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.