Electroconvulsive Therapy Deserves a Second Look

By Amy Higgins

Ms. Higgins teaches composition and creative writing at Washtenaw Community College and facilitates the newly-formed NAMI Washtenaw County Friends and Family support group for WCC Students.

Testifying before the FDA in 2011 as chair of an American Psychiatric Association task force on electroconvulsive therapy (ECT), Dr. Sarah Lisanby was direct: “I’m here to deliver one critical point . . . . Depression kills, while ECT saves lives.”

Twenty-two years ago, eight months after my daughter’s birth, I agreed to be hospitalized for ECT treatments for postpartum depression that had not responded to other treatment and had deepened into major depression with psychotic features. Since then, I’ve paid close attention to how people react when I raise the subject of shock therapy. I bring it up because no one else ever does. In a liberal college town with a world class School of Social Work and the University of Michigan Depression Center, and with a socially engaged population that questions norms and takes on taboos, ECT is still either off the radar or off the table.

A friend asks how I’m doing with the empty nest; it’s a comfortable lead-in to say I’m researching and writing about ECT. Invariably, there is a pause, an uncomfortable silence. I used to rush in to bridge the gap by saying ECT is a very effective, but widely misunderstood, treatment. I had it, and — see? I’m okay. But I’ve learned to listen instead.

First — and this is the most common response — there are people who have never (to their knowledge) met anyone who has had ECT. “Do they still do that? I thought they phased that out a long time ago.” They are surprised and a little alarmed when I tell them that it’s still very much in use. They say, “Doesn’t it cause brain damage or memory loss? Isn’t it kind of . . . barbaric?”

The second, only slightly less common, response is “I have a friend [or an aunt, or a grandfather, or a colleague] who had that. It made them better.” They say this with lowered voice, as if it might be a bit of a betrayal to even speak of it. It is not only stigma, but also compassion and loyalty to people we love who have suffered that makes us tread carefully when we speak of mental illness.

Then, in both conversations, there follows a relaxing of reserve and a slew of questions. For instance, “Why, if it’s so effective, don’t we hear more about it?” One reason is because it is a treatment that is considered only after other treatments have failed. According to Dr. Lisanby, who is also Director of Translational Research at the National Institute of Mental Health in Bethesda, Maryland, “ECT is now considered one of the most effective treatments for people who haven’t been helped by antidepressant medication. In the US alone, that’s more than five million Americans suffering from depression so crippling it leads many people to take their own lives.”

Who wouldn’t prefer seeing a therapist or taking a pill, or both, to being put under anesthesia, given muscle relaxants to prevent injury, and having an electrically induced brain seizure? The trouble is that between 35 and 40% of people are — as my admitting psychiatrist described me — “refractory to multiple antidepressant medications.” Dr. Lisanby says, “It’s not uncommon for someone to have tried 20 or 30 different medications by the time that they come to see me.”

Another reason we don’t hear more about ECT is because many therapists and psychiatrists have had limited access to ECT information and training during their education. Dr. Dan Maixner, Clinical Professor of Psychiatry and Director of the ECT program at the University of Michigan, says, “Psychiatrists may not have much training or very good exposure to the treatment because there might be very limited residency requirements, and a trainee may only be exposed to a single lecture about ECT and a few patients receiving this treatment.”

This “last resort” designation explains in large part why the general public and many medical professionals are underinformed about ECT’s effectiveness. But professionals like Dr. Lisanby and Dr. Maixner and people who have found remission from their depression would like to see that designation change. Dr. Lisanby says, “One study found that among people who had undergone the treatment, 98 percent said they would do it again if their depression recurred.”

In a 60 Minutes segment that aired in May 2018, Anderson Cooper pushed back against Dr. Lisanby’s reassurances: “It’s still frightening for people.” She responded, “It’s not something that you have to be afraid of, and so many of my patients, after they’ve had ECT, say to me, ‘Why did I wait so long to do this?’ or ‘Why did my doctor wait so long to refer me for this?’”

Dr. Maixner knows the answer to this question: “A big issue for people is fear of memory side effects. I spend the biggest chunk of time [with a newly referred patient] talking about a couple different types of memory problems.” I asked him to tell me what that talk entails because I vividly remember my psychiatrist talking to me as I was weighing the option of ECT, and I wondered if it was the same talk. It was.

He launched in. “You may have some memory loss of recent past things. It tends to be spotty and is rarely permanent. It tends to be around the time of treatment, going back sometimes a few weeks or a few months. It does not erase the brain. It doesn’t cause you to have permanent forgetfulness. It doesn’t cause you to forget your spouse’s name or your kids’ names. . . . The vast majority of studies say that there is very little risk of having any sort of perpetual memory difficulty.”

I asked Dr. Maixner if he had ever seen a case where someone experienced permanent, debilitating memory loss that he would directly relate to ECT. He deliberated, as if searching back through a vast mental file. “No, not that I can think of. I’ve been doing this for 25 years.”

Given the high number of Americans with treatment-resistant depression, the enormous costs in lost productivity at work, damaged relationships, suffering, and the high rate of suicide, it is more than past time that we bring ECT back into the discussion. This is one life-saving option that belongs on the table.

References

Abraham, S. (2018, May 11). Surprising finding about ‘shock therapy’ for depression suggests more patients should try it sooner. In UofMHealth.org. Retrieved October 19, 2018, from https://members.depressioncenter.org/newsroom/article.php?articleId=2734

Cooper, Anderson, Correspondent. (2018 May 13). “Is Shock Therapy Making a Comeback?” Interview with Dr. Sarah H. Lisanby, NIMH Director of Translational Research. 60 Minutes. Los Angeles. CBS.

Dukakis, Kitty and Larry Tye. (2006). Shock: The Healing Power of Electroconvulsive Therapy. New York, New York: Penguin.

Duke, Patty and Gloria Hochman. (1992). A Brilliant Madness: Living with Manic Depressive Illness. New York, New York: Bantam.

Higgins, Amy. (2018, June 21). Interview with Dr. Daniel Maixner, Clinical Professor of Psychiatry and Director of the ECT program at Michigan Medicine, UM’s academic medical center, Ann Arbor (sound file and transcript available upon request from the author).

Hurley, Dan. (2015, December). “The return of electroshock therapy.” The Atlantic Monthly. Retrieved from https://wwwtheatlantic.com/magazine/archive/2015/12/the-return-of-electroshock-therapy/413179/

Kellner CH et al, the CORE/PRIDE Work Group. (2016, July 15). Right Unilateral Ultrabrief Pulse ECT in Geriatric Depression: Phase 1 of the PRIDE Study. Retrieved on line from http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.15081101

Kellner CH et al, the CORE/PRIDE Work Group. (2016, July 15). A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study. Retrieved online from http://dx.doi.org/10.1176/appi.ajp.2016.16010118
Kimball, J. M. (2007, May). Electroconvulsive therapy–an outdated treatment, or one whose time has come? [Electronic version]. Southern Medical Journal, 100(5), 462-463. doi: 10.1097/SMJ.0b013e318046f8c1

Manning, Martha. Undercurrents: A Life Beneath the Surface (1994). New York, New York: HarperCollins.

Ross EL, Zivin K, & Maixner DF. (2018, May 29). Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States. JAMA Psychiatry, 75(7), 713-722. doi:doi:10.1001/jamapsychiatry.2018.0768

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