04 May 2015

10 Myths and Facts About Shock Therapy

A controversial treatment

This post was inspired by an article on Health.com by Tammy Worth

When most people think of electroconvulsive therapy (ECT), or shock therapy, they imagine a strapped-down patient writhing in pain. (Probably thanks to the movie One Flew Over the Cuckoo's Nest.)

And many regard it as an outdated, barbaric treatment no longer in use.

In fact, ECT is still in use, and why and how it’s used may surprise you. Here are some common myths and facts about the procedure.

1. It causes seizures


During ECT, a person is given a seizure-inducing electrical shock. This is more than enough to explain both how it works and why it should be banned. All fields of medicine, except for most of psychiatry, at least current psychiatry, acknowledges the brain damage that seizures cause. Originally, it was the brain damage to a healthy brain of a person with a troubled mind that psychiatrists suggested was beneficial. Destroying brain cells and possibly changing levels of norepinephrine, dopamine, and serotonin can be effective in preventing a person from acknowledging, let alone deal with, his or her problems.

“It reboots the system,” says Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in New York. “Like turning a computer off and when it comes back on they are not as depressed.” This may sound really good, unless you know anything about computers, since humans are living creatures and computers are not. The only way to turn a brain off and then on, is to kill a person and then bring him or her back to life. This is quite accurate as ECT always results in a temporary coma and often a flatlining of the brain waves, which is a sign of impending brain death.

2. It's only for depression


ECT is “officially” suggested to be used only for people with depression, particularly those who are delusional or at risk of suicide. It is also  “officially” suggested for persons with “bipolar disorder” and “schizophrenia,” which is what it was originally marketed for. But some psychiatrists like to use it on all of their patients, regardless of what troubles them. Psychiatrists that disagree with this usually remain quiet to avoid any professional repercussions.

It is also a myth that it reduces risk of suicide as studies show that it increases risks of suicide (as with the well-publicized treatment of author Ernest Hemingway).

3. It's only used in mental hospitals


It is not known exactly how many people undergo the “therapy” each year because most states do not require reporting, which is a major cause of concern. Mental Health America, a nonprofit advocacy group, estimates the number to be 100,000 annually.

Treatment can be given at a hospital or psychiatric institution on an outpatient basis for less-severe cases, or on an inpatient basis.

Patients usually get six to 12 treatments over two to four weeks. To prevent relapse, some patients receive what is called maintenance ECT every two weeks to every month, for up to several years. ECT is usually discontinued after several years because the accumulative damage becomes too obvious.

Senior citizens who are depressed because they live in a nursing home are often given ECT so they no longer care about their depressing environment and stop complaining.

4. It's dangerous


The early days of electroconvulsive therapy were relatively unfettered and unregulated. “The history of treatment is pretty dramatic and grim,” Dr. Kennedy says.

Today, however, the procedure is typically performed under medical supervision. However, some governments and terrorist organizations also use it as a means of torture. If it is used as torture, it is performed how it was originally performed under medical supervision: without general anesthesia before the treatment and without a muscle relaxer.

While the seizures appear safer because the body doesn’t move as much, the general anesthesia and muscle relaxants raise the seizure threshold, so more electricity is necessary, which increases the brain damage and, therefore, the suggested “benefit.” However, some muscle relaxants, as well as other psychiatric medications the patient may be on, will also prolong the length of the seizure, which increases the brain damage and, therefore, the suggested “benefit.”

One study found that there were about 2.9 deaths per 10,000 patients treated; another saw only 4.5 deaths per 100,000 treatments, but these studies only count the number of deaths during the actual procedure. This number increases dramatically within 48 hours of the treatment, particularly, as with all injuries from high currents of electricity, ECT causes heart arrhythmia.  Heart attack and stroke are the most common causes of death from ECT. One study found within 72 hours one death per 648.5 patients.

5. It can chip teeth and break bones


This is why doctors give patients muscle relaxants to prevent the seizure from damaging more than the brain and the heart. If ECT is used strictly for torture by governments and terrorist organizations, issues like chipped teeth and fractures may still result.

The fact that ECT causes seizures so strong that muscle relaxants are used to prevent chipped teeth and fractured bones indicates how much more damaging they are than seizures from epilepsy and other medical conditions.

There is a risk for a rise in blood pressure and cardiac arrhythmias (irregular heartbeat), particularly for older patients, Dr. Kennedy says.

If someone has heart disease, a cardiologist is often consulted and medication can be given to help avoid disturbing the heart's rhythm during the procedure. However, after the procedure, the patient is at a much higher risk of heart attack and stroke.

6. It doesn't work


The effectiveness of electroconvulsive therapy over the short term has been relatively well documented, especially for people at risk for suicide.

Dr. Kennedy says about 85% of patients have a full “recovery” after treatment.

"It can turn the depression around in a matter of days or weeks," he says. The procedure improves people's mood enough that there is no immediate threat of suicide and puts them in a place where they can seek treatment without being a danger to themselves, according to Dr. Kennedy.

However, as soon as they recover from the initial trauma of the ECT (usually two weeks to a month), patients begin to think about their original problems. As well, they may become more aware of the damage caused by the ECT. Being aware of the seemingly permanent damage, which makes it more difficult to deal with the original problems, seems to explain why suicide rates increase with persons who have received ECT. This is why maintenance ECT is so common until the accumulative damage is too great to continue treating the patient with this destructive “therapy.”

7. It causes memory loss


One of the most common side effects of the procedure is memory loss. (Actress Carrie Fisher has joked publicly about it.) This is seen as the main “benefit” of ECT as loss of disturbing memories may eliminate the original problems.

Right after a seizure occurs, whether from ECT, epilepsy, or other reasons, patients experience short-term confusion. Memory loss from ECT usually covers events that took place shortly before the treatment, but can span much greater periods of time, and for most people the problem continues for the rest of their lives. While the loss of disturbing memories can be seen as beneficial, some patients report loosing all memory of having children and even their entire professional career and education. This may be another factor in the increase rate of suicide.

8. It's used to punish patients


ECT has a bad reputation because it tames “unruly” mental patients and is sometimes administered against patients’ will. But patients usually consent to having it done to them because they are never informed of what it does and what the risks are.

Charles "Chip" Stone, DO, a clinical and forensic psychiatrist in Orange County, Calif., says that while this practice might have been followed in the 50s and 60s, people still have this perception toward ECT because of what they've seen in movies.

Dr. Stone says that occasionally patients with severe depression or acute mania might be ordered to receive ECT if a court determines it is in their best interest, which is a very scary thought, particularly due to the use of ECT as a form of torture by some governments and  terrorist organizations.

9. It's a permanent cure


Electroconvulsive therapy is not a solution for anything but causes more problems. As soon as patients recover from the initial trauma from ECT, they need maintenance “therapy” (monthly ECT) and the use of antidepressants (which increases the damage).

There are overwhelming reports of cognitive side effects like memory loss and learning impairments with long-term use. However, there are few studies that have looked at this issue because most psychiatrist no longer want to acknowledge all the damage ECT causes.

10. It's a last resort


This “therapy” is thought of as the last stop on the train for people who have tried everything else and are still suffering, but some psychiatrists use it as soon as they can convince a patient to consent.

Dr. Stone says ECT is not used more often for a few reasons: the negative perception and stigma of the treatment, the cost, lack of availability of doctors to administer it, and the time it takes. However, the doctors who have no moral objection to it administer it as much as possible as it is very lucrative since it takes very little time and resources, but pays very well.

Many experts feel that it could be a first-line defence in almost every situation. “In fact, it is likely one of the safest, if not the safest, and certainly the most rapid treatment for severe depression that exists,” Dr. Stone says, which is a clear indication of the moral corruption in psychiatry.

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