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Archive for Monday, August 11, 2008

Treatment spurs wide range of opinions

Electroconvulsive therapy seen as boon for some patients, while others emphasize dangers

August 11, 2008

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Depending on whom you talk to about electroconvulsive therapy, otherwise known as "shock therapy," you can expect a wide range of views about its effectiveness and use.

Some patients who have had ECT might tell you that the procedure brought them back from the brink of suicide when all medications failed.

Others might remark about the problems that ECT can cause - mainly memory loss and cognitive deficits.

And those unfamiliar with the medical field might ask, "They still do that?"

Yes, they do, and experts estimate that the procedure is performed annually in the United States on hundreds of thousands of patients, mostly suffering from depression and bipolar disorder.

ECT has been around since the 1930s, and doctors and researchers still aren't positive how it works. Several theories exist about why the seizure induced during the procedure improves depression.

Several facilities in the region regularly provide ECT treatments, including Stormont-Vail Regional Health Center in Topeka and Shawnee Mission Medical Center, which both perform the procedure three days a week.

Donna Robinson, of Topeka, has been receiving ECT since 1990, most recently at Stormont-Vail, to treat severe depression. Robinson said she wants to speak out about her experience with ECT - which she credits with saving her life - to fight the social stigma associated with a treatment that in the past was viewed as barbaric and inhumane.

"Without it, I would have committed suicide," Robinson said, adding that ECT has helped her "almost get back to a normal life."

Evaluation

Dr. Ty Porter, a psychiatrist, has been performing ECT on patients at Stormont-Vail since 2001 and is responsible for screening patients for the treatment and explaining potential side effects. Candidates for the treatment are people whose illnesses have not responded to a range of other options, Porter said.

Porter cautions that the treatment is not appropriate for everyone nor is it a cure-all for depression. "(ECT) doesn't cure depression. It treats it," Porter said. "(ECT is) not something we want to market."

The procedure

With advances in technology and research, modern-day ECT is far from the painful, violent and sometimes forced procedure it once was.

Patients are anesthetized during the procedure, during which electrodes placed on their body force, or "shock," patients into a seizure. The process takes a few minutes, and patients awaken shortly afterward with no memory of the procedure.

Response to ECT varies, but Porter said patients typically are given three treatments a week for four weeks, and possible maintenance ECT treatments thereafter. The initial ECT treatment is usually given as an inpatient procedure, but after that, ECT can be performed on an outpatient basis.

Patients can expect some muscle soreness after the procedure, as well as possible gaps in memory about the day of the procedure.

Side effects

The severity and frequency of the long-term side effects of ECT, as well as its effectiveness, remain a controversial topic in the medical field.

Steve Ilardi, Kansas University professor of clinical psychology, questions the long-term effectiveness of ECT. Ilardi admits that ECT can be very effective in the short-term, with about half of ECT patients reporting a favorable response.

But he noted that a majority of those will relapse. "It's not a sustained recovery," Ilardi said.

Ilardi, who spent five years working in a mood disorder clinic at Duke University, said many of the patients he saw who had ECT showed significant cognitive impairments as a result of ECT.

"The level of functional impairment in these individuals is disturbing," he said.

Liz Spikol, a journalist who underwent ECT in the Philadelphia area to treat bipolar disorder, has joined others in the online community who speak out against the negative effects of the treatment, effects that she says were not thoroughly explained to her at the time of her treatment.

"I was given little information about memory loss. : My memory has been seriously compromised: long-term, short-term, cognitive difficulties, you name it," said Spikol, who is working on a book about the memory loss she attributes to ECT.

Ilardi advises those considering the treatment to view it as a "desperate, last-ditch effort" for treatment of mental illness.

But for some, including a 22-year-old Lawrence woman who has undergone ECT for treatment of depression, the memory problems she experienced after ECT - such as forgetting birthdays and phone numbers - don't come close to outweighing the positive difference ECT has made in her life.

"After ECT, I noticed how much I was missing. : I have more to live for now," she said.

- Freelance writer Shaun Hittle is graduate student at Kansas University's William Allen White School of Journalism and Mass Communications.

Comments

TheEleventhStephanie 6 years, 4 months ago

It is still just as scary as it was back in the old days.

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