In praise of 'electroshock'

What does it feel like to be profoundly depressed?

“Sometimes you feel like your head is going to explode,” Richard Braudo explains. “There were times I was so depressed, I was comatose. You can reach the point where you don't want to live – the pain is too much.”

Mr. Braudo knows. His diagnosis: treatment-resistant bipolar affective disorder.

The Toronto lawyer and management consultant has survived 30 bouts of severe depression, each lasting many months, not to mention a couple of suicide attempts.

But, at the age of 55, he has finally achieved “stable wellness.”

Mr. Braudo credits electroconvulsive therapy for his recovery. He has undergone 10 courses of ECT since 1991, the last about 18 months ago – the longest period, by far, in his adult life that he has gone without a bout of depression.

He has chosen to tell his story to help counter the negative public image of ECT as barbaric and painful and to underscore that prescription drugs are not the be-all and end-all for people with psychiatric illnesses.

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Brain Stimulation: Electroconvulsive Therapy ECT, checkered past and all, is making a quiet comeback

Electroconvulsive therapy, also known from times of old as "shock therapy," is on the rise—albeit a relatively quiet one. Considering its beginnings as a crude and violent procedure, it's not surprising that ECT's comeback isn't loudly publicized. The treatment, which involves inducing a controlled seizure, is most often administered to patients with significant psychiatric illness—depression, mania, and bipolar disorder—and is one form of brain stimulation therapy for people whose symptoms don't respond to medications. Kitty Dukakis, actress and wife of 1988 presidential candidate Michael Dukakis, has spoken candidly in recent years about her reliance on the treatment, the only one that significantly alleviates her bouts with severe depression. Many clinical trials are currently investigating ECT to better understand why it seems to work against major depression—it puts 60 percent to 80 percent of people who try it into remission—and researchers at the National Institute of Mental Health are investigating the therapy's potential in treatment of schizophrenia that does not respond to common medications. Still, the treatment suffers stigmatization—in part due to its association with mental illness but also due to its checkered past since its inception in the late 1930s.

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Antidepressants aid electroconvulsive therapy in treating severe depression

Combining antidepressant drugs with electroconvulsive therapy (ECT) does a better job of reducing symptoms of severe depression and causes less memory loss than using ECT alone, according to a new study by researchers at Wake Forest University School of Medicine and colleagues.

This finding could alleviate one of the primary concerns about ECT – that it causes memory loss, said W. Vaughn McCall, M.D., M.S, professor and chairman of the Department of Psychiatry and Behavioral Medicine and the principal investigator for the study's Wake Forest Baptist site.

The full study appears in the current issue of the Archives of General Psychiatry, published today.

ECT uses an electrical stimulus to the brain to induce seizures. It is prescribed for patients with crisis-level severe depression – who are catatonic (people who are so slowed down that they stop moving, talking and eating) or suicidal – or for patients with major depression who have not responded to medication. Electrodes attached to the head deliver the stimulus and patients are anesthetized and receive muscle relaxants during the procedure.

Patients receiving ECT often experience some memory loss that usually improves within days of treatment.

Researchers wanted to find a way to increase the effectiveness of ECT while reducing the side effects of memory loss.

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Shock therapy makes a quiet comeback - Despite the stigma, 100,000 desperate patients a year now seek treatment

When Bill Russell tells people that his severe depression was relieved by shock therapy, the most common response he gets is: "They're still doing that?"

Most people might be quicker to associate electroshock therapy with torture rather than healing. But since the 1980s, the practice has been quietly making a comeback. The number of patients undergoing electroconvulsive therapy, as it's formally called, has tripled to 100,000 a year, according to the National Mental Health Association.

During an ECT treatment, doctors jolt the unconscious patient's brain with an electrical charge, which triggers a grand mal seizure. It's considered by many psychiatrists to be the most effective way to treat depression especially in patients who haven't responded to antidepressants. One 2006 study at Wake Forest University School of Medicine in North Carolina found that ECT improved the quality of life for nearly 80 percent of patients.

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