More on ECT and Other Treatments

By Dr David Laing Dawson

Throughout medical history, every treatment that actually works becomes overused.

Examples today include treatment for high blood pressure, statins, mastectomies, arthroscopies, opioids for pain, antibiotics, aspirin…..

When a treatment is found to work, the criteria for use informally expands until large studies find this to be either detrimental or unhelpful and then the practice shrinks. The current opioid crisis is a good example. The struggle to control the overuse of antibiotics is another.

ECT was first used in 1938 and found to be dramatically effective for patients with very severe depression, intractable mania, and some forms of psychosis. This at a time when there were no other explicitly effective treatments. This at a time when most of these cases were thought hopeless and all other treatments constituted a mix of hocus pocus and wishful thinking.  The very first patient to receive ECT was a man found by police wandering in the Rome train station muttering gibberish to himself. After this first rather unrefined ECT treatment the patient was discharged from hospital fully oriented and talking sensibly.

ECT was also introduced at a time when depression could reach a point of severity to justify the adjectives “stuporous”, “vegetative”, “retarded”. People died in this state from the consequences of malnutrition, starvation, unrecognized infections, and all the problems associated with total immobility. For this subset of severe depression ECT is a miraculous and dramatic (sometimes temporary) cure. It similarly had stunning results with intractable mania and catatonia, and pretty good results with something called “agitated depression”.

Hemingway was hospitalized with a form of psychotic depression (severe depression with agitation and some paranoia), was treated with ECT and returned home to work. For eight months or more he wrote at his standup desk somewhat unsuccessfully, drank too much, relapsed, and was readmitted to hospital. This time he talked his way into being discharged without treatment. And then he killed himself.

Through the 40’s, 50’s, and 60’s ECT became overused, both excessively used for single intractable cases, and used to “treat” many problems that simply don’t respond to ECT. Then our new drugs began to replace ECT, attitudes changed, One Flew Over the Cuckoos Nest hit the big screen, and, perhaps more significantly, with our new drug treatments, very few people got to the late stage of depression and psychosis we called, “stuporous”, “vegetative”, “retarded”, “agitated” and “catatonic”.

Over the years I have received heart felt thanks from a few people for whom I recommended ECT.

And it seems clear to me that all or most of those people who complain of the barbarity and after-effects of ECT are victims of that overuse mentioned above.

There are many human conditions for which ECT is not helpful, but, in some of those cases, once used, ECT becomes the perceived cause of all succeeding problems.

In reality ECT remains a very safe and effective treatment for serious depressive illness. Today it is mostly used when trials of medication have failed. Curiously, though pilloried and thought to be barbaric by some, ECT is actually one of most dramatically effective and safe treatments in all of medicine.

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5 thoughts on “More on ECT and Other Treatments

  1. Thank you. I underwent ECT and benefited greatly from it. I didn’t find it to be the least bit barbaric. I wrote a series of blogs about my experiences with it.

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    1. Thank you for letting us know that it worked. In my experience I have seen many really benefit from it though in the sixtties it may have been overused.

      However it is hard to know when the patients had been ill long before the introduction of antipsychotics and in the case of schizophrenic patients they often had entrenched delusions which often were very dominant and hard to keep in the background. In these cases the resort to was often ECT. Hindsight is not easy to assess.

      But with major depression it often produced very quick relief. In my time as a nurse Holloway sanatorium the the timing of the electrical exposure was carefully calibrated and monitored. Perhaps in recent times it has been underused given the fear mongering by the Anti ECT Lobby.

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  2. It is interesting that none of the readily available articles ever discuss what actually happens as a result of ECT, other than describing which mental illnesses it deemed appropriate to, how it is done, and a few common side effects. It might be true that ECT is the only reasonably effective treatment currently available in some cases for some conditions, but I tend to think that it is in fact somewhat barbaric. I have had some, albeit few, instances to observe the changes in individuals as to before and after ECT. In those cases the individuals had become much more passive, emotionally detached from life, far less expressive of themselves and less responsive and expressive as to life, and in every way seemed remarkably damaged, even if seeming submissively at peace, compared to their former selves. While that might be desirable in some cases, and might even be desired by the patients who undergo the treatment, there is something barbaric involved, and that is not being talked about. Could it be brain damage ? It does emulate some instances of that.

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    1. For many years before ECT was developed it had been observed that (and here you need to picture many 40 person wards of very ill people in a large mental hospital) when someone had an epileptic seizure his or her severe depression, mania or catatonia improved. So the question was asked, can we induce a seizure? Drugs were tried, but a small jolt of electricity worked best. The technique has been improved to the least possible amperage with anaesthesia and muscle relaxant medication. How it works we don’t know, though theories abound. One I like is the suggestion that the impending seizure stimulates the body/brain defenses against the spread of wide random firing of neurons and this resets our various connections. (much like other treatments stimulate or aid our natural defenses). But I must say, to use your words, I would rather live “submissively at peace” than in a constant state of agonizing fear, despair, or fury.

      David

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  3. Why is it that neurosurgeons can perform deep brain surgery to alleviate movement disorders,, without being called torturers,, butchers or worse names and that psychiatrists may not stimulate the brain externally for a few seconds without being saddled with those names ?

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