Why Electroconvulsive Therapy Works




Psychiatry_Psychology.jpgElectroconvulsive therapy (ECT) has a bad reputation, due in part to the graphic media portrayals we see in films like One Flew Over the Cuckoo’s Nest and A Beautiful Mind, and probably also in part to an innate distaste for the idea of receiving electrical shocks to the brain.

Despite the popular disgust for this treatment, ECT is still used in patients with psychiatric disorders that have not responded to other therapies, most commonly major depression and bipolar disorder. In these severely affected patients, who have tried counseling, medication and hospitalization to no avail, ECT often provides a huge improvement in their mental state, with 80 to 90 percent of patients responding to ECT. New research suggests that the effects of ECT may be associated with proliferation of brain cells.

Researchers used rats to looked at the effects of ECT on the prefrontal cortex, an area of the brain linked to emotional function, and with physical connections to the amygdala and hypothalamus, also involved in emotional processing. Patients with mood disorders have decreased activity and a reduction in glial cells (“support cells” to the active neurons) in the prefrontal cortex. In this study, rats were treated with ECT and then evaluated for cellular changes in this area.

The study showed ECT to stimulate increased production of glial cells, the exact cells that are decreased in mood disorders. The increase in cellular growth persisted for four weeks after treatment. These findings agree with earlier studies that showed ECT to increase cell proliferation in other emotional control centers, including the amygdala and hippocampus.

ECT was initiated as therapy many years ago, long before the mechanisms behind its effects were understood. Most rational people would scoff at the idea of electrocuting the brain to treat any disease, and this is reflected in popular culture. I don’t doubt that there are plenty of people out there with horror stories related to ECT and its adverse effects. But there is also a large population of people who can thank ECT for saving their life when nothing else worked.

However, desperate times call for desperate measures. ECT is now reserved for only the most severe cases, and can provide life-changing improvements for very sick people. It’s nice to see scientifically sound support for a treatment that has such a negative connotation. Hopefully, evidence such as this will allow patients to feel a measure of ease with a procedure that, in and of itself, is frightening.

Reference

Ongur D et al. Electroconvulsive Seizures Stimulate Glial Proliferation and Reduce Expression of Sprouty2 within the Prefrontal Cortex of Rats. Biol Psychiatry. 2007 Sep 1;62(5):505-12. Epub 2007 Mar 6.

  • Dan Rogers

    This doctor needs to do more research with primary sources and stop allowing herself to be indoctrinated so easily.

    The only two large-scale studies ever published assessing cognitive function in post-ECT patients both found that ECT routinely causes long-term, permanent cognitive dysfunction. Both of these studies were published within the last two years. The cognitive dysfunction was found to be global, not just with autobiographical memory. Post-ECT patients six months and beyond were found to have problems thinking, remembering, processing, forming new memories, and had various slowed reaction times on neuropsychological testing. One of these studies was led by Harold Sackeim, one of the most well-known former advocates of ECT, and the other was led by a Glenda MacQueen from Canada who assessed cognitive function in post-ECT patients who had bipolar disorder.

    In addition, in the article above the doctor points out that ECT has been associated with proliferation of brain cells, but this can actually be indicative of brain damage. For example, when a person cuts their hand increased proliferation of skin cells results in the area, same with a damaged liver, etc. Brain damage has not been routinely documented in humans who’ve undergone ECT because MRI and CAT scans do not reveal the type of mild, evenly diffuse brain damage that ECT causes. In order to reveal this type of damage, functional brain imaging techniques are necessary like fMRI, SPECT, or PET. In addition, neuropsychological testing is still the best measure of determining whether diffuse brain damage exists. MRI scans show damage on a “macro” scale like lesions, not damage on a “micro” scale like damage occurring at the cellular and subcellular levels as from ECT.

    In addition, multiple studies have been published in the last few years showing that patients after ECT have abnormal PET scans and SPECT scans of the brain. One of the most recent from the summer of 2007 found that ECT leads to a profound decrease in regional cerebral blood flow, which the Israeli researchers conclude to be a quote, “finding of reduced brain function.” More than one PET scan study has documented abnormal, reduced metabolism of glucose in the brain in post-ECT patients.

    Moreover, a recent 2005 Russian study using new and sophisticated techniques found definitive evidence in a rodent model that ECT causes substantial diffuse neural loss. According to the authors, as high as 10% loss of brain cells in certain areas.

    As far as the efficacy of ECT for depression, in a new published review of the sham-ECT literature it was noted that not a single published study has found ECT to be more effective than sham-ECT one month after treatment, and that many trials even failed to demonstrate a benefit over sham(placebo) ECT even during the course of treatment.

    ECT produces a temporary delirium similar to a slightly drunken state. Patients are initially slightly confused, have bad short-term memories, and impaired judgment. Within a few weeks, this delirium or fog begins to clear, the depression returns, and the only thing lasting about it is the permanent cognitive dysfunction it causes from the diffuse brain damage it inflicts. It is a well-known fact that closed-head injury victims with a history of depression often have a lifting of mood after their accident along with brain damage. Sometimes these closed head injury patients are not even aware of their own brain damage when they are recovering in the hospital, and at some point the doctor and the family agree on a time to tell the patient that he or she has suffered brain damage that likely will not fully heal. It is no different with post-ECT patients or the patients who had frontal lobotomies decades ago. These people often are not aware of their own deficits initially until it becomes obvious to them that they cannot remember random past events, and can no longer function at the same level at work or in challenging academic endeavors as they used to. This is confirmed through hundreds/thousands of personal testimonials from post-ECT patients who’ve posted their stories on the web. Most of these people complained to their doctors, and the one things almost all of them have in common is that their doctors never published a case report on their symptoms. Psychiatrists who give ECT can make salaries twice or in some cases even up to three times that salary of psychiatrists who do not perform ECT. This is the real reason why it’s not reported. Doctors are all too quick to report a little skin rash or problems getting an erection from a new prescription drug, but when a patient reports persistent organic brain dysfunction after ECT, they shove the patient out the door. This is evil, and it must stop.

  • http://www.endofshock.com Norman Moore

    Dan Rogers is completely correct. I have interviewed roughly 30 ECT survivors and none of them were happy that they had ECT. ECT and brain injury is the perfect analogy. I would add that most “treatment resistant” patients who receive ECT had months or years of bad reactions to harsh medications before ECT was presented as the “only solution”. The WHO has done two studies that showed people in countries without access to psychiatrsits can completely recover from schizophrenia if they are not drugged and instead cared for and given some mild job around their family while the people who receive western psychiatric treatment are much less likely to ever recover fully.

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  • http://www.explorelifeblog.com Joseph Bernard

    Have you ever watch the process of ECT. I have and it is barbarian and only used by primarily male MD’s who don’t know what to do but try to damage people back to health. What arrogance, the kind that starts wars, that tortures, etc.

    Sorry for the heaviness but if you saw what goes on you would be outraged. Science has been used to rationalize all kinds of horrible treatment.

    What happened to the heart as a guide to therapy?

    Joseph
    Joseph Bernard, Ph.D.
    http://www.ExploreLifeBlog.com

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  • Deanna

    I am 45, always did well in school, college, learned a second language & worked in a very good job for 21 years. I had a trauma at 19 & suffered depression, postpartum depression and recently anxiety, on and off, ever since. I handled it on my own, with family & friends, until 1995 when I decided that I could no longer treat depression by getting pregnant!

    I then started antidepressants and have tried at least 30. None were very effective, for very long. I was able to work until 1999 & was first hospitalized in 2000. I had ECT’s over the years as I just kept getting worse. Doctors were reluctant to try MAOI’s due to their dietary restrictions even after diagnosing Atypical Depression.

    At first when I had ECT’s they helped. My memory and cognitive abilities returned except for the short period of time during and surrounding the ECT’s. In 2003, I was cleared to return to work and attended college for 5 months, an OJT and a gradual return to work to increase my confidence and chance of success.

    I had a relapse in 2005 and had to stop working again. I had obtained a 99% average in college and excellent performance appraisals on my OJT and from my actual job, as I always have. Afterwards my self-esteem was destroyed because I had tried so hard to get back on track and had the posting at work that I always dreamed of.

    My depression became severe at that time and I had more ECT’s & many hospitalizations. This resulted in my marriage being destroyed, conflict with my teenagers and eventually I was unable to care for them or even live in the same house. I am physically healthy and relatively young but cannot work. I often feel totally useless!

    Now I cannot remember the material I learned in college in 2003, names of co-workers, some past, some current events, both positive and negative. I am not even sure most times whether or not I washed my hands, so just wash them again! I write everything down as I cannot rely on my memory and note that my math skills have decreased.

    My psychiatrist says that my memory problems are not caused by ECT’s but are caused by severe depression and anxiety, a brain that never stops and possibly the fact that I have hypothyroidism and obsessive tendencies. I think ECT’s helped initially but their benefits don’t last long before more are needed. In the long run they do much more harm than good!

    They have finally put me on MAOI’s, now that my life has already been destroyed, so although they are a little better than the other meds it is too little too late! Ever since I began treatment my condition has progressively worsened to the point that I have lost all faith in psychiatry and pharmacology.

  • OneWhoFlewAway

    I applaud Dan Rogers and the other learned comments on this page. I am not a Doctor, just a person who has personally witnessed first hand the damage done to someone very close to me by ECT. We are taught to believe in Doctors, and I was only 16, so I didn’t understand. All I saw was how she rapidy deteriorated from a perfectly normal person who suffered headaches, into someone who was too weak to even get up and couldn’t even remember what day it was, once “admitted” into “care” of that kind.

    Years later, after she slowly regained her functioning (after numerous frightening mental “black-outs” when she couldn’t recognise anything – not even her own street and home!), she recounted some of it – of being strapped down to the bed, stuff stuffed in her mouth and being tortured with electrocution till every cell in her body and brain shook etc. Absolutely horrific. Very much like the movie. Sickening. Like torturing prisoners, except there’s no escape.

    Whenever I hear anyone talk about it, it gives me goosebumps. If in any way it is reputed to “treat” depression – well I guess it’s hard to be depressed if you can’t even remember who you are!! How it hasn’t been banned yet, I’ll never know. Yeah… medicine etc – just like they used to treat people by bleeding their blood, leeches and maggots in the old days – we obviously haven’t progressed very far!!

    I think any doctor, before administering it, should go through a course of ECT themselves, and see what it’s like!!! I’m sure it would make them re-evaluate!

  • divalicious

    Electro Convulsive Therapy – or as many mentally ill patients refer to as LRT – Last Resort Therapy, is to my mind one of those bastions of victorian treatments that were over-prescribed and not understood. Why do I feel this? Because I’ve had it. Years ago now, but I shudder to think what I’ve lost as a result. Not least that my short-term memory was affected for months, but because a sort of fine blade that gave me an emotional and mental edge has now been blunted. I am a musician, and so I need to be able to access the wells of emotion that I have in order to do my job convincingly well. However, since I had this treatment, I’ve found that my emotional life has been rather blunted. I don’t care what the medical evidence says about there being few or no long term affects to the brain: I’m living proof that there are. Before you ask, I’ve been well for some time, and I don’t remember ever having felt detatched like this before treatment, so I really don’t think this feeling is a result of being ill most of the time. Artists live in an emotional world that is much more dynamic than other people would realise – and this is because it takes a huge amount of emotional energy to be really creative. I’ve never felt comfortable with the idea of having a current driven through my braincells, but nothing else worked, and I was convinced to accept this treatment as a last resort. In the back of my mind, the human brain has always represented a landscape that is so complex that it seems incredibly arrogant to suggest we understand it enough to justify passing an unnatural electrical current through it. In addition to this, I would say that the sheer horror of knowing that I was undergoing ECT was enough to depress me and frighten me in itself, warranting further psychiatric treatment that I might not have needed if I’d been helped to bottom out and been given psychotherapy at a time in my life when these issues I had could have been tailed off without the need for such major intervention. Gosh what a long sentence – well at least they haven’t deadened my sense of rage as well…

    Divalicious

  • Dr. Chee

    Yes, ECT is good for something: Makeing SCAR TISSUE form inside the most important organ of your body- your BRIAN. I do not recomend it to anyone. It is an aged form of not only mental, but physical torcher. If you are depressed or have another “Condition”, find posative ways of dealing with that or those negative experience that have tiped it off. Remove your self from the negative environment. Find light and meaning in your worth while life. You do not need crutches. You can do it!

  • Roy Hollandsworth

    As a caregiver for over 5 years now I ‘ve had the same male client who has treatment resistant paranoid schizophrenia . Lately my client has had some 15 ECT’s and is currently having one per week as maintence while he’s in the hospital.

    This therapy has creatly improved his former uncoopertive and combantant self. However I must admit that his memory definetly seems to be adversely impacted from this therapy. If you told him that today is Saturday Dec. 13th, 2008 he’d very likely not be able to remember what day it is 10 minutes later.

  • Tree

    If you, or someone you love is considering ECT….please I beg you, find another alternative. I have had them and will never …ever….be myself again. I now have periods of, …umm not sure what to call it, but some kind of psychosis, I forget who I am, where I am, and dont recognize my family, and this happens when I have terrible headaches, so this gives us a little warning. My memory is awful, I can’t work, and I feel so useless. But I try to live each day the best way I can. But its very heart breaking, when my granddaughter 11 months old wants mamaw to hold her, but I can because mamaw is having an “episode” !…its very frustrating!

  • http://daytodaywithdepression.blogspot.com Angel

    I am a ect survivor and I believe that their are some good aspects. For some out their ect might be the only hope. If they have tried ever drug imaginable and therapy does not help then it might be right for them. Now on flip side, I had ect treatments and it has had a negative effect. I have lost most of my memory for the year that I recieved treatment. Even now it is sometimes hard to remember things. I wish I never had done ect. But I I think their are a select few that would benefit from the treatment, and I do mean a SELECT few.

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  • gwk

    I’ve searched this article just tonight and it sort of makes my stomach feel sick. My 62 year old husband has had ECT monthly for two to two and a half years. Before that, he had it as much as three times a week off and on. He was diagnosed in 1982 with PTSD and had scads of therapy with psychiatrists and psychologists. He’d been on just about every antidepressant medication known to man.

    During a hospitalization he mentioned to his doctor that he’d had ECT before and it was like the doctor seemed very excited about it. He put my husband on the schedule for the next day and just about every other day after for nearly two weeks. I was heartened, because he seemed to have lightened moods after each treatment.

    That was followed by a decrease in the treatments. First to 3 times a week, then twice a week … you get the picture. It culminated in a schedule of once monthly ECT. That was 2½ years ago (at least). I will admit that the treatments never failed to improve my husband’s moods. During the middle weeks he would get progressively more and more depressed, lackluster and verbally abusive. I’ve looked forward to the treatments all along.

    Today he came in from a round of neuro-psych testing with a diagnosis of progressive dementia and a prognosis of five to eight years of life remaining. Whoa! What a kick in the head. We both knew he had more memory problems and coordination issues. But we’re blown away by this … death sentance!

    I can see that this blog doesn’t exactly have brisk traffic, but if anyone happens to see this entry and has any input to this entry I’d surely appreciate it. I just wonder how much the ECTs actually contributed to this latest diagnosis. Could it partly be a result of nearly 25 years of psych drugs, too? I’m just looking for some answers, and perhaps for some hope.

    Best regards

    • Devon

      I am deteriorating to, maybe progressively…you say your husband has progressive dementia, what kind of dementia? How do they know it’s a death sentence?

      Ect destroyed my life, it “watered down my brain,” to the point where I have barely any conscious thinking, and I have no thoughts going in my head.

      I feel like my brain “signal” is weak, if that makes sense. words can’t explain the torture I’m in.

      Why can’t we sue our ECT doctors?

  • http://www.yahoo.com/ Roy R

    I’ve been a caregiver with a Laotion man for 5.5 yrs who has treatment resistant schizophrenia. He began ECT a year ago and it helped improve his condition usually on the 2nd day after treatment . The improvements to his mental condition however seemed to be gone about the 3rd day post treatment. His treatments finally stopped after several months when his balance worsened and one day he fell down several stairs receiving a mild occipital concussion. He’s doing ok these days, but has nearly lost all ability to speak the English language. He speaks Hmong, his native language, but cannot revert to speaking English when so directed. However, he still understands English sentences. In brief I strongly beleive his inability to no longer speak English is due to the ECT treatments because he began having this language problem very shortly after these treatments began. Prior to the ECT treatments he could speak in English when so directed. Now he can no longer do so. I also began noticing a deterioration in his thinking abilities once ECT was initiated. I’ve had several MD’s liken ECT to fryng the brain and it truly makes me wonder if they might not be correct. Then again, I do not know how much of my clients problems can be attributed to the antipsychotic meds he’s taken these past yrs, plus he’s also been on dialysis for some 6.5 yrs. I can only say that I’m glad he had that fall because it put a stop to his electrical shock therapy. I think they could have made a vegatable out of him had this treatment continued for months longer.

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  • Devon

    guys what we should be doing is telling our former ECT doctors how messed up we have become, and being strong enough to not allow them to blame the horrific cogntiive effects on our “illness.”

    I volunteer with Mindfreedom.org, you should check it out, they have a list server that specializes in ECT, and people who have been hurt and want to see it banned.

    It outrages me, that despite so many, (usually the majority) of us complaining of devastating memory, cognitive, even physical imapairments, are being completely ignored, like the person who wrote this article.

    If I were a doctor, or nurse practicing ECT, I would care enough to read and listen to all the bad outcomes, and I could not live with myself administering such a dangerous procedure.

    I don’t know how ECT doctors can be so heartless, and how the whole industry has no problems backing all the “false informed consent lies,” up.

    This is a lie that has destroyed so many of us, even the vast majority I believe, but yet no one is able to stop the pro ECT nonsense that is being told to everyone. How CAN’T the industry realize what ECT is doing to us? The whole history of shock explains how it was used to help slaughter pigs, and “modified” ECT is even worse in terms of higher voltage. Are doctors that blind? Or are they kind of like Nazis?

  • http://epetitions.direct.gov.uk/petitions/16278 Cheryl Prax

    The UK government has recently introduced e-petitions online.
    Please sign this ‘Abolish ECT’ e-petition and relegate this barbaric ‘treatment’ to the history books along with lobotomy. We need 100,000 signatures to get it debated in parliament.
    To sign an e-petition, you must be either:
    • a citizen of the UK (can live abroad)
    • a resident in the UK (you normally live in the UK)
    It only takes a minute! Please pass this on.
    http://epetitions.direct.gov.uk/petitions/16278
    Thank you for your help.

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Lindsey Kay, MD

Lindsey Kay, MD, is a medical doctor with training in pathology, and an avid writer. During his training, he worked on pre-clinical and clinical trials in a variety of laboratories related to alcohol effects on the brain, cancer diagnosis, and alternative medicine.
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