DEPRESSION DIALOGUES: Michael Corry questions the continued use of electro-convulsive therapy
Mary, a 66-year-old woman, was one of 859 patients who, in 2003, received electro-convulsive therapy (ECT). Two years later she has trouble remembering how many shock treatments she received, can't remember what time of year she was in hospital or how many weeks she spent there. "It's all a blur." One thing Mary is certain of is that her memory is greatly diminished: "I feel as if I'm suffering from dementia. I can't remember things and I keep losing the thread of conversations and I'm always forgetting where I left things. I have to look at old photographs to remind myself of the life I had."
Mary is a retired schoolteacher whose husband was killed in a road traffic accident in 2002. After his death, she was inconsolable and her adult children were so worried about her living alone that they advised her to sell her home in the country and move to an apartment in Dublin where she could be close to them. It did not work. "I felt enclosed and trapped, I missed the open spaces, my garden and the familiar surroundings. It was like living in a coffin with the lid off." She became anxious and fearful and disliked going to the shops. She dreaded answering the phone. Her admission to a private psychiatric hospital with depression was a speedy one.
After three months of hospitalisation and eight sessions of ECT, she was discharged on three different kinds of medication - an anti-depressant, an anti-psychotic and lithium, all of which she still takes. Mary now wants to come off this medication. "I feel numb and my emotions are frozen. I can no longer feel joy or sadness, instead I feel nothing. If I stop the pills and can start feeling again, maybe it will compensate for my confusion and memory loss."
Mary's story is not unusual for many survivors of ECT. But what exactly is ECT? In many respects it resembles a surgical procedure. An electrical current of 70-400 volts is passed through the brain of the patient with the intention of producing a grand mal or major epileptic seizure. The voltage is typically as great as that found in the wall sockets in your home. If the current were not limited to the head, it could kill patients through inducing a cardiac arrest, the cause of death in electrocution.
Electrodes are placed over both temples. The electric shock is administered for as little as a fraction of a second to as long as several seconds. The electricity in ECT is so powerful it would burn the skin on the head where the electrodes are placed unless conductive electrode jelly was used.
A shock-induced seizure is typically far more severe than those suffered during spontaneous epilepsy. To avoid muscle spasm sufficiently violent at times to crack vertebrae, break limb bones and damage teeth, the practice involves sedation with a short-acting intravenous barbiturate, followed by muscle paralysis with a curare derivative, and artificial respiration with oxygen to compensate for the paralysis of the patient's breathing musculature.
The shocks create an electrical storm that obliterates the normal electrical patterns in the brain. They are administered in a series over a few weeks, up to an average of six to 10 sessions, to ensure the procedure "takes", that is, alters the electrical activity of the brain in such a way that the individual will not remember, at least for several months, the depression that they were experiencing before the shocks.
In essence, ECT is an electrical brain injury, typically producing a global mental dysfunction. Following it the individual is dazed, confused and cannot remember or appreciate current problems. The changes one sees are consistent with any acute brain injury - a concussion such as from a blow to the head from a hammer.
If a woman like Mary came to A&E displaying the same symptoms, perhaps from an electrical accident in her kitchen, she would be treated as an acute medical emergency and might be placed on anticonvulsants.
If she developed a headache, stiff neck and nausea - symptoms typical of post-ECT patients - she would probably be admitted for observation to the intensive care unit.
Memory deficits, retrograde and anterograde (before and after the event), are among the most common early signs of traumatic brain damage, and are seen in virtually all cases of ECT. Events which follow an ECT session are forgotten completely and personal history details can be foggy.
Arguments put forward as to the benefits of ECT have to be examined with extreme caution as:
It is fundamentally traumatic in nature.
Many of the patients are vulnerable and unable to speak up for themselves.
It is administered to many involuntarily due to their having being committed against their will.
Most controlled studies of efficacy in depression indicate that the treatment is no better than placebo.
It perpetuates the illusion that depression is the result of a disease of the brain rather than an emotional response, as in Mary's case, to life events.
Why has the questioning of ECT as a procedure not occurred? It can only be one of two answers. Either the psychiatrists using it are misguided enough to still believe that the dubious benefits outweigh the well-established risks to their patients, or a cover-up is occurring where once brain damage to patients is acknowledged, lawsuits will follow.
ECT should be abandoned on the grounds that it is no longer medically sustainable and is dehumanising for all concerned.
The eminent American psychiatrist Thomas Szasz wrote: "Electricity as a form of treatment is based on force and fraud and justified by 'medical necessity'. The cost of this fictionalisation runs high. It requires the sacrifice of the patient as a person, of the psychiatrist as a clinical thinker and moral agent."
Michael Corry is a consultant psychiatrist and co-author of Going Mad? (Gill and Macmillan) with Dr Aine Tubridy.
Depression Dialogues is a series of open meetings with members of the public welcome. Each meeting will be facilitated by Dr Corry and is held on the first Thursday of each month. For more information, tel: 01 2800084 or visit www.depressiondialogues.ie