How to choose ECT and what does it entail?

February 25, 2010 5:08 PM

What is the science behind E.C.T.? Do they know why it works (if it does)? How do I decide to do it or not?

My apologies for yet another depression related question.

(skip to the bottom and ignore the boring history if you so wish)

My psychiatrist suggested today that I think about electro-convulsive therapy. Nothing right away but an option to consider in the near future if they suggest it at the appointment I'm getting at the nearby University.

Problem is I know nothing about it really. I know it is not Cuckoo's Nest anymore. I saw part of a documentary about a girl who was depressed for two years and after 6 sessions it turned her right around. I know someone on a message board whose life and memory was destroyed by it. So I'm at a crossroads.

How do you objectively consider something like this?

I have had depression and Major depression since I was 12. I am 35 now. I basically live in a state of utter blankness mixed in with deep resentment that the doctors won't put me to death. If I had energy I would like to just disappear. (My doctor knows all this and I keep close contact with him about this. I just quit therapy as the therapist was an utter idiot. Yes, I've tried all sorts of combos, MAOIs, etc. )

So after all that rambling and example given just how do I make a decision about something like this in life especially where I'm unsure of the science? Any help will be appreciated.

(Apologies if this should be in the science section. I'm an ass at figuring that out.)

posted by beautifulcheese to health & fitness (24 answers total)

The things you mention (a documentary about one person, a forum post) are anecdotal. Your psychiatrist is a professioanl and is presumably making the recommendation based on a body of scientfic evidence suggesting that this would be an effective course of treatment. There's no real reason to treat it differently than a recommendation of a drug, which could also have long term negative effects. If you're concerned that your doctor might be making the wrong recommendation, talk to other doctors before you make a decision. If you're inclined you could read some clinical studies yourself, but the pros are probably going to be better at interpreting the information. You make your current situation sound pretty miserable, so it does make sense that more drastic treatment options would be on the table.
posted by contraption at 5:25 PM on February 25, 2010

A friend of mine was helped a lot by ECT. He had tried most meds for depression, without much success, and after some ECT sessions he became functional and happy. Some years ago I worked as a nursing assistant in a mental hospital, and saw other people who were helped by ECT. It sounds quite scary, but isn't horrific to experience (afaik from what people have told me) and can help greatly.
posted by anadem at 5:42 PM on February 25, 2010

Damnit! I screwed up the "choose" in the title. So sorry about that.

I guess part of the problem is that I'm so blank and barely there in real life that it is hard to even weigh the options.
posted by beautifulcheese at 5:48 PM on February 25, 2010

ECT is vastly different from the media portrayals--and you know this, as you said it's no longer like the Cuckoo's Nest.

I am not a psychologist, psychiatrist, therapist, or any kind of mental health professional. But I was raised by two mental health professionals, one of whom was completing an advanced degree in psychology while I was of high school and college age, and I can tell you that (having had loads of conversations with both of them about mental health issues and treatments) both of them have very positive perceptions of ECT, particularly for those patients with deep and seemingly untouchable depression (i.e., patients like you). Additionally, the science of ECT has definitely progressed a lot in the last several decades. There is more "finesse" (for lack of a better word) now and the treatment will be specifically geared towards your particular problems and needs. ECT is no longer the psychological equivalent of fishing with TNT.

Are there risks? Sure, but there are risks to any treatment. Given you are concerned about those risks, please do not hesitate to ask for a second opinion. Even given the scientific developments, ECT is not a treatment to be taken lightly. I suspect your doctor will be more than happy to have you seek a second opinion.

(Notably, the fact that you are concerned enough to seek out information on ECT suggests some very positive things about your mental state. You are not as blank as you feel. Please continue to stick with treatment, whether that treatment includes ECT or not.)
posted by devinemissk at 6:24 PM on February 25, 2010

Also, the Wikipedia page on ECT has some good sources. Obviously Wikipedia is only as good as its editors, but this one seems pretty well-researched and balanced -- and well-sourced. Perhaps explore some of the sources cited there?
posted by devinemissk at 6:27 PM on February 25, 2010

I have had depression and Major depression since I was 12. I am 35 now. I basically live in a state of utter blankness mixed in with deep resentment that the doctors won't put me to death. If I had energy I would like to just disappear.

Then what's your downside risk? Even if ECT caused complete brain shutdown, that sounds to me like an improvement on where you are right now.

If doesn't sound that way to you, then your self-talk about wishing to be put to death is actually lying to you, and you need a better therapist to help you steer it in healthier directions.
posted by flabdablet at 6:34 PM on February 25, 2010 [3 favorites]

OK,

I've seen ECT used in emergency situations many times from my days as a psych orderly (serious and acute suicide risk in patients who do not respond well to medication, and unable to think clearly enough in the short term for talking cures to help), and it does seem to be of benefit in these situations. However the side effects are not particularly nice - headache and short term amnesia around the time of the ECT. On the other hand the short term memory loss can be good if you can't remember how things were at your lowest.

My old clinical psychology lecturer from my undergrad psych degree nearly 20 years ago said that "ECT is like kicking the TV. We don't know why it works, but it seems to help" (paraphrased). I did the orderly stuff after the psych degree by the way, but never ended up working in mental health psychology (did some head injury stuff for a while then changed career).
posted by singingfish at 6:50 PM on February 25, 2010

I've read some about ECT and I've watched it being administered. I have not extensively studied it, nor am I a doctor.

I have no idea how you weigh your choice here, and I don't think anyone can tell you. I am a mental health professional so I have some idea of the toll that depression can take on you. I also know how important it is to have real treatment options.

I don't think anyone really understands why ECT is effective, if it is effective. My understanding is also that ECT is not appreciably different than it was in the 60s and 70s. I think the "changes" to how it is administered are largely cosmetic. I don't think, for instance, although I cannot provide a citation, that the amount of electricity has changed appreciably. This is, of course, not a reason not to choose it as a treatment. You should evaluate the treatment on whether or not it works, and its relative risk.

There is stuff written about the troubles with ECT. Peter Breggin has written fairly extensively about it, and while his tone is sometimes shrill, his does cite his criticisms. There are several citations on the wikipedia page that you might follow-up, looking particularly at his citations. There are a few hundred free full text articles on PubMed if you search for "electroconvulsive therapy."

Best of luck with this. Feel free to email me if you would like.
posted by OmieWise at 6:56 PM on February 25, 2010

beautifulcheese, I know it's hard to be objective, much less optimistic, when you're riding the black dog. But focus on this: your psych, who clearly cares about you, has made a suggestion for a kind of therapy that has a good chance of improving your mood either a little or a lot. If you're afraid, that's fine; it's a scary thing.

But don't let that fear stop you from taking action.
Don't let the dog stare you down.

Talk to your psych again if you need to. Talk to another psych if you must. I think you may find that this could be the thing that turns you around. And wouldn't it be so much better to say with a smile a year or two from now, "I'm so glad I did that; I feel so much better" rather than just keep on riding the dog and wondering if it would have worked...

I've read some of your other posts and you seem like a thoughtful, caring and loving person. I wish you the best of luck with this, and hope to see you posting more about your progress!
posted by seanmpuckett at 7:28 PM on February 25, 2010

I think its just sort of like a simulated seizure. After seizures, sometimes depression is reduced. That old observation led to ECT.

ECT can lead to people having no short term memory.

There are neuromuscular blockers involved in an ECT session, so its not nearly as "shocking" or scary as you might think. Please pardon the pun.
posted by candasartan at 7:38 PM on February 25, 2010

I worked for several years on an inpatient unit of a prominent psych hopsital. The unit housed patients with bipolar & psychotic disorders, which sometimes included the severely depressed. ECT was on occasion prescribed to these patients, and this is what I learned from observation. Maybe it can help you understand ECT a little better. Note that I was not involved in provision of care, so I can't speak from that standpoint.

The process of ECT was as follows:

For first time ECT patients, the hospital usually required a brief inpatient stay of 2-4 days. The treatment appointments were all early morning, and for 12 hours before that, patients had to refrain from eating. You will be sedated, though I'm not certain if you go under completely or are given something like the laughing gas at the dentist's office. Either way, you will not feel or remember the actual administration of the electrical current. Everything is very carefully monitored and controlled; your heart rate and breathing are observed the whole time. Patients were generally sleepy & kind of out-of-it for the rest of the day after the ECT. Typically, you have several ECT sessions within a week or so; this may be different based on your doctor's assessment.

One of the things that seemed most important to understand--and I hope another MeFite or perhaps some of the PubMed literature can speak to this more authoritatively--is that once you have had ECT, if it is helpful to you, you will probably need to have it again in your lifetime. Apparently the effects can wear off after a time, but subsequent treatments can give you a "boost," as it were. If this is correct, you may want to keep it in mind when making your decision. The more often you undergo ECT, the more opportunity you may have to experience adverse side effects.

However, your depression sounds like it is consuming your life, and like flabdablet said, anything is an improvement on where you are now. And as a 12-year sufferer of depression, I don't say that lightly. I hope with all my heart that you are able to make a decision that satisfies you, and that if you do choose ECT, it improves your life.

I can't speak to whether the patients at my hospital improved after ECT per se; I did not observe them after they had returned to their everyday lives. I do know that for some "repeat" patients, ECT literally saved their lives and allowed them to live independently and, in some cases, work.

To objectively make a decision on this, I think you should read as much factual information as you can, if you find reading a helpful way of absorbing information, and talk to your doctor and ask as many questions as will make you feel comfortable. If you have family, a partner, or close friends in the picture, you may want to speak with them. The people who love you want you to be well and may have a different, perhaps helpful perspective on whether or not the risks outweigh the benefits for you.

Good luck with your treatment, whatever you decide.
posted by Fui Non Sum at 7:42 PM on February 25, 2010 [1 favorite]

I've had two courses of ECT, one set of four in Canada (BC) and one set of 8 (I think) in the US. I can't speak to the particular effectiveness of it -- I was later diagnosed bipolar, rather than major depressive, and it didn't make a huge difference that I could tell, although it did calm me down a great deal, which was kind of nice.

In both countries, the procedure was similar. It can be done inpatient or outpatient (yeah, I found that surprising too!). It's not like Cuckoo's Nest at all; more like going in for a typical day procedure. You'll get into a super-ugly gown, they'll lay you down & put in an iv with relaxants, put on the blood pressure cuff etc. Then they put on a mask (oxygen or something), you count backward, and that's it. No memory of the ECT itself. You'll pop awake in the recovery room. You might have a headache (I never did), and will probably feel a bit, well, calm.

ECT is usually done in a "course" of 6-10 treatments. They usually start with "unipolar" treatment, where they just do half the brain, and then ramp it up to both sides for a stronger effect. When I had the second course done, they put in an iv shunt into my arm so they did'nt have to find a vein every time. This is great but can get you some weird looks.

The biggest issue for many people is probably the memory loss. It's not complete loss, but you may find there are random holes in a 3-6 month period. I have to say, that period of my life is a bit fuzzy, but that's OK - it was a shitty time and I'm actually relieved to not have to remember some of the details. I'll occasionally read a book for the "first time" and my husband will tell me I already read it. My best friend tells me I wrote my dissertation, forgot it, and then wrote it again ;-) I find it more funny than anything else. There's a lot less loss with unipolar treatments.

The one thing that made me feel pretty good about ECT was how "clean" it was. I had a lot of bad experiences with psych drugs, which can drive you nuts after weeks of ramping up and then you have to go off them and the side effects are awful. In comparison, a little localized memory loss seems to me a good trade. I don't regret trying it out, and I saw several other people for whom it made a big difference.

Good luck, whatever you decide.
posted by media_itoku at 9:13 PM on February 25, 2010 [2 favorites]

The second part of the recent PBS documentary This Emotional Life actually shows an ECT session. If you can get your hands on it, I'd recommend it, since they also discuss the procedure a bit, and why/how it works: it actually helps to physically repair the damage caused by depression by triggering the growth of new neurons. It was pretty fascinating.

In truth, I think that most of the time when we go in for medical treatments, we're not entirely sure of the science behind the procedure. (All I really know about chemotherapy, for example, is that it kills cancer cells.) We do these things because our doctors tell us that X may work, and that X has been effective for others in our situation. Most of the time, we just have to compare it to the alternatives. From my understanding, when you're being told to consider ECT, there aren't many alternatives left.

I agree with seanmpuckett and others when I say that I hope you don't let your fear of the unknown prevent you from taking action. Best of wishes.
posted by blazingunicorn at 9:31 PM on February 25, 2010 [1 favorite]

There are other, newer approved therapies that use electricity instead of drugs against medication refractory depression. One is the vagus nerve stimulator; another is transcranial magnetic stimulation. It seems to me that anyone considering ECT might be interested in knowing about these other therapies as well.
posted by Protocols of the Elders of Sockpuppetry at 10:10 PM on February 25, 2010

All I can say is what I told myself when I started taking antidepressants- this sucks, time to try something else. Or, what flabdablet said. ECT seems to work for a lot of people, and even if it doesn't work for you, it is another life experience to learn from. Good luck!
posted by gjc at 6:41 AM on February 26, 2010

The side effects of ECT are along the lines of memory loss (quite likely) and personality change (not so likely).

So: How much do you value your memories and your personality?

If you have some treasured memories, or recent relationships you don't want to forget, or important traits which are valuable to you, then you'll have to decide whether to risk those things. Maybe you could try writing all these things down, writing a letter to your post-ECT self, if this makes you feel better about it.

But if your memories are mostly of depression and you can take-or-leave your particular personality traits, then what do you have to lose?

On another topic - it's my understanding that the positive effects of ECT are often temporary. If it works you need to be very prepared to grab life with both hands as soon as possible, and take all opportunities to make the change more permanent. Getting a lot more exercise, working with your health care team on meds, therapy and anything else they can come up with. Working to reinstate whatever habits you may have lost (eating properly, personal hygiene, hobbies, anything that you should do but you are letting slip because you are depressed). All of these things will be easier to do once you are a bit better, and will make it more likely that you will stay better.
posted by emilyw at 7:06 AM on February 26, 2010

From ECT of Major Depressed Patients in Relation to Biological and Clinical Variables: A Brief Overview (2003):

Today the indications for use of ECT seem well codified, and its technique and practices have evolved considerably. It is now firmly established as an important and effective method of treating certain severe forms of depression. However, still very little is known about the mechanism of ECT.

Some other references that you might find useful:

Patients' perspectives on electroconvulsive therapy: systematic review

Information, consent and perceived coercion: patients’ perspectives on electroconvulsive therapy

Therapeutic Alternatives for Difficult-to-Treat Depression: A Narrative Review of the State of the Evidence

Electroconvulsive therapy: what the internist needs to know (links to pdf)

I would strongly recommend that you discuss any further questions or concerns that you may have after reading any of this stuff with your doctor.

Best of luck.
posted by kisch mokusch at 1:50 PM on February 26, 2010

Thanks for the anecdotal accounts and scientific links. When I'm up enough where I can focus to read longer than two minutes I will definitely look at them. I guess I've never seen A/Ds as having the potential for serious side effects like ECT as in 15 years of taking them on and off I've only had weight gain, weight loss and mild headaches for brief brief periods of time as problems. I think I'm immune to them or the various docs are just giving me placebos all these years.

With ECT it just seems a frankenstein-ish way of attempting to fix something that is beyond repair anyway. It would be better to find a vet to put me down.
posted by beautifulcheese at 6:06 PM on February 27, 2010

>>The side effects of ECT are along the lines of memory loss (quite likely) and personality change (not so likely).

Take both of these seriously. I am not in a medical or therapeutic field, but I was in contact with a dorm-mate who went through electro-shock therapy. I am quite sure it saved her from a terrible future, but both effects were evident. Talk to your doctor(s) about this. Don't go in blind or let them blow off the questions.
posted by Ys at 8:31 PM on February 27, 2010

With ECT it just seems a frankenstein-ish way of attempting to fix something that is beyond repair anyway. It would be better to find a vet to put me down.

I read this and winced. I feel for you. I've had Major Depressive Disorder since adolescence, and I'm lucky in that right now my meds are working & I'm able to put CBT into practice. It's a struggle sometimes, though.

What you've written in the two sentences I've quoted really sounds to me like depression talking. Depression tells us all sorts of nasty things that seem to make a lot of sense, when we're in the thick of it.

It would not be "better", as you say, to "find a vet to put [you] down". You are suffering, yes, and your quality of life right now sounds very low, but there's a chance, yet, that it can improve. It might even improve drastically; certainly, if you manage to find an effective treatment, it will improve in ways that you can't foresee right now, in no small part because depression is making it hard for you to see objectively.

Look at it this way -- if your doctor is recommending a treatment to you, it's because they believe it has some not-insignificant chance of being effective. If your medical team is recommending treatments to you, it means that to objective, knowledgeable observers your emotional health is not beyond repair.

I don't have any advice, specifically, about ECT, but I did want to put that out there. I wish you well. You're not alone.
posted by dryad at 10:39 PM on February 27, 2010 [1 favorite]

With ECT it just seems a frankenstein-ish way of attempting to fix something that is beyond repair anyway.

You have a choice of people to take advice from here: (a) a psychiatrist, who is used to making sick people better, and who has seen good results from ECT before or (b) a severely depressed person whose observations are skating very close to the edge of parody.

It would be better to find a vet to put me down.

If I were you, I wouldn't take that kind of bullshit from me. I'd get out of my professional care team's way and let them do their job.
posted by flabdablet at 1:21 AM on February 28, 2010

Yeah I know I am a big walking cliche. I'll try to be more inventive in my descriptions or just shut up.

Anyway, thanks everyone for their perspectives. I'll just let it figure itself out.
posted by beautifulcheese at 8:23 AM on February 28, 2010

For the record (and slightly off-subject), I did not like and was very afraid of the treatment my team recommended for the life-destroying anxiety I suffered from. After my initial reaction of OMG NO WAY SHUT UP!!!, it occurred to me that these people (1) new me well and over a fairly long period of time. ME, not just their jobs. (2) they were people I had come to trust. I finally screwed my couraged to the sticking place & asked a lot of searching questions about why they wanted wanted to change course, what they were seeing that had led them to conclude that the previous treatment would not, ultimately, get me where I needed to be, what they hoped to gain for me from the new approach, what I could reasonably expect from the treatment and where the downsides were. I also talked for a long time, over multiple visits, about my fears regarding the proposed new course. It isn't paranoid or childish or silly or wrong to ask a lot of questions: It's part of dealing with the fear of the unknown and past dissapointments. A good team will honor that need.

You are not "bothering" them or "procrastinating" by taking time to explore the parameters of a radical treatment or your concerns about it. It is also not a foregone conclusion that you will be consenting to this treatment. Perhaps in exploring your concerns you and your team will turn up other avenues to try. Or you may conclude that this is a reasonable thing to try.
posted by Ys at 10:09 AM on February 28, 2010

Yeah I know I am a big walking cliche. I'll try to be more inventive in my descriptions or just shut up.

I think you're still missing the point.

It's not that you are a big walking cliche. It's your observations that are cliched. When you tell yourself stuff like "I'd be better off dead" or "I am a big walking cliche" you are telling yourself lies.

You really need to be challenging this self-talk, even though you might not feel inclined to. Because the truth of it is that you would not be better off dead; you'd be better off not feeling like crap all day every day.

The simple fact is that most of us only feel like crap occasionally, not all the time, and that you currently have an illness that's preventing you doing the same. That illness (not you - you and your illness are not identical) is screwing with your ability to judge what is and is not reasonable and what is and is not achievable. Listen to your psychiatrist, because your psychiatrist has your best interests at heart.

Nobody who tells you that depression makes veterinary-assisted suicide your best option has your best interests at heart, even if they're you. There is no good reason why you should continue to pay attention to poisonous bullshit like that.
posted by flabdablet at 12:05 AM on March 1, 2010 [2 favorites]