good psychotherapy works much better for depression.

Ted Chabasinski of California, 73, fiercely opposes ECT after getting it at age 6 at Bellevue Hospital in New York. Chabasinski said his mother was mentally ill and he was a foster child at the time. He said it left him with only “a few scraps of memory and a broken spirit.” He said he was lost on familiar streets while riding his tricycle.

Taylor acknowledged that ECT has a dark past, but disagreed with Breggin’s scientific assessment. He said flat-line EEG is normal at the end of a seizure as neurons reset themselves, and occasional high blood pressure can be easily managed by the anesthesiologist. ECT is “restorative” to the brain, he said, not damaging.

“The worse somebody is, the better their prognosis is,” Taylor said, adding that it’s not a cure. “Just like in cancer, if somebody’s in remission, it might come back.” But memory loss is often the price patients pay for that remission. Casey and other doctors said it usually wears off in a few days or weeks, with only a few patients suffering severe or long-term problems — but many call the side effect significant and disruptive. 
In Andrea's case, she had no recollection of work she’d already finished, and she forgot how to get to familiar places. It took her until August to read a book because she couldn’t retain any of it. “I think the doctors don’t realize how much confusion you feel,” she said.

Andrea said she now feels “pretty much back to normal.” She has a serious boyfriend and works as a management assistant for J. Gumbo’s restaurants. She said she’s trying to stay healthy by managing stress, taking medication for her bipolar disorder, getting enough sleep, eating well and doing yoga. She also gets psychotherapy, uses light-box therapy and takes dietary supplements.

She rejected one doctor’s suggestion of “maintenance” ECT, but said she’d undergo the treatment again if she sank as low as she did a few years ago. “I never want to have ECT again, but I won't rule it out completely, either,” she said. “I just want to try everything else first.”

Reporter Laura Ungar can be reached at (502) 582-7190.

Additional Facts:

How ECT is done

* Electroconvulsive therapy may be used in cases of severe depression, catatonia, and at times mania, that resist other treatments.
* Patients receive anesthetics and a muscle relaxant.

* Electricity is administered through two electrodes placed on the scalp.

* Electrical stimulation typically lasts a few seconds, depending on the machine and dose used, typically five seconds or less. This induces a seizure that lasts about 30 to 60 seconds.

* EEG monitoring electrodes monitor the seizure and blood pressure is monitored, typically on the lower right leg.

* After the seizure, the patient awakens as the anesthetics wear off, having been asleep for about 10 minutes.

* Sources: Dr. David Casey, University of Louisville; National Institute of Mental Health

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