Woman details shock cure of depression

April 26, 1995|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

Martha Manning had long rejected electroconvulsive therapy -- "shock treatments" -- as a cruel relic of a less sophisticated era. She developed that bias in the 1970s while training to become a psychologist.

Her opposition began to crumble five years ago when talk therapy and medications failed to rescue her from a major depression that seemed to be pulling her inexorably toward death. She said she never planned to kill herself -- her commitment to her teen-age daughter was too strong -- but found herself fantasizing about the relief that could come from speeding cars and guns.

A psychologist with a successful practice in Alexandria, Va., she knew that her condition was likely to worsen. So when her therapist suggested shock treatments, she didn't worry much about side effects.

"I was most afraid that this wouldn't work," Dr. Manning, 42, said yesterday before addressing a conference on depression at the Johns Hopkins School of Medicine. "It was mostly the fear that if this didn't work, there was nothing else."

In her book, "Undercurrents," she chronicles in a series of journal entries her plunge into depression and the recovery that began only after she was hospitalized and given several treatments of ECT. Yesterday, Dr. Manning said she doubts she would have survived another month without them.

She is the latest in a line of authors and celebrities -- Mike Wallace, William Styron and Dick Cavett are a few examples -- to share experiences of depression at the annual Hopkins zTC conference. The meeting, which drew 650 patients, former patients and therapists, was sponsored by the Johns Hopkins Affective Disorders Clinic and a patient group called the Depression and Related Disorders Association.

Dr. Manning devoted most of her book to helping readers understand that clinical depression bears little resemblance to the sadness and grief that practically everyone feels at one time or another.

"I think it is the basement of hell where the doors are unmarked and there are no exits," she said yesterday in an interview. "And what you know is the absence of everything, not the presence of everything. It's the absence of light, sound, color and texture."

She wrote of crying jags that had no apparent cause. During a Montana vacation, she felt "anxious and tremendously out of place" despite spectacular scenery, gracious hosts and the prospect of hikes and horseback rides.

Although her accounts of ECT occupy a relatively small portion of her book, they have attracted the greatest attention. The treatment's grisly history ensured that.

The therapy fell from grace in the 1960s, after a 30-year history in which it was used widely to subdue unruly patients. It was also applied indiscriminately against a variety of conditions, almost any that didn't respond to other treatments. Powerful jolts of electricity caused patients to suffer such violent seizures that many broke bones and teeth. Treatments were often given 50 times or more, wiping away years of memory.

Although ECT remains controversial, it saw a resurgence in the early 1980s. New technology has made the treatment gentler, and doctors have been able to identify the patients most likely to benefit.

Today, it is given to three groups: people who don't respond to drugs, those who cannot tolerate anti-depressants because of other illnesses, and people who are liable to kill themselves in the weeks it takes drugs to take effect.

Patients are put under general anesthesia to obliterate any sensation of the shock and are given a muscle relaxant to prevent fractures. The jolt, about enough electricity to light a 100-watt bulb, lasts less than a second and produces a brain seizure that lasts about a minute.

"So many people only understand ECT as some sort of dark and dingy past history of psychiatry," said Dr. J. Raymond DePaulo Jr., director of the Hopkins affective disorders clinic. Dr. Manning "helps people understand that it's a safe and effective treatment" that is now widely used. "It's not a panacea," he said, "and she doesn't present it as such."

After ECT, Dr. Manning's head and legs ached and she couldn't remember her last vacation or the last book she read. When she returned home, she couldn't negotiate the front-door lock. A few weeks later, she had to pull over while trying to drive her daughter to a friend's house. She had forgotten the way.

Dr. Manning's focus soon returned, as did most of the memories that seemed obliterated by her shock treatments. "I have gaps of memory of the time in the hospital . . . there are events that people tell me about -- gifts people gave me, people who visited -- that I don't remember at all," she said.

Most important, her depression lifted.

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