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Treatment for severe
depression includes antidepressant drugs, psychotherapy
and counseling. But when treatments for depression do
not work, many are turning to Electroconvulsive Therapy
or ECT. It can often be the only cure for severe depression,
mania and schizophrenia.
Electroconvulsive therapy
(ECT) remains an important treatment in modern psychiatry,
which despite many advancements, wrestles with an outdated
public image that impedes its potential usefulness.
The ECT administered today is not painful or punitive,
and it doesn’t produce the zombie-like state portrayed
in films such as “One Flew Over the Cuckoo’s
Nest.” ECT is given as a series of treatments
under full general anesthesia with muscle relaxation.
It is normally done on a three times per week schedule
and is currently available to both inpatients and outpatients.
Typically, a course is from 6-12 treatments and is individualized
to the patient’s needs. Interestingly, ECT works
best in the most severely depressed patients who have
often failed to respond to other methods of treatment.
Two leading researchers
on ECT, Dr.
Charles Kellner and Dr.
Georgios Petrides, direct the ECT service at University
Hospital. Dr. Kellner, a member of the American Psychiatric
Association’s (APA) Committee on ECT, is Chair
of Psychiatry at New Jersey Medical School and Chief
of Psychiatry at University Hospital. Dr. Petrides is
the Vice-Chair of Psychiatry at New Jersey Medical School
and director of an ECT training course. “ECT is
a safe, modern, comfortable treatment that is commonly
used for people with severe depression, proving effective
more than 80 percent of the time. It can also benefit
patients with mania or schizophrenia,” says Dr.
Kellner.
Depression affects an
estimated 20 million Americans to varying degrees, and
of them, about 100,000 patients have ECT each year.
People with severe depression typically have a profound
sense of hopelessness that interferes with their ability
to work, eat, sleep, or participate in activities they
once enjoyed. Some symptoms of depression include persistent
sadness, lack of energy, insomnia, difficulty concentrating,
weight loss, and thoughts of suicide, but the condition
manifests itself differently from person to person.
A physical examination and a mental health evaluation
are used to make a diagnosis and develop a treatment
plan, which often includes antidepressant medication.
When an antidepressant
or combination of drugs are not effective or cannot
be taken because of other health problems, ECT can be
a viable treatment option. “I provide patients
with as much real information as they need to make a
reasonable decision, and for people with severe depression,
ECT can be a very reasonable choice,” says Dr.
Kellner, noting that ECT patients sign an informed consent
form prior to treatment. “My typical ECT patient
is an elderly woman with severe depression who after
about two weeks of treatment is back to a productive
life.” While ECT usually is not administered as
an emergency treatment, says the psychiatrist, in rare
instances when the patient is suicidal, very psychotic
or extremely agitated, it can be used in lieu of anti-depressants,
which can take up to three weeks to become effective.
ECT has been continuously
used since 1938, and organizations such as the National
Institute for Mental Health (NIMH) and the APA acknowledge
the therapy’s effectiveness and safety. Dr. Kellner
was quoted in a recent article in Health magazine in
which he acknowledged ECT's re-emergence as an effective
tool for combating depression.
However, doctors still do not know exactly how ECT works.
One theory, says Dr. Kellner, is that ECT affects the
chemicals in the brain called neurotransmitters much
as antidepressants do, only more powerfully. Another
possibility is that the seizure produced by ECT releases
peptides, hormones in the brain that control mood.
ECT
and Memory Loss
As is true of any procedure,
ECT can produce side effects. Minor side effects include
headache, muscle soreness, and nausea. Other side effects
include the very rare and more serious risks associated
with general anesthesia, such as stroke, heart attack
and death. But the most controversial side effect –
and the one most patients are concerned about –
is memory loss.
Advances in ECT technique
have allowed doctors to improve the cognitive side effect
profile while maintaining its remarkable antidepressant
efficacy. “Almost everyone who has ECT experiences
some amount of memory loss,” says Dr. Kellner.
“The question becomes how much. It’s believed
that the length and dose and where the electrodes are
placed affect the degree of memory loss.” Bilateral
ECT, where electrodes are placed on both sides of the
head, is most effective at alleviating major depression
but causes more significant memory loss, while right
unilateral placement produces less memory loss but is
not as effective. A third placement, bifrontal, may
be the middle ground, offering good efficacy but moderate
memory loss. Accordingly, cognition is carefully monitored
throughout the course of treatment. “For most
people the memory problems are transient and have to
do with events around the period of treatment,”
explains Dr. Petrides. “The ability to create
new memories is not affected. If anything, when the
depression is lifted, cognitive function improves.”
In addition to starting
an ECT program at University Hospital, Dr. Kellner also
developed a major ECT research program at New Jersey
Medical School. Dr. Kellner and Dr. Petrides are members
of the Consortium for Research in ECT, or C.O.R.E.,
a well-regarded group of researchers who have recently
studied the role of maintenance ECT in preventing recurrent
episodes of depression. While many patients do well
taking antidepressant medication after ECT is complete,
a small number of them do not and can benefit from a
single administration of ECT about once a month. C.O.R.E.’s
other major study compares the three-electrode placement
techniques’ effectiveness against depression and
their impact on memory loss.
Some patients –
and indeed, some psychiatrists – cannot get beyond
the ECT of yesteryear. But for severely depressed patients,
ECT brings hope. “ECT is currently the most effective
treatment for severe depression,” says Dr. Kellner.
“ECT is a mechanism for change in improving the
patient’s quality of life.”
For more
information, visit our ECT website at www.TheUniversityHospital.com/ect.
For a consultation regarding ECT treatment, call Dr.
Kellner at (973) 972-7117 or Dr. Petrides at (973) 972-1606.
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