In Defense of Electroconvulsive Therapy October 30, 2007Posted by Johan in Abnormal Psychology, Applied, Emotion.
The TED talks website contains material for a hundred posts, but a video posted earlier today hits particularly close to home. In this talk, Sherwin Nuland, a surgeon turned writer, gives an authoritative and unexpectedly personal account of the history of electroconvulsive therapy (ECT), sometimes known as electric shock therapy. The talk is only about 20 minutes, and gets very interesting around the 7 minute mark where Nuland describes how ECT once saved his life, as he puts it.
If the general public could be accused of placing too much trust in antidepressant medication, the reverse is certainly true of ECT. Ask anyone about electric shock therapy, and they’ll conjure up horror stories, and associations with frontal lobotomy. This is unfair, since there is some evidence that ECT actually works for depression.
The research on this issue has produced mixed results and plenty of controversy, as reviews by Challiner and Griffiths (2000) and by the UK ECT Review Group (2003) outline. However, there is no shortage of positive findings, and this in itself is rather remarkable, when you consider the patients that receive it. Since ECT is considered rather drastic, it is only really considered for patients who are severely depressed, and who have failed to respond to antidepressants. In other words, ECT is usually only considered in cases with the worst possible prognosis, so the fact that it does seem to help at times is quite powerful in itself, given the probability of spontaneous recovery from such conditions. That being said, a read of the ECT literature is unsatisfying. Because ECT is viewed as such a dramatic intervention (even in the absence of evidence that it causes long-term harm), it has rarely been tested on “normal” depressives in random control trials.
As Challiner and Griffiths (2000) outline, a lot of the popular conceptions of ECT are untrue. It doesn’t cause massive spasms – muscle relaxants are administered. It is not going to be a traumatic experience, because you will be put under a general anaesthetic. Although bilateral administration of ECT has been associated with memory loss, this does not appear to happen with unilateral administration, where both electrodes are kept on one side of the head (as shown in the picture at the top).
There is another issue with ECT, which I think bothers practitioners than clients. In the case of antidepressants, we at least know how they work, although it is far from clear why boosting synaptic Serotonin levels should work, given the weak evidence for a lack of Serotonin in depression. With ECT, there are no convincing explanations for either the how or the why. Psychiatrists stumbled upon ECT in the happy days of wild experimentation that preceded Ethics Committees, without much of a theory. It is quite embarrassing that even to this day, we can say so little about what this treatment does, or indeed if it even does anything at all – a pertinent question given the claim on Wikipedia that 1 million people receive ECT each year worldwide.
If I ever developed a severe depression, I would try ECT before antidepressants. Unlike antidepressants, the effects of ECT can be instantaneous, and there are no long-term side-effects, nor any withdrawal symptoms when the treatment ends. Since the treatment is extremely safe when administered properly, there is really very little to lose.
Challiner, V., and Griffiths, L. (2000). Electroconvulsive therapy: a review of the literature. Journal of Psychiatric and Mental Health Nursing, 7, 191-198.
The UK ECT Review Group. (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systemic review and meta-analysis. Lancet, 361, 799-808.