Electroconvulsive therapy (ECT) is the most powerful treatment psychiatry has on offer. It is effective in more than 80 percent of patients with serious depression – no drug comes anywhere close to that – and it is quite safe, the scare stories about memory loss being vastly overblown. Compared to the side effects of pharmacologic agents, ECT is really a walk in the park.
But it scares the dickens out of everybody.
Thanks to the 1975 film One Flew Over the Cuckoo’s Nest, ECT remains an object of horror for much of the population. “Are they still doing that?” one often hears. Poor Jack Nicholson, sitting there with his brains burned out. Is this what we want for Mama?
Is there a way to induce a therapeutic brain seizure that does not involve electricity? Yes, there is. Hungarian psychiatrist Laszlo Meduna used camphor in 1934 to pioneer convulsive therapy, but in 1938 Italian psychiatrist Ugo Cerletti suggested electricity as a quicker and less alarming means of initiating a therapeutic convulsion.
ECT won out over chemical convulsive therapy until the Flower Children, who hated ECT, came along in the 1960s, and until the pharmaceutical industry shoved ECT off stage with “antidepressants.”
Since then, ECT has undergone a revival – because it is so effective. Yet much of the population remains fearful of it.
If we could find a means of eliciting convulsions other than electricity, similar to Meduna’s, that would really be very promising, wouldn’t it?
But you know, there is a way. And it is one briefly tried in the 1960s, then put aside, for no very good reason. But good ideas often die in psychiatry for no very good reason, usually because the pharmaceutical industry doesn’t get behind them.
The non-electrical convulsive agent was the anesthetic gas flurothyl, marketed as Indoklon in 1964 in the United States by Ohio Chemical, a subsidiary of the Air Reduction Company, as “a significant new advancement in the treatment of mental illness . . . schizophrenia and depression.” “A preferred treatment to electroshock for many,” said the ads.
Flurothyl could be inhaled through a mask or injected. New York psychiatrist William Karliner, who conducted a careful trial of flurothyl in his private practice, felt that injection was better. When inhaled, everybody else in the room was inhaling some too, and one reason that flurothyl died may have been staff fears of themselves going into convulsions (unlikely). (Shorter & Healy, Shock Therapy, 2007)
Now it’s 2013. There have been no new antidepressant drugs for thirty years. (Prozac was patented in 1975.) The available agents for depression, largely Prozac cousins, are unsuitable for serious, suicidal depression, often called melancholic depression. ECT works well in melancholic depression, yet patients and their families are often afraid of it and refuse referrals. The U.S. suicide rate has been rising dramatically.
What to do? In the absence of progress in drug treatment, there is an argument for reviving flurothyl. It seems to have fewer cognitive effects than ECT; it is just as effective; and it does not involve what some patients fear as “electrocution.”
Are you with me on this? The pharmaceutical industry is unlikely to be on board because flurothyl can’t be patented, the original patents having long expired. But maybe there’s a work-around? Another trifluorodiethyl ether? A use patent? This is not beyond the ingenuity of man, given that depressed patients – who could be saved with convulsive treatment – are dying every day.