Electroshock makes a comeback as treatment for depression Therapy found effective, now less disturbing with anesthesia

July 19, 1993|By New York Times News Service

NEW YORK -- Roland Kohloff, principal timpanist of the New York Philharmonic, had such a severe depression last spring that he was forced to stop performing. "I could feel it coming on," he said. "My chemistry was going out and I was totally helpless. You don't want to get out of bed. It's very hard to do anything."

Because his son, who has schizophrenia, had been helped by electroshock therapy, Mr. Kohloff decided to forgo medication and talk therapy, and try a treatment that many people associate with oppressive efforts to control the mentally ill in the 1940s and 1950s.

"What I think it did was to act like a Roto-Rooter on the depression," said Mr. Kohloff, 58. "It just reamed me clear and the depression was gone."

Although many people still recoil at the thought of electroshock, the treatment has made a discreet come back in the last decade. Increasingly, those who have been aided are willing to speak out, describing its benefits and lobbying to make the treatment more widely available. And these days, with the treatment practically abandoned in state institutions, those on the receiving end tend to be middle-class and professional.

Electroconvulsive therapy -- as doctors prefer to call it, since it is the convulsion, not the shock, that is the healing agent -- has attracted more notice in recent years for two reasons. Although it carries a risk of memory loss, it remains more effective for treating severe depression than medication, and the procedure itself is much less disturbing than before.

Before the advent of new drugs to treat mental illness in the 1950s, doctors say, hospitals administered shock treatments too often and for too many diagnoses, without anesthesia (leaving patients awake) or muscle relaxants (often leaving patients with broken bones and lost teeth from the convulsions). And sometimes, as the American Psychiatric Association recently put the treatments were given "even to control troublesome patients."

Now with modifications like reduced doses of electricity and fewer sessions, the treatment seems almost as routine as a visit to the dentist -- in fact, a majority of patients said in a recent survey that they considered it less distressing than a trip to the dentist.

Recently at Long Island Jewish Medical Center in Hillside, Queens, a retired bookkeeper, 74, was being prepared for the procedure that doctors hoped would end a depression so severe that she had practically stopped eating.

After she received muscle relaxants and a mild barbiturate, a doctor applied electrodes to her temples. In minutes, she was asleep. The doctor pushed a button on a gray box, releasing two seconds of electrical current. For about 45 seconds, her arms and legs jerked a few inches up and down. Her expression did not change.

Doctors expected the seizure to alter the chemical balance in the woman's brain, ending the depression.

Use of electroshock therapy has risen gradually since the early 1970s. One indicator is the number of sessions paid for by Medicare, the federal health insurance program for elderly and disabled people. In 1986, 88,847 sessions were covered by Medicare; last year, there were 101,854. A patient typically requires 8 to 12 sessions over three weeks.

From a survey of 22,000 Americans last year, the National Institute of Mental Health concluded that 110,000 people each year undergo electroconvulsive therapy. But some experts consider that estimate to be high. Dr. Richard D. Weiner, director of the electroconvulsive therapy program at Duke University Medical Center in Durham, N.C., put the number at 30,000 to 50,000.

The National Alliance for the Mentally Ill, a leading advocacy organization of families and patients, believes more people could be benefiting from the therapy and last year urged that it be made more accessible.

Experts say that virtually all the growth in the treatment has occurred at private hospitals, rather than the public institutions so associated with the therapy in past decades. As a result, the therapy has evolved into a treatment for the well-to-do.

The use of electroshock plummeted in the 1960s and 1970s as the revolution in drug therapy gained momentum and as harrowing depictions of the treatment in movies like "One Flew Over the Cuckoo's Nest" made it look like government-sponsored torture. The paradox is that by 1975, the year the movie was released, anesthesia and muscle relaxants were in universal use -- making electroshock virtually painless -- and doctors had long realized that drugs were not a panacea.

"The one reason that electroconvulsive therapy has not gone away after 55 years is that it works so well," said Dr. Matthew V. Rudorfer, assistant chief of the clinical treatment research branch at the National Institute of Mental Health.

Experts say that anti-depressants are successful in 65 percent to 75 percent of patients with severe depression. By contrast, shock treatments, usually given to those for whom drugs had failed, relieve depression in 75 percent to 85 percent.

Still, shock therapy is frightful, psychiatrists concede.

"Outwardly the treatment is so bizarre," said Dr. Harold A. Sackeim, a psychologist and an expert on electroconvulsive therapy. "That it would ever be therapeutic sounds ludicrous, and undoubtedly it scares people. But from a medical point of view, ECT is the most effective treatment we have for severe depression."

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