Nobody really knows how it works, but electroshock therapy is an effective way to treat serious depressions and psychosis related depressions. That's why a modern version of electroshock is making a quiet comeback in psychiatry.
'One Flew Over the Cuckoo's Nest', is a film Dutch psychiatrist King Han Kho despises. "It was very harmful to psychiatry," he says. The 1970s blockbuster featured Jack Nicholson as a psychiatric patient being submitted to electroshock treatment in a truly barbaric fashion: without any anaesthesia and serving as a type of punishment.
As a result of 'One Flew', electroshock therapy has been taboo for decades, asserts Dr Kho. And that, he says, is all the more serious because it does work - and the treatment in its modern form is painless and safe.
"As a result of that movie several generations of patients have been denied effective treatment."
Convulsion
Dr Kho is a practising psychiatrist in a big mental institution in Delft. He has extensive experience with the use of ECT, as shock therapy is officially called.
ECT stands for 'Electro Convulsion Therapy': it artificially produces an epileptic attack, or convulsion. This is done by sending a powerful yet safe electric current through the brain.
The convulsion is in fact no more than a side-effect, and nowadays it is suppressed as much as possible with muscle relaxants and full narcoses. What matters is the current itself, which runs though the brain for a couple of seconds; that's what produces the therapeutic effect.
For whom?
ECT is still rather a 'heavy-duty' treatment, which is why not every sufferer of depression is treated in this fashion. "Some 30 percent of those suffering from heavy depression simply cannot be helped with medication," says Dr Kho.
"Even after taking drugs for a very long time there is no improvement. These are the patients for whom ECT is an option. There is a second group: patients who are diagnosed as having 'psychotic' depression. These are not only very deeply depressed; they also suffer from delusions and extreme paranoia. As these people are known to run a very high risk of committing suicide, it is wise not to wait with ECT: drugs just might take too long."
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Han de Vries, treated in 1956
"It helped, that much is true. I've been 'shocked' five times and my depression got a little better every time, but the way it was done…Thank God it was under full narcosis. My psychiatrist was enlightened for the time, but nobody asked me anything. I was simply told: "Mr de Vries, we're going to treat you with electroshocks."
"A couple of days later while I was lying in my bed, I asked the nurse when the treatment would begin. She told me to look at my arm where I saw a patch; it covered the little wound the syringe had made for the anaesthetic! It was all over! There was no further special care or any explanation. I certainly hope that's different these days."
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The treatment itself
First, patients undergo an examination in order to determine whether there are any physical problems. Above all, the risk of cardiac arrest has to be excluded.
Then, they are asked to lie down on a trolley and electrodes are stuck to their chests and heads for monitoring brain activity during treatment as well as vital functions. The anaesthetist injects a fast-working narcotic directly into the bloodstream, together with a powerful but equally fast muscle relaxant. Once patients are fully unconscious, they are ready for shock treatment.
The psychiatrist then holds two handlebars with electrodes against the skull - one on top and one just above the ear - and applies a specially modified electric current for five to eight seconds. An epileptic attack occurs (the convulsion) but, as a result of the full narcoses and the muscle relaxant, only a slight tremor of the hands is visible.
For approximately one minute after the actual shock the line on an ECG (electro cardiogram) monitor peaks sharply. This shows extreme brain activity and is the proof that an epileptic attack is indeed in progress. The line flattens out very quickly, and in about five minutes after treatment the patient regains conciousness while being attended to by a nurse.
The theory
Although it's not clear exactly why shock therapy works, there are a couple of theories. Dr Kho believes it's all about desensitising certain brain cells.
"We know that depression, just like schizophrenia, is somehow related to a malfunction of neurotransmitters, the chemicals that serve as messengers inside our brain. Deep within our skull is a little area that can be seen as our 'emotion centre'. If, for whatever reason, brain cells in this emotion centre are oversensitive to certain neurotransmitters, they can constantly produce sombre feelings even when there is no real reason for the patient to feel depressed. I believe a powerful electric current desensitises these cells. That could be the therapeutic principle."
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Irma Beiling, treated in 2005
"I was very thoroughly informed about ECT and that was good. Electroshock therapy sounds scary, doesn't it? Of the treatment itself, I only remember the doctor saying: "Now we're going to give you the anaesthetic." About ten minutes later I woke up beside the nurse. I had a headache, but nothing serious, one Paracetamol took care of that…"
"I did suffer a bit from memory loss and that's slightly disconcerting, but it went away again. Mind you, I was so severely depressed that a bit of memory loss seemed a good deal; all I did before the treatment was lie alone in the dark and cry… Now I can do things again with my husband and children.
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Effectiveness
But even though the 'why' isn't fully understood, the results of ECT are impressive: 70 percent of the patients who can't be helped with medication benefit from shock therapy.
What's more, the side-effects are relatively mild; sometimes there is a temporary loss of short-term memory and, immediately after treatment, a slight feeling of disorientation. But at the same time, the potentially very serious side-effects of anti-depressant drugs like sleepiness, obesity and reduced libido can be avoided.
The future
As far as Dr Kho is concerned, shock therapy needs to be researched and developed further, in order to improve the treatment even more. It's important to know why some patients suffer from memory loss while others don't; that might give clues about how to prevent it. But above all, patients and the medical profession alike need unbiased information about ECT.
"My research proved one thing without a doubt," Mr Kho stresses, "the longer a patient suffers from depression and the longer the psychiatrist waits, the less effective shock therapy will prove to be. In other words: 'Shock sooner for better results'."
Tags:
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King Han Kho,
neurotransmitters,
psychiatrist,
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KJ,
24-07-2007
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Isn't it funny how the doctor states "What's more, the side-effects are relatively mild; sometimes there is a temporary loss of short-term memory and, immediately after treatment, a slight feeling of disorientation.
And then later states "It's important to know why some patients suffer from memory loss while others don't; that might give clues about how to prevent it."
With his first statement the reader would think there are no problems with memory. So why would more research in this area be needed.
With ECT one has to always read between the lines. The doctors and reseacher tend to leave the devastating side effects of premenate memory loss out.
Also one may also want to re-read the doctors use of percentages. Just where is he getting the 70%.
ECT is the same treatment it was 70 years ago with the exception of being put to sleep and muscle relaxers. Make no mistake about it, the brain still feels the effect and premenate disabling cognitive disfunctioning is occuring at an alarming rate (just what this rate is is hard to determine since ECT is not regulated).
I agree with another poster, have the good doctor have just one treatment as it is so safe. I am sure he wouldn't mind.
jasmin,
05-07-2007
- India
My friend who is an anaesthetist posted in the Amritsar Mental Hospital, one of the renowned in India agrees to ECT. She says that only their hospital is allowed to do this under anaesthesia as per the orders of the High Court.And their hospital has good results.
russ,
04-07-2007
- usa
I have reconsidered my last comment. Please ask Dr. Kho to post the US dollar amount he would require to be given ect on national television. I'm sure that we can work it out.
Russ,
04-07-2007
- usa
please offer the doctor 20,000 to allow himself to recieve his "safe" jolt of electricity through his own brain. If it is truely "safe", he will be glad to do this for us all to see.
Esa Ronkainen,
04-07-2007
- Finland
I am suffering of the bipolar mental disorder.Depressiopn is difficult to diagnostize. my case started with a years long depression.it was like physical pain.
My firends who suffer of serious depression perefere an elshock to it.Many patients wish for electroshock.
In London a nurse told that it is used only when nothing else helps.
I guess brain is still a black box what is an eneigma to the science.
Esa Ronkainen
Finland
sickmind fraud,
03-07-2007
- North America
There are many cases which demonstrate that electroshock results in nothing more than glorified brain damage, even if administrated with muscle relaxants or sedatives., etc.
Furthermore, the use of electroshock as a tool of political control is also troubling.
That are many people who consider electroshock barbaric, an attempt to do something for the patient when nothing is effective. even if that something is on the order of a blunt object applied to the skull.
Because modern psychiatry has as many criminals in as in the normal population (there is no difference) you also have a sub group of people who like to use it for perverse reasons.
Real science needs to be applied to the problem of depression. Being docile and unfeeling due to brain damage is not a cure.
Otherwise electroshock would be the recommended course of treatment to victims of violent crime and war. I suspect most people would find this repulsive.
