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by Max Fink, MD
Modern electroshock (ECT) is no longer the terrible treatment pictured in One Flew Over the Cuckoo's Nest, nor are the memory changes that accompanied the treatments in the 1940s and 1950s still evident. Much has been learned about how ECT works so that our treatments today are more effective and much safer. Indeed, the United States Surgeon General, in his report on mental health in December, 1999, concluded "No controlled study has shown any other treatment to have superior efficacy to ECT in the treatment of depression."
Who is treated?
ECT is usually suggested when a depressed patient has not gotten better with antidepressant medicines. ECT is the most effective antidepressant treatment that we have, working even after medicines have failed. It is sometimes used before medicines, as when a patient is suicidal, when they fail to eat and have lost much weight, and when psychotic thoughts accompany the depression. In the depressive or manic phases of bipolar illness, ECT is an effective option when two or more medical combinations have failed.
When delusions and hallucinations dominate a clinical picture of schizophrenia, ECT is effective in relieving these thoughts. And patients who are mute, posturing, and stiff, a syndrome described as catatonia, are treated successfully with ECT.
ECT is effective in patients of all ages, including the elderly and adolescents.
What does the patient experience?
Electroshock requires repeated treatments. The number and frequency of treatments depend on the type and severity of the illness. The patient does not eat or drink for eight hours before the treatment. A nurse puts a needle into a vein and attaches a bag of fluid so that medicines can be given intravenously. Electrodes are attached to various parts of the body to record the effects of the treatment on the heart, brain, and muscles. When all preparations are made, an anesthetic is given and the patient falls asleep. (The patient recalls nothing after this moment until awakening 15 to 30 minutes later.) A muscle relaxant is given, a rubber bite bloc is inserted into the mouth, and an electric stimulation is given. A seizure follows (usually from 30 to 180 seconds in length). Throughout the procedure, the patient is breathing pure oxygen, delivered through a face-mask by an anesthetist.
Within a few minutes the patient awakens and recovers awareness. Within half an hour, the patient is allowed to walk about and return to the ward or home. The usual procedure takes less than an hour. Headache, nausea, and muscle aches may occur, but these symptoms usually resolve quickly with simple medicines.
What about memory problems?
Memory for the events occurring during the course of treatment is often blurred or lost. Whenever we undergo anesthesia, the events surrounding the period of anesthesia are not registered. Since electroshock treatments are given a few times a week, over many weeks, the events during the weeks of treatment are blurred. Sometimes, the events can be reconstructed by reminders, such as a description by a friend, a family member, a picture, a letter, or a videotape.
When we are emotionally ill, when our moods are disturbed and our thoughts disordered, we record little of what occurs in our lives. When we are given medicines meant to improve a mental disorder by changing the brain's delicate chemical balances, our ability to record life's events and to recall them may be impaired. When we are given electroshock after these treatments have failed, these functions are further impaired. We recall little of what occurred during our illness, less when we took medicines, and even less of the events during the weeks of active ECT.
When we recover from the illness, and our minds clear and our mental health is restored, we are again able to record and to recall and learn, much as we did before we were ill.
Where is ECT given?
ECT is available at the principal hospitals that treat the mentally ill. Each hospital has ECT consulting psychiatrists who are specially trained. The first few treatments are usually given as in-patients, and as patients recover, they go home and come for treatments when these are scheduled. Some patients are treated wholly as out-patients.
Where can I find information on NMS (Neuroleptic Malignant Syndrome)?
We have included additional information on this syndrome.
Where can I learn more about ECT?
The book ELECTROSHOCK: Restoring the Mind by Max Fink was published in August, 1999, by Oxford University Press. It is available in most bookstores and on the Internet from the principal booksellers. A web-site www.electroshock.org provides up-to-date information about ECT for patients and for professionals. The site is updated each month, and the archives give answers to many questions.
ABOUT THE AUTHOR:
Dr. Fink is Professor of Psychiatry and Neurology Emeritus at SUNY at Stony Brook, and Attending Psychiatrist at the Long Island Jewish-Hillside Medical Center. He has done extensive research in ECT since 1952, published a textbook in 1979, developed a scientific journal for ECT in 1985, and maintains the electroshock web-site.