Annette Taylor asked some questions about ECT. The other day, I was able
to answer a question about the origins of ECT because I had several
history books avaliable in my office. Today, however, all my psychiatric
textbooks are at home. Therefore, the information I am giving is from my
lecture notes on this topic. I have gleaned the information from several
sources (such as the _Textbook of Psychiatry_ published by the American
Psychiatric Association).
> In intro today several students had questions about ECT, especially
> why it seems to work for 'remitting' depression.
I have little information with me on this. I know that there are several
theories. The typical ones (e.g., that it affects the activity of
certain neurotransmitters such as norepinephrine and serotonin) are
popular. But I don't think anyone really knows how ECT achieves its
effects on depression. This is no different, however, fromn what we know
about most other biological treatments for mental disorders. That is, we
typically don't know precisely how most of them achieve their effects.
Most have been discovered through sheer, dumb luck (from my reading of
the literature, at least).
> How many sessions/series of ECt does it usually take?
The patient is given muscle relaxants (to prevent the breaking of
bones), a fast-acting anesthetic, and oxygen (because breathing stops).
The patient receives about 65-140 V (usually in pulses) for about .5 s
either bilaterally (more effective for depression) or unilaterally (the
latter is preferred because there are fewer complications; see below).
There must be convulsions lasting for at least 20 s for the treatment to
be effective. The shock is given on alternate days for about 2-3 weeks
(about 6-10 sessions). They wake up within 10 minutes.
> How [much] memory loss is there and is this really the only adverse
> symptom?
There is often temporary confusion just after ECT (about 20-30 minutes).
Memory loss is highly variable. Some people have no problems. Others,
however, may have anterograde and/or retrograde amnesia of varying
severity. Most of these problems remit between 1 and 6 months after
treatment. Rarely, such amnesia is permanent. Bilateral treatments lead
to more memory problems than unilateral treatments (bilateral tends to
be used only for the most severely depressed patients). What is
permanent in many patients, however, is memory loss for the period of
time just before and after the series of treatments: about a six-week
loss of information in these patients. The most common complaints
besides memory loss are headaches and muscle aches.
When patient selection is done carefully, there are fewer than 2 deaths
in 100,000. These deaths are usually due to heart attacks. There is no
good evidence that ECT causes brain damage. For example, before and
after MRI scans show no damage resulting from ECT (but this could be
missing subtle damage). One must be very careful with patients who have
brain lesions, increased cranial pressure, significant cardiovascular
problems, brain aneurisms, brain hemorrhages, or retinal detachment.
Elderly patients, thus, are at a significant risk since they are more
likely to have one or more of these problems. It should go without
saying that a complete medical and neurological examination is necessary
before ECT can be considered.
> And how much does it really resolve?
I am interpreting this to mean: how effective is this therapy? In
carefully selected patient groups, there is marked improvement in at
least 80% of patients. It is rarely the treatment of first choice,
however. It tends to be used only for patients who have depression with
psychosis (since only about 40% of these improve with antidepressants),
who show severe side effects with antidepressants, who do not respond to
antidepressants, who are pregnant, who have cardiovascular problems
(antidepressants can have dangerous side effects with them, but so can
ECT, so caution must be exercised), and who are strongly suicidal
(antidepressants take too long to work). About 50% of patients given ECT
relapse within a year. If maintained on antidepressants, however, only
about 20% relapse. For a small proportion of patients, maintenance doses
of ECT are given once a week to once every few weeks for varying periods
of time.
Psychotherapy is often required, not only for depression, but also
because of the negative stereotypes surrounding ECT: patients often need
to be helped with their negative feelings about getting "shock
treatment."
ECT also is sometimes used with manic patients, schizophrenic patients,
and those with schizoaffective and schizophreniform disorder. I don't
have any information on its effectiveness with these patient groups.
> What exactly have been the 'advances' in recent years to make it
> popular again?
Most psychiatrists believe ECT to be the safest and most effective
treatment for depression. But its use has been attacked (especially
during the 1960s and 1970s) by many in the wider culture. In recent
years, psychiatrists have been more likely to use it, I think, because
much of the bad publicity is in the past. But I believe it also is
considered to be less expensive than psychotherapy and (perhaps)
long-term drug treatment. Thus, I believe that insurance companies have
pushed for its increased use (but I may be wrong about this: it is an
inference I am making).
> Somebody please answer these--sometimes I don't get answers to
> questions....
Join the club. Often, I feel as if everyone has my posts filtered out on
their e-mail programs (for example, there was not one response to my
post on the origins of ECT the other day...not even, "hey, that's
interesting"). I often imagine the sound of crickets as I hit the "send"
key. I guess we can't all have the gift of getting people to respond
that certain TIPSters seem to have. In fact, there are some people on
TIPS (OK, just one I know of) who seem usually to get a deluge of
responses to their posts. Oh well, thank God I'm schizoid: being a
social isolate doesn't bother me.
Jeff
--
Jeffry P. Ricker, Ph.D. Office Phone: (480) 423-6213
9000 E. Chaparral Rd. FAX Number: (480) 423-6298
Psychology Department [EMAIL PROTECTED]
Scottsdale Community College
Scottsdale, AZ 85256-2626
"The truth is rare and never simple."
Oscar Wilde
"Instead of having 'answers' on a test, they should just call
them 'impressions'. And, if you got a different 'impression',
so what? Can't we all be brothers?"
Jack Handey
