Is ECT Worth the Risks?

Shock treatmentis helpful.

By Michael Yapko, published on May 13, 2003 - last reviewed on August 30, 2004

My mother is in her late 50s. Her episodes of depression have gone from bad to worse over the years. Her psychiatrist has always been responsive to questions my brother or I might ask and open to hearing our observations. After my mother's last episode, which was especially long and terrible, the psychiatrist suggested shock therapy. I thought that was an outdated treatment, extreme and unreliable. The psychiatrist insists it is safe and effective. I'm afraid of shock therapy for my mom; reading about it hasn't made me or my brother feel much better about it. Does it really work?

The technical term for the procedure is electroconvulsive therapy (ECT). It involves passing an electrical current through the brain to induce a seizure. Many people's only exposure to ECT is through old movies such as One Flew Over the Cuckoo's Nest, deliberately designed to make ECT look scary. ECT has been refined and many studies demonstrate effectiveness. It is now widely used in the U.S.

ECT is administered by a psychiatrist typically when the depression is so severe that the person is in physical danger from the symptoms or is psychotically depressed (with delusional thinking and even hallucinations). An individual ECT procedure takes about 20 minutes, although the actual passing of the electrical current takes but seconds. The rest of the time is spent administering anesthesia and muscle relaxants.

An anesthesiologist is present and regulates the patient's breathing. The patient's brain waves are also monitored.

With an electric ?paddle,? the psychiatrist passes a relatively small electrical current at either one temple (unilateral ECT) or both temples (bilateral ECT), depending on the treatment plan. The patient experiences a convulsion lasting several seconds, visible as a ?ripple? moving through the body, a vibration and a curling of the toes. After being aroused to consciousness, the patient is usually somewhat disoriented and likely to complain of a headache. ECT is usually done in a series of 10-15 separate treatments over several weeks.

The electrical current has a disorganizing effect on the chemical/electrical makeup of the brain. It is believed that as the brain reorganizes, its chemical balance is restored. However, some brain cells are likely damaged in the process. Patients commonly complain of short-term memory loss.

ECT patients may feel they have traded some recent memories for depression relief. But most say it's a fair trade. The treatment also carries the risk that attends any use of anesthesia.

ECT is an extreme treatment, no doubt about it. Some doctors are more casual about it than others, but you shouldn't be. You may want to consult with some other psychiatrists for additional opinions to help you make a comfortable decision.

Q. You consistently recommend that someone who is depressed get psychotherapy. I know I need help, but I still avoid finding a therapist, scheduling an appointment and going. I think it's because I'm still afraid of therapy even though it's supposed to be helpful. This may be a dumb question, but what actually happens in a typical therapy session?

Many people feel the same discomfort, which is why only about one-fourth of those who need help actually go get it. Everyone has their reasons and/or excuses, but depression isn't something that can easily be self-diagnosed and self-treated. Thus, a good therapist who knows how to treat depression well is worth seeing.

What actually happens in therapy? Talking, sharing, educating, confronting, supporting, laughing, crying, experimenting. And growing.

Therapy begins by giving the therapist a description of the symptoms you're experiencing, the factors you think contribute to your problems, the ways you've been coping and the goals you have for treatment. The therapist will discuss how often you'll meet, the charges, what's expected of you.

Subsequent sessions begin by reporting back what you have started to do differently or changes you are noticing in symptoms. Sometimes, significant events occur between sessions and get discussed; other times the discussion picks up where it left off. Discussion typically focuses on specific skills that address your ongoing concerns. The therapist will also offer guidance as to how to respond effectively to life situations.

The quality of interaction between therapist and client can vary depending on circumstances and the therapist's treatment style. Some therapists ask about and explore your feelings; others focus more on alternatives for resolving problems you face. Some may hesitate to give you direct advice, others more forthright in helping you devise a plan.

Sessions usually last 45 to 60 minutes. Often the therapist suggests readings or other homework to help you develop important skills. Research shows that those who do homework and are active in the therapy process recover better and faster. The most important thing to remember is that therapy isn't done to you, it's done with you. You get to co-design how you want the therapy relationship to function.