Uh yeh, if you're willing to be a human guinea pig (or slaughterhouse pig, as it were) for the psych community. Don't go to the "experts" who stand to gain monitarily, for accurate stats. Sounds like the program owners tauting a 90something% "satisfaction" rate. If that were my only choice, I'd choose to stay depressed. Fortunately, there are many, many alternatives that carry NO risk, or memory loss, or unknown long-term effects.
http://seattletimes.nwsource.com/html/h ... ock28.htmlShock therapy makes comeback but remains controversial
By Benedict Carey
Los Angeles Times
The electrical current throbs from one side of the skull to the other, scrambling circuits along the way, inducing a brief seizure. When it's over and the anesthesia wears off, patients often are subdued, confused, sometimes unsure of where they are or why. Then, sometimes, the remarkable happens: Severely depressed people feel better than they have in years. Others are left distraught. They feel no better than before.
Scientific interest has surged, partly because drugs don't help many deeply depressed people, particularly older adults. The government is funding some 20 ECT studies to test different techniques on behavior.
Researchers have studied the brains of shocked rodents to learn how bolts of current alter the biology. And in June, a leading medical journal published the results of a survey detailing what former ECT patients think about the treatment.
Yet far from proving the effectiveness of ECT, the research only accentuates its unknowns and shortcomings. Doctors still don't know exactly how the shocks affect the brain, whether they cause permanent damage, or why they affect
depression. Though techniques and technology have improved, ECT itself appears no more effective than it ever was.
When it comes to treating older people, doctors have no scientifically rigorous evidence establishing ECT's safety or effectiveness, according to an exhaustive review of the literature published last year. "Proponents have been saying it's safe and effective, but their statements go beyond what we know for elderly people," said John Bola, a researcher at the University of Southern California.
Slaughterhouse pigs
The reputation of shock therapy has alternately risen and fallen since 1938, when Italian psychiatrist Ugo Cerletti decided to try shocking one of his patients after watching slaughterhouse workers subdue pigs with bolts of current to the brain.
Cerletti reported that the man improved after repeated shocks, and the idea caught on among doctors desperate to help disturbed, often aggressive patients. But use of ECT declined in the 1960s and '70s, with the introduction of new
psychiatric drugs.
That decline stopped in the 1980s, researchers say, because psychiatrists refined their techniques and continued to report recoveries in severely depressed people. By 1990, an American Psychiatric Association task-force report concluded that the treatment was effective, "with 80 percent to 90 percent of those treated showing improvement." The association set guidelines for
treatment, specifying the amounts of electricity and placement of electrodes.
"You're talking about people who are desperate, who are often suicidal," said Harold Sackeim, chief of biological psychiatry at the New York State Psychiatric Institute and a professor at Columbia and Cornell universities. "This is a
treatment that we know can help."
Just buying time
Psychiatrists acknowledge that the mood-altering effect of ECT is usually short-lived. Those who feel better after a series of shocks almost always plunge back into depression within weeks or months.
"It must be thought of as a stopgap measure in life-threatening situations," said Dr. Jeffrey Schwartz, a research psychiatrist at the Neuropsychiatric Institute at the University of California, Los Angeles. "All you're doing is
buying more time to get to a place where drugs, or cognitive therapy, can have some effect."
In an article in the March 14, 2001, Journal of the American Medical Association, researchers at Columbia University in New York reported that a
combination of ECT and aggressive drug treatment successfully vanquished depression in 14 of 23 people (61 percent) for at least six months. ECT alone helped only four of 25 people in the study (16 percent).
But the researchers also reported that more than half of the 316 people originally enrolled and given shock therapy dropped out of the study or were excluded. Most of them didn't feel better after the shocks; others refused further treatment; and some suffered complications.
The success rate is based only on the people who responded well to the shock and had no adverse reactions or second thoughts. Without continual therapy of some kind, the authors conclude, "almost universal relapse should be expected."
Some psychiatrists believe the solution is more ECT. Continuation-ECT (C-ETC) involves "maintenance" every few months. Some psychiatrists have been giving C-ECT for years, and hundreds of people are already on this regimen, experts estimate.
Yet there's no solid evidence that continually shocking a person is safe, and it could cause damage, some doctors say.
New cells and 'mossy fibers'
In recent studies in rats, scientists have reported some of the first direct evidence of biological changes from the treatments that might be related to changes in behavior. They report that ECT accelerates production of new brain
cells in rats and spurs growth of neural connections called mossy fibers. Some ECT doctors say new neurons are probably helpful and new nerve connections may enhance brain function.
"These changes could help explain how it is that these severely depressed patients recover," said Dr. Sarah Lisanby, who heads the American Psychiatric Association's ECT Committee.
Lisanby acknowledges, though, that doctors aren't sure whether the brain changes are good or bad.
The studies purporting to show brain-cell proliferation from ECT may in fact be showing evidence of cell damage, according to Richard Nowakowski, a neuroscientist at the Robert Wood Johnson School of Medicine in New Jersey, who
pioneered the techniques used in the studies. "It's not clear ... whether
they're seeing proliferation or something else," he said.
Nor is it clear what the growth of new neural connections means. Neuroscientists say the brain's nerve networks are laid down over years, as the brain develops and responds to stimuli. Chances that an instantaneous, shock-induced fiber would make exactly the right connections to enhance function are extremely remote.
Moreover, the mossy-fiber proliferation seen in shocked animals also turns up in brains of people who have epilepsy or other seizure disorders. "There's a debate over whether the epilepsy causes the fibers, or the fibers cause the epilepsy," Nowakowski said.
Lost memories
Some people who undergo ECT insist the shocks both relieved their illness and improved their cognitive function. But over the years, the practice of ECT has spawned a large and vocal group who say the shocks harmed them, mainly by
erasing memory.
"There are thousands of people out there who feel they weren't told the whole story before getting the treatment," said Juli Lawrence, who started the Web site ect.org after shock treatments failed to lift her depression and killed about two years of memory.
In the first major effort to learn from ECT patients, researchers in England reviewed 35 studies involving more than 2,000 men and women who got ECT treatment. Depending on the study, 30 percent to 80 percent reported lasting memory loss. In one survey, a third of patients agreed that: "Electroconvulsive therapy permanently wipes out large parts of memory."
Those who saw ECT as ultimately helpful varied from about one-third, when patients helped design or conduct surveys, to about three-fourths, when doctors did.
"When you ask patients what they think," said patient turned ECT critic Linda Andre, "you get a completely different story from the one psychiatrists are telling."
Dr. Loren Mosher, former director of schizophrenia research at the National
Institute of Mental Health and now a professor at the University of California, San Diego, said the issue comes down to a "cost-benefit" analysis. "Does it make sense to expose people to something which not only isn't very effective but also has serious inherent danger? In my view, the cost to the person is greater than the potential benefit."
