ECT–The Less Than Shocking Story, Part II

Georgios Petrides, Adjunct Associate Professor, Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, found in a study of 253 patients with severe depression that the remission rate was 87%. Interestingly the statistics split between those with psychosis and those without: those with psychotic depression had an astoundingly high remission rate of 95%, while those with nonpsychotic depression remitted at 83%.

As cheering as those rates are, there are a several downsides to ECT, perhaps the worst of which is the tremendously high rates of remission. Sackeim (see last post) himself writes in a 2001 issue of JAMA, “ Our study indicates that without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT.”

Transient side effects are headaches and mental confusion, which last for part or most of the day of treatment. Curiously, a few patients have reported that ECT “cured” the chronic daily headaches they had endured for years.

The most feared side effect is memory loss This is an adverse effect to be reckoned with. There are two types of memory loss following ECT. The first involves quick forgetting of new information, for example forgetting the pages of a magazine you have just read. This type of loss generally lasts less than a few weeks after the final session of ECT.

The second type of loss deals with events from the past, a longer-lasting deficit. It is possible that patients will have trouble remembering things tht occurred from weeks to months and possibly even years before they began their treatment. This does improve after the treatments end, but it is quite possible that permanent memory gaps will exist for some patients.

Despite the memory challenge, ECT has been endorsed by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health association (NMHA).

I can report one dramatic successful story I myself witnessed. A man in his late 70s became suicidally depressed when his wife of 50 years was dying of cancer. His doctor acted quickly after he made a suicide gesture to switch from medications to ECT. The patient has no memory of his suicide attempt. He has gone on to remarry and have excellent quality of life with no remission in the last 12 years. (However we should note that this man had no history of chronic depression and was therefore an unusual subject for ECT.)

Armed with the pros and cons, does the severely depressed patient take a chance on a treatment that is likely to work, but only for a while, and that will leave her with memory deficits? Severe unremittting depression is so bad that many will choose some relief over none, despite the caveats. Sadly, there may be nothing better to offer at this time.