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Treating Mental Illness with Electroconvulsive Therapy

ECT Machine

When Jane[*] finished her series of electroconvulsive therapy (ECT), her mother was furious—but not for the reasons you'd expect. Her daughter had undergone a series of procedures in which doctors at the Huntsman Mental Health Institute (formerly University Neuropsychiatric Institute or UNI) induced seizures by sending electric currents through Jane's brain.

In just two weeks, Jane's depression had seemed to disappear. After years of suffering, trying medication after medication, ECT was the blessing that finally helped Jane, which left her mother asking, Why didn't anyone recommend this sooner?!

Howard Weeks, MD, co-medical director of the Treatment Resistant Mood Disorder Clinic at HMHI (formerly UNI), is passionate about ECT. "It works," he said. "It can be a miracle for some patients."

For patients with the crippling diagnosis of severe depression, bipolar disorder, or psychosis, electroconvulsive therapy (ECT) can be a life-changing procedure. Not only does it work better than medications (according to Weeks, medications have a success rate of 50-60 percent of patients getting better, while ECT succeeds at a rate of 70-90 percent), it works faster.

Medications typically take up to eight weeks to show improvement. "With ECT, I can get them feeling better in two weeks or less," said Weeks. It can also be very effective in patients for whom multiple medications have failed. And when it comes to suicidality, its effectiveness can mean the difference between life and death.

Patients undergoing ECT are first given general anesthesia and a muscle relaxant. Electrodes placed on the patient's head send electric currents through the brain, stimulating a brief seizure, which is closely monitored. When the anesthesia wears off, the patient wakes up. This whole procedure, which often takes as little as 15 minutes, will be repeated around eight to twelve times in a series over three weeks.

Though ECT may seem to miraculously erase mental illness, Weeks says it is not a cure. "We do not have cures for depression or mental illness in medicine. But what we do have is an effective treatment that can get someone over an episode of depression." Patients of ECT still need to be on medication and in therapy to prevent future episodes. Some patients will need to undergo a couple series of ECT, or use maintenance ECT (ongoing ECT treatment) if medication fails to prevent episodes.

ECT Side Effects

Just like anything in medicine, patients will have different reactions. Some patients experience side effects such as headaches, nausea, and jaw pain, but the most concerning side effect is memory loss. According to Weeks, research and clinical experience suggest that this effect is mostly temporary short-term memory loss. Many patients have trouble remembering the time during an ECT series. Patients may also have a hard time remembering things from the past.

"After ECT, within one to two months, those memory problems mostly dissipate," said Weeks. "You don't continue to have ongoing short-term memory problems and memories from before ECT tend to come back."

The severity of memory loss varies from patient to patient. Of course, as with any other medication or treatment, patients must weigh the side effects against the benefits. Patients can feel comforted in knowing ECT is one of the most common procedures in the country, with more than 100,000 series done in a year. It's also considered one of the safest procedures.

"We're not cutting anyone open and they're under anesthesia for a very short period of time," said Weeks. "It's tolerated remarkably well." Weeks also assuages discomfort surrounding short-term memory loss by inviting patients' family members to sit in on the procedure—they can then serve as a trusted source for the patient who can't recall what happened during that time.

ECT is also the treatment of choice for catatonia and neuromalignant syndrome. Severely depressed women who are pregnant are also ideal candidates for ECT as it is much safer for the fetus than many medications.

However, ECT wasn't always seen as a miracle. Pop culture has long represented the procedure as painful and involuntary, most notably in Ken Kesey's novel-turned-film One Flew Over the Cuckoo's Nest, in which ECT was performed without anesthesia. "That hasn't been done since the '50s, but it made for a good movie," said Weeks.

In the past, Weeks would have to spend much time explaining to patients that ECT is not a barbaric treatment; fortunately, the stigma has begun to fade away, perhaps due in part to endorsement by public figures, such as Kitty Dukakis and the late Carrie Fisher, who both experienced personal success with ECT.

These days, ECT is not administered against a patient's will, and the use of anesthesia and muscle relaxants prevents pain and injury. Weeks believes inviting family members into the procedure room helps to reduce the stigma and fear. Some of Weeks' patients and their family members are staunch supporters of ECT, including one who filmed himself to provide an honest portrayal of the procedure. Weeks continues to break down misunderstanding and advocate for this life-saving treatment.

"The most important thing to recognize is that severe mental illness is treatable and getting help is important," said Weeks. "There's hope out there. Just because you haven't done well with a particular treatment doesn't mean it's the only one."

[*] Not her real name.