Despite bad rap, treatment with electric shock helps

ONCALL

January 25, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q: My wife has been treated for depression in a psychiatric hospital for over a month. She has shown a little sign of improvement on two different drugs for depression.

Her psychiatrist has recommended electric shock treatment, but I have been unwilling to consent to such treatment because of the things I have read and heard about its side effects.

How do you feel about the benefits and dangers of electric shock treatment?

A: The use of electric shock (electroconvulsive treatment or ECT) has been limited by its undeserved poor reputation among the lay public who have the impression that it is dangerous and leads to brain damage.

In fact, ECT has an important place in the treatment of depression; its success rate is high, and improvement occurs more rapidly than with any other form of treatment. The procedure was once reserved for those who, like your wife, have not responded to psychotherapy and medications or for patients whose depression is life-threatening.

In recent years, its use has been expanded to include depression associated with delirium. About half the individuals whose depression is resistant to drug therapy will respond after a course of six to 12 ECT treatments.

In ECT, electrodes are attached to the head and a controlled seizure, lasting about 40 seconds is produced by sending a small amount of electrical current through the brain for 1 to 2 seconds.

Many people have been frightened by unexpectedly witnessing a spontaneous seizure, and the notion of passing electricity through the brain conjures up images of horror movies. In fact, most experts believe that, in addition to its relatively rapid and frequent benefits, ECT is at least as safe as the drugs commonly used to treat depression.

The safety record of ECT has been greatly improved since its introduction in the 1940s by refinements in the delivery of the electrical stimulus, the administration of muscle-relaxing drugs to prevent physical injury during the seizure and the use of general anesthesia to eliminate pain.

Elevation of intercranial pressure is the only absolute medical contraindication to ECT. Caution is also necessary in people who suffered a recent heart attack or have disturbances of their heart rhythm.

Temporary confusion is common immediately after each treatment. Even though post-ECT confusion increases with advancing age, the greatest use of ECT is in individuals older than 61. Other short-term side effects are nausea, headaches and muscle soreness. Some memory loss may occur, but it usually lasts for no longer than a month after the last ECT treatment.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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