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Treatments

ELECTRO CONVULSIVE THERAPY (ECT)

Electro Convulsive Therapy (ECT) can be an effective therapy for very severe depression, but it would probably only be considered if you were bad enough to be hospitalised for your depression. The treatment involves administering, under anaesthetic, a series of electric shocks to the brain at intervals over a few weeks. Many complain of memory loss following ECT.

There has been fairly minimal research done using ECT as a form of treatment for depression. In the research that has been done children and adolescents have rarely been included beacuse of unproven fears that ECT may damage the developing brain.

In a research done by Rey and Walter, of 396 adolescents and children who recieved elctroconvulsive therapy, improvement rates were of 80% for catatonia, 80% for mania and 63% for depression. These results were given after all other forms of antidepressant treatments had been used.

Improvments have been seen in tests using ECT in patients with psychotic depression, bipolar affective disorder and psychosis.

In an Australian experience with ECT between 1990 and 1996, 42 patients (aged 14 - 18) underwent 49 courses of ECT comprising of 450 treatments. Symptoms improved in half the completed courses, especially in patients with mood disorders, with transient side effects.

The adverse effects of ECT have been fracture, panic episodes, fear, spontaneous seizures and headaches. These side effects are avoided these days by using anethesia, muscle relaxation, oxygenation, brief-pulse stimulating currents, selected electrode placement and energy dosing. The primary impact of ECT remains its effect on recall and learning.

Adults often have vague recollections of events and experiences that occured during their illness. Some patients report more persistent memory difficulties.

Generally speaking ECT is used as a 'last resort', especially on children and adolescents, and only after all other first-line therapies and treatments have failed to help.

From Dr. Catherine Delin......
There are more than 4,500 articles on ECT accessible through the Medline data-base. Generally, ECT is seen to be beneficial in cases of severe treatment-resistant depression and some types of psychosis. In one US study, people who received ECT were compared with those who received other forms of treatment. The ECT group did not differ from the non-ECT group in gender composition, marital status, race, education, employment status, overall severity of depression, chronicity of depression, adequacy of prehospitalization antidepressant treatment, extent of physical illness, or extent of social support. The ECT group was older and had greater weight loss, and worse functioning in their daily lives. The results of studies on how ECT works are still controversial, but a seizure occurs which may stimulate some brain regions and cause electrochemical changes. One writer likens ECT to "a deep and restorative sleep".

Research

Dealing with depression
REPORTER: Dr John D'Arcy
BROADCAST DATE: May 25, 2004, Today Tonight

A Study on the Efficacy of Continuation ECT and Antidepressant Drugs Compared to Long-Term Antidepressants Alone in Depressed Patients

Articles and News

Call to reform shock treatment
Author: BILL BIRNBAUER
Date: 9th April 2001
Section: News
Publication: The Age

COMMENTS
by people who have been using E.C.T.

Please send us your comments and experiences with E.C.T to share with others.

I have just read the comments by people who have had ECT. I was surprised to see so many negative stories about ECT as my treatment changed my whole life. I had been on the change of medication treadmill for about five years before I realised that I had to try something (ANYTHING). My memory was only temporarily affected. I found some of my memory fog really funny, I paid not an inconsiderable amount for my daughters private school fees during my treatment and rang up to ask for more time to pay the fees. The accounts department was dumbfounded that I had forgotten that I had paid the fees already.

I was in hospital for about three weeks and I feel that it was not only the ECT that helped, it was also the chance to stop the world and get off for a period of time to ponder and unwind.

As far as cognition is concerned, I feel that depression and the drugs that are used to treat it are just as likely to affect memory. As a masters psych student put it "they (expletive) around with your brain".

Since my time in hospital I have taken control of my life again, I had the confidence to get out of a BAD relationship, resign from a steady job to study nursing and achieve success. I am now finishing my Batchelor of Arts which I had defered from because I had panic attacks when attempting to write essays.

I am not suggesting that ECT is a panacea but for those with endogenous (as mine is) rather than reactive depression it seems to be an effective treatment when all else fails.

I am not sure why there are so few success stories posted, perhaps those who have had successful treatments do not feel the need to use this medium. Having just completed a paper on the role and mechanisms of ECT (I should acknowledge my vested interest) my Medline search found as many journal articles for, as against ECT. I decided to do this article to see if the literature could tell me why I feel so well. I think the jury is still out as to why ECT works and it may be that untill we are able to definitively solve this problem that ECT will remain a source of controversy.

I baulked at ECT for a long time, the "One Flew Over the Cuckoos Nest" view of ECT was all I could think of. I myself admit to my depression and the treatment that brought about such a successful change in my life. I admit to my depression because I believe that as long as depression sufferes hide their diagnosis mental illness will remain a stigma. I admit to ECT because I was not "mad" when I had it, I was depressed. The treatment is humane and in my case changed my life. It may do so for others.

(22/09/2005)

I am a nearly 54 year old male who had my first course of ECT in November/December 2004. There was a total of 10 sessions in this time and yes i did suffer short term memory loss and headaches and as i have been unemployed for the last 5 years I thought this was a good option to try this as my psych said it was a type of last resort treatment. In the past 5 years I have been on at least 12 or 13 different types of a.d medication and anxiety medication as well.

On discharge from Toowong Hospital I felt fairly good but still had mild memory loss/headaches and sort of felt that some good had come out of it. now the wheels have fallen off me again and back on the roller coaster ride once again. I am another different type of combination of a.d medication but it is not doing much good really. It is the bad days that I cant handle much more. My pysch said at the last consutation with him that on going "maintenace" ECT is an option once again. but whether it happens or not remains to be seen.

I do have good faith in my psych and I suppose it remains to be seen if it happens again. I am sure others out there have and are in the same boat as me. Good luck and best wishes to all out there

(16/03/2005)

I am a 43 year old male who has suffered with depression and anxiety most of my life. My recent episode of depression began towards the end of 2002 where I had to give up my work (Community Support Worker) and drop out of my Masters of Social Science (Counselling). Being labbeled as 'treatment resistant', my psychiatrist had been trying to convince me to undertake a course of treatment of electro-convulsive thereapy for the past 18 months or so. I eventually agreed to be a voluntary patient at Glenside Psychiatric Hospital in S.A. where I agreed to a course of upto 12 treatments (performed on a Monday, Wednesday, and Friday). I was informed of "possible" memory problems as a result of having E.C.T. However, I was informed that such memory problems would ONLY be associated with events that occur during the period of treatment. After 5 or 6 treatments, I signed myself out of the hospital. Why? Well, besically I became very anxious over having more treatments. The memory problems I was told I may encounter ... I certainly did. Less than 48 hours prior to leaving I was taken out to see a movie. I have no idea what the movie was or where it was I saw the movie. There are many examples of such memory loss. However, there is more.

In the week following my exit from hospital, I also found that I have experienced major retrograde amnesia, being unable to recall many aspects of my life prior to any ECT treatments. In addition, I now have severe difficulty concentrating and remembering events that occurred even during days after the cesation of treatment. Some of the overal difficulties I've encountered are: forgetting how to get home from the local shopping centre, forgetting my home phone number, forgetting how old I am, being unable to remember visiting a friend only 3 days prior, forgetting what was in cupboards etc in the home. In addition, while I experienced depression and anxiety prior to ECT, in the past week I've experienced depression and anxiety attacks to the degrees very rarely experienced.

In the past week I've spent considerable time on the internet looking up reports and anecdotes of peoples' experience with shock treatment. My findings suggest that my experiences with ECT are not uncommon, with some reporting permanent brain damage and memory problems many years after the ECT. I believe there should be an onus on treating psychiatrists to 'fully' inform the client of the risks associated with shock treatment. In order to do this, they need to be fully informed. I suggest that unbiased authoritative standardised literature sanctioned by the government be provided to all who are seriously contemptlating ECT. I will never voluntarilly have ECT again.

(09/12/2004)

I had ECT, for the first time, early this year (2004) after approximately three decades' worth of treatment-resistant depression and repeated hospitalisations. It didn't assist in my case, except for a very temporary lift in mood; and the side-effects were most disconcerting. Primarily the long-term as well as the short-term memory loss - almost a year later I still undergo the greatest difficulty in remembering, for instance, the names of people whom I've known for ages - but also the extremely severe muscular pain that I had throughout my body after the ECT, though that only lasted a matter of days, admittedly. My doctor thinks (he could well be right) that this was an allergic reaction to the anaesthetic.

In general, I would say that if you are in - or if you intend returning to - work that compels lots of cogitation on your part, ECT isn't worth the risk. Such was, at least, my experience. Of course, being ill is in itself very damaging to any hopes of carrying out cogitation; so I guess in my case the whole ECT issue was a matter of "damned if you do, damned if you don't".

(09/12/2004)

My first ECT treatment was back in 1998 which saved my life. As awful as it sounds I decided to have it in the hope that it would somehow kill me on the table. I experienced headaches as soon as I awoke from treatment. It took about 9 treatments (3 a week) before I noticed any positive effects and that was that everything seemed brighter, colours of plants, flowers and everything in general and also felt better. The negative aspect was short to medium term memory loss. I would ring my mum and dad after each treatment from a payphone in the psych ward as they were interstate and tell them how it went and no sooner had I hung up the phone I would walk away and go back to the phone and ring them, mum and dad would say you just rang us son and I couldn't believe that I had done so and this occurred after each treatment and sometimes I would ring four or five times. I had about 20 episodes of ECT treatment in 1998 and then another 20 in 2001, my short term memory never came back between 1998 and 2001. Around the end of 2003 my memory started to come back and now in September 2004 I would have to say I have most of my memory back. When my memory was affected people would come up to me in the street and claim that they knew me, and I had obviously had met them before so sometimes I would talk to them and other times I wouldn't. One of ECT's side-effects was that it was impossible to hold much of a conversation because I couldn't remember what the person I was talking to just said to me and I couldn't think of anything to say. One thing I had noticed that up until my memory came back I never dreamt in my sleep. I am not sure if I will have ECT again and I still find every day a battle.

(29/09/2004)

I have undergone ECT treatment for depression for the second time. I was initially treated 2 years ago on my 3rd admission to hospital. I had been non resxponsive to drug treatment and ECT worked for me. Recently I beca,e depressed again. Life became very dark and without hope for me. Suicidal thoughts pervaded every aspect of my life and life was definitley not worth living.

Ultimately I was hospitalised and underwent a course of ECT. I continue to have treatments as an outpatient at increasing intervals. I cannot begin to tell you the differerence that ECT has made to my life. I am now a fully functioning human being again. I am able to take pleasure in evey day events and feel that life is worth living.

I hope that other people respond as positively to ECT as I have.

(05/08/2004)

I had ECT recently, and while it has affected my memory to some extent it has been worth it for the improvement in mood which I have experienced. Everyone says I look better, and for once they are right, I still go up and down but overall I do feel better and I have more energy to try to work on my problems. I saw several others benefit from it while I was having it, we had 3 people per day having the treatment and almost all of them improved. My aunt had it and improved. Sure it is no cure, but I have had benefits and so have others I know.

(15/11/2002)

I was admitted to hospital after finding that no treatment was bringing me out of the deep depression I was in. While in hospital ECT was suggested to me - believe me I was totally against it.

With advice from both my GP and the Psychiatrist - I still wasn't sure what to do - I had heard so many stories regarding ECT - some of course were exaggerations or not based on fact - but I still had so many doubts.

After alot of thinking - trying to decide what was best....all I could think of was how much I wanted to make a recovery or at least some improvement - and with medication not making a substantial difference to me I decided that I really didn't have anything to lose but could have alot to gain.

I knew there was the possibility of short term memory loss, headaches and other side affects - but these only seemed minor compared to the hell I was living with the depression - please don't think that I wasn't scared or didn't have my doubts because I did - I had alot - I didn't know what was right or wrong - but I had to make a choice - and if it meant a possibility of improving or even getting better - that chance was worth taking for me. This may not be the choice for everyone - and ECT may affect each individual differently but I had to see what it could do for me.

What followed for me was 3 treatments of ECT per week over a 4 week period. I admit the only side affect I had was short term memory loss - and when prodded I could remember - I didn't experience headaches or any other affects.

At the time I was having ECT - there was another patient that also underwent treatment - I will briefly describe what I saw while she was having ECT - the changes were remarkable - here was a woman - who had no self-esteem, confidence and was so vague due to all the drugs she was on - she was in a very deep depression - who didn't see any positives in her life or feel there was anything worthwhile in her life - once her ECT treatment was completed - everything changed - she changed - she dressed differently, wore makeup, had confidence - felt good about herself - looked upon life differently - was looking forward to being discharged and having a new start. She turned things around - she suddenly felt there were things in her life again, friends, family - things to focus on and be positive about. I tell you it was something amazing to watch - and a very pleasing outcome for her. I have seen her in the past couple of months and she feels great - she puts it all down to the ECT and is so glad she went through with it.

Now for me personally - it has been nearly 12 months since I had ECT treatment - and I really didn't get a significant benefit or there was no significant change in my condition. BUT - I still am glad I had the opportunity for there to be a change - and I even think if it was offered to me again - I would strongly consider having the ECT done again.

It is an individual decision - but I must say - that if you are feeling you don't have alot of treatment options - and are feeling you aren't getting anywhere and ECT is offered it is probably worth considering - I really can't say there was anything that affected me permanently - the only affect I had was short term memory loss but was able to remember if people prodded me - it wasn't everything - just certain details or small issues.

ECT can affect people differently and maybe it doesn't help everyone - and it could possibly affect each person in a different way.....but for me - it was worth a try.

I've never really spoken about my experience with ECT and I hope this helps someone. Just because it didn't work for me............I really believe it does help - because I've seen it work for other people.

Hawk

(6/03/2001)

ECT/Depression - ross January 14, 2001 (1)

  • Re: Has anyone had E.C.T?? - moonlight January 27, 2001 (0)
  • Re: Has anyone had E.C.T?? - Peanut January 27, 2001 (0)
  • Re: Has anyone had E.C.T?? - Stormie January 27, 2001 (0)
  • Re: Has anyone had E.C.T?? - Heshin January 28, 2001 (0)
  • Re: Has anyone had E.C.T?? - eveross January 28, 2001 (0)

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    The factual information on E.C.T. contained above was taken from:
    (http://www.mhsource.com) Psychiatric Times

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