HEALTH / Common Remedies: Electroconvulsive therapy

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IF DOCTORS suggest that a patient suffering from depression should be treated with electroconvulsive therapy (ECT), many people react with horror. The idea of treating illness by passing an electric current through the brain to induce a convulsion seems primitive and outdated in an era of gene therapy, magnetic resonance imaging, and transplant surgery. The common impression is that ECT is about as scientific as kicking a television set because it is not working. These negative attitudes are reinforced by horrific descriptions of the treatment in films and books. These portray ECT as very unpleasant for the patient, causing loss of memory and destruction of the personality and turning people into zombies.

The treatment is still used, however, by some caring psychiatrists. Research studies in the past 10 years have shown that ECT relieves the symptoms of depression more quickly than drugs, and that it is often effective in patients who have not responded to other treatments. There is less agreement about its unwanted effects on the brain, short-term and long-term.

When the treatment was first introduced between the wars, it was hailed as a miracle. At that time there was no drug treatment for depression, known then as chronic melancholia. The wards of large mental hospitals held hundreds of patients who sat in unrelieved despair. When ECT was found to work, the prospect for these supposedly incurable patients was transformed, although this treatment had no satisfactory theoretical basis and it was crude: patients endured massive convulsions which were sometimes so severe that they crushed bones in their spines. When anti-depressant drugs became available, ECT was largely abandoned. Its reintroduction has been based partly on the recognition that drug treatment is not always effective and partly on advances in anaesthetics. When ECT is given nowadays, the patient has a general anaesthetic and a drug to paralyse the muscles so that the convulsion is reduced to a slight muscle twitch; the shock given is less than it was.

Nevertheless ECT remains a controversial and empirical treatment: its mode of action is still unknown, though it seems likely that it induces chemical changes in the brain similar to those induced by drugs. Analysis of large numbers of patients treated in research studies has established the circumstances in which ECT is most effective; those most likely to benefit show severe depression marked by strong feelings of guilt and sin, by delusions, agitation, and loss of interest in the outside world.

The downside of the treatment is the variable loss of memory. Some patients say their intellectual powers have been permanently damaged by the treatment. Research has shown that any impairment improves with time; advocates of the treatment claim that six months after it has been concluded, the memory is usually back to normal.

Further research is needed, both into how ECT works and its effects on the brain. Modern ECT is a very different treatment from that portrayed in the film One Flew Over the Cuckoo's Nest. If it is suggested for a patient, it should not be rejected out of hand. ECT remains in use because it may sometimes be effective when all else has failed.