ELECTROCONVULSIVE  THERAPY:  Is  it  really  valid?

Electroconvulsive therapy (ECT), formerly known as electroshock, is a form of psychiatric treatment. The procedure, which dates back to 1938, involves passing electrical currents though the brain to trigger seizures in anesthetized patients for therapeutic effect. Nowadays, ECT is most often recommended for use as a treatment for severe depression where the patient has not responded to other forms of treatment. It is also used in the treatment of mania (which is the opposite of depression) and catatonia (a state of neurogenic motor immobility and behavioral abnormality manifested by stupor). A report in the Canadian Medical Association Journal in 2008 showed that the procedure was commonly used to treat drug-resistant seniors suffering from depression. This form of treatment is considered a ‘last-resort’ therapy to treat severe depression. ECT is being increasingly relied upon to treat patients for whom antidepressants have proved ineffective. One person who got the ECT treatment said that she had more than 100 ECTs in the nine years she was treated for major clinical depression.

Despite protests calling for a ban on this kind of treatment, electroshock therapy is frequently used by Canadian psychiatrists to treat severe depression. The Canadian Institute for Health Information estimated that in 2007 it was used in Canada more than 15,000 times. ECT is being administered across the province of Ontario in record numbers however the psychiatrists are doing it with scant oversight. Nearly three decades after a government inquiry called for provincial training and clinical practice standards—an inquiry launched after a Hamilton housewife was prescribed shock therapy against her will, since then, no such guidelines exist. Certainly no one should be subjected to ECT without their consent. And if they are unable to understand what this form of treatment is supposed to do, they should not be given the treatment. An exception should be for those suffering from catatonia.

Dr. Nizar Ladha, a psychiatrist based in St. John's, has been using ECT for three decades. He admits that the procedure does induce seizures, but they're not painful and it doesn’t cause convulsions. He didn’t say if his patients were conscious or not when undergoing the treatment.

There are instances where the patients after receiving ECT have suffered pain from strained muscles because of the convulsions they experienced during the shocks being administered in their brains.

Critics of the procedure believe its usage should be stopped because it is a painful procedure and that it can lead to brain damage. It certainly is painful if they are not anesthetized first and are undergoing the ECT and having convulsions during this form of treatment. There have been instances of this occurring. 

The side effect of ECT that has received the most attention is memory loss. The Canadian Psychiatric Association argues that ECT is safe and effective, although the Canadian Medical Association admits that it can cause memory loss. The loss of memory is a terrible side effect.

ECT results in two kinds of memory loss. The first involves rapid forgetting of new information. For example, shortly after the treatment, patients have difficulty remembering conversations or things they have recently read. This type of memory loss is short lived and has not been shown to last for more than a few weeks after the completion of ECT. The second type of memory loss concerns events from the past. Some patients will have gaps in their memory of events that occurred in the weeks to months and, less commonly, years before they received the treatment. Memory problems also improve after the completion of ECT. However, permanent gaps in memory may exist for some events, particularly those that occurred close in time to the treatment. It's important to note that the benefits of ECT are not related to memory loss—that is, patients don't feel better simply because they can't remember something from their past that bothered them and would prefer to forget.

The treatments certainly do affect short-term memory during the period they are being administered (generally three to four weeks) and for a while afterwards. Doctors tell their patients to expect this. But what is not agreed upon is whether ECT can affect long-term memory and, if so, for how long. 

One ECT patient said, “I had 15 ECTs for depression between November and January. (I don’t know what year she was referring to) The depression was relieved for about a month, but now I have severe memory loss, problems concentrating, and other thinking problems. I've lost the memory for almost all of last year and I have no idea where anything is in the house. I can't operate any appliance and I get lost if I'm more than a few miles from the house. I haven't been able to drive since November.” That certainly was a serious form of memory loss.

Another patient who received ECT who received 69 of these treatments said, “I am losing the ability to do simple things. I can no longer spell simple words and I forget phone numbers I've known all my life. I once called my daughter while crying from the side of the road because I forgot the way to her house (just 15 minutes from mine). I've opened savings accounts for my grandchildren without any memory of doing it. My family must constantly repeat answers to questions I've already asked. When I go grocery shopping I intentionally keep my head down and don't look at anyone, I'm terrified I will look directly at one of my husband’s co-workers and not recognize him/her and just walk past leaving them thinking I was being rude. My last treatment left me exhausted for 2 days.”

Scientific evidence allegedly strongly supports the impossibility of ECT causing brain damage. Careful studies in animals have shown no evidence of brain damage from brief seizures such as those given with ECT. In an adult, seizures must continue for hours before brain damage occurs while, the ECT seizure lasts only about 1 minute. Brain scans after ECT have shown no injury to the brain. During ECT, the amount of electricity that reaches the brain is too small to cause electrical injury. However, will the brain suffer damage if a person receives ECT a hundred times?

Electroconvulsive therapy (ECT) reduces frontal cortical connectivity in cases of severe depressive disorder. The specific area is the dorsolateral prefrontal cortical region of the brain. It is in the area of the forehead. That area of the brain contains nerve trunks connecting the rest of the brain with the frontal lobes which gives us our capacity to be thoughtful, insightful, loving, and creative. What is required to be a normal person is the unimpaired functioning and connectivity of the frontal lobes of your brain. This is the same area that was assaulted many years ago by surgeons using surgical lobotomy which is no longer used because it caused more damage that a cure. But can continuous ECT treatment damage that area of the brain like lobotomy did?

A new study contradicts claims by shock advocates such as psychiatrist David Healy who says that that ECT does not cause brain damage. The report from the study argues that this ECT effect supports the idea that depressive patients have too much activity in their frontal lobes and are returned to normal by damaging the offending area of the brain. Psychiatrists frequently take this position. For example, antipsychotic drugs (which four of the nine patients were taking) also reduce the function of the frontal lobes, in this case by suppressing the main trunk nerves from going deeper into the brain from the frontal lobes (dopamine neurotransmission). Proponents of the drugs then claim that the patients have an excess of activity in these nerve trunks, so that the patient is helped by damaging the region. However, an extensive long-term follow-up study indicates that most ECT patients will never recover from the damage by suffering from some form of persistent severe mental deficits.

This may be sufficiently scientifically proof which is demonstrating that ECT is a closed-head injury in the form of an electrical lobotomy. Now we find that the ECT damage is sufficiently gross to show up on an MRI  even though we are told it's good for the patients. This is what I call the brain-disabling principle of psychiatric treatment which is just another form of lobotomy. ECT and psychiatric drugs all share the same common factor that they damage the brain and suppress brain function.

It has been estimated that death associated with ECT occurs in 1 out of 10,000 patients. This rate may be higher in patients with severe medical conditions and is most closely associated with the use of anesthesia, just as it would be with any minor procedure. I can’t wonder if it should be used on someone with a weak heart. This is probably why it is often not recommended to treat mental disorders in patients who have other serious medical conditions.

                 

Some patients developed serious complications such as headaches.  While having a headache is a documented side effect of ECT, there is little information on this phenomenon. In a study conducted in 2005; ninety-eight patients were surveyed retrospectively about their experiences with headache prior to and following ECT. Of the 54 patients who submitted properly completed questionnaires, five reported new onset of headaches following ECT, four reported exacerbation of a previous headache problem, and two reported their headaches had improved. The patients experienced changes in the character or location of pain, with a tendency to progress from tension-type to migrainous headache. In all but two cases, these developments persisted at least eight months after ECT.

I believe that eventually electroconvulsive therapy (ECT) will go the way of lobotomy—gone forever. Anyone who ever saw the movie, One Flew Over the Cuckoo’s Nest will remember the horrible effect that ECT had on the brains of two of the protagonists. They ended up like zombies.