Susan Brown* has known about depression from an early age. Her mother has had depression for as long as Brown can remember. As for herself, “Since I was about five, I’ve had times I became sad for no reason and cried a lot. I’ve been diagnosed with clinical depression for many years,” she says. “But the difference between my mother and me is that I’ve sought treatment.”

For nearly 30 years, Brown, now in her mid-50s, has been under psychiatrists’ care for her depression. Psychotherapy, or “talk therapy,” and medication had been the mainstays of her treatment, and for many years, they worked quite well for her. She works in a field that carries many responsibilities, and for some time was able to do her job well despite her depression. But when she was in her late 40s, the medicine no longer helped Brown. She was tired, had little energy, and as a side effect of the anti-depressant, had gained weight. But even more significantly, Ms.Brown began having severe depressive episodes. “After awhile, I began to believe that life as I was living it was not worthwhile,” she said.

At that point, Brown’s psychiatrist, Dr. Charles Kellner, professor and chair of psychiatry at New Jersey Medical School and chief of psychiatry at University Hospital, suggested a treatment reserved for people with the most severe clinical depression, electroconvulsive therapy (ECT). “I had a lot of reservations,” says Brown. “I am a person who needs facts, and even though studies show that ECT can be an extremely effective treatment for depression, I was initially very unsure.”

Dr. Kellner, a director of University Hospital’s ECT program, says he and Dr. Georgios Petrides, vice chair of psychiatry at New Jersey Medical School, treat many patients with depression, some of whom have the condition severely enough to be considered for treatment with ECT. These patients have a persistent sadness despite talk therapy or medication and may even contemplate or attempt suicide. It’s for patients such as these, Dr. Kellner says, that ECT may be the best course of treatment, a therapy about 100,000 patients undergo each year.

Dr. Kellner says that while doctors don’t know precisely why the treatment helps many people with severe depression, they believe that ECT releases neurotransmitters, chemicals in the brain that regulate mood. “It’s similar to the release of mood-regulating neurotransmitters achieved by medicine, but in a more powerful way,” he says.

figure 1.

[SOURCE: Charles H Kellner, John T Pritchett, Mark D Beale, C Edward Coffey, “Handbook of Ect ,” Psychiatric Pub, Inc., 1997]

“There are many benefits of ECT for people with severe depression,” says Dr. Kellner. “The most telling is that ECT is effective for over 70 percent of the people who undergo the therapy. And, unlike how it is often portrayed in movies or by the media, ECT is a safe and comfortable treatment.”

Ms. Brown had the first of her six ECT treatments last winter at University Hospital. Dr. Kellner told her about the possible side effects, the most common of which are headache and memory loss. “I really did not have severe side effects following ECT treatment,” says Ms. Brown. “A couple of times I had a headache, and once I was unable to remember the name of a street in the neighborhood where I’d lived for nearly 15 years. One day, however, I suddenly was able to remember the name of the street again.”

Memory loss is the most troubling side effect of ECT for many patients, Dr. Kellner says, but most of the time, as in Brown’s case, it is a temporary loss. “It’s not unusual for a patient who’s had ECT to experience memory loss of some degree. Usually, the memory comes back in a few months following treatment, but there are patients who have severe, long-lasting memory loss.” Researchers have found that electrode placement and length of dose can contribute to memory loss. Bilateral ECT, in which the electrodes are placed on both sides of 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.

Brown, once doubtful about ECT, is now a firm believer in the therapy. In her case, she had six treatments, but the number varies by patient. “ECT has made an amazing difference in my life. The thoughts and feelings I had before are gone, and I enjoy life again,” says Ms. Brown. “My family – a husband of nearly 30 years and two children – is convinced the therapy has changed all our lives for the better. Once I was a skeptic, but now I am a believer in the worth of ECT.”

* A pseudonym

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.