ECT Controversy and Interpretation
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ECT: controversy, ranting and raving, and how to interpret all that

Q: I have been diagnosed as BP II. After about an eight-month-long depression, when I comtemplated suicide several times, my doctor suggested that I should take electroshock therapy. My brother, a manic-depressive, took that therapy and considered it a police technical torture. But my doctor told me that now the technique is much milder, and anesthesia is used. I left her office in terror, and looked for another doctor. This doctor told me his colleague´s proposal was correct, but told me it was not necessary at the moment. I got out of the depression, and am feeling fine. But I found it strange that neither of these two doctors said that in some cases there may be an irreversible damage to memory, as I read in a medical book. Don´t you think omitting this information to the patient is unethical? Respectfully yours, Ney

Dear Ney --
Sounds like you might have read the Riverfront Times article (or other material from ect.org)?  The author does a very nice job of rounding up extreme views on both sides, which makes for good journalism I suppose, because it makes it sound like there's really a controversy.  After you read the whole thing, which if you haven't, you may as well, because I haven't seen a better summary of the controversy side of things -- after you read it though, you should still be wondering about the actual risk, because the article doesn't really cite any data about risk.

But understanding that data is not easy for someone without pretty sophisticated training in statistics.  I used your question as an opportunity to look over some studies on ECT and memory (for a list, try entering "ECT memory randomized" on Pub Med).  The variables involved are pretty complex: how much current?  unilateral or bilateral?  how long were the seizures?  how many seizures were induced?  how was the person's memory before ECT?  how long after ECT did you look?  After looking it over, I find myself coming back to some simple "clinical realities", as we would say in my business.

Clinical reality #1: the people for whom I would consider ECT are really ill.  We're talking really, really ill -- and nothing we have tried has worked well enough, and usually we've tried a heck of a lot of stuff.  So remember, we're comparing having ECT -- to the picture of what things would be like without ECT, and usually that picture looks really, really awful.  So even if ECT is associated with some severe memory problems, perhaps (note: "perhaps") even some permanent changes in memory for some (note: "some") people, by the time I would invite you to consider that as a treatment, you've got few alternatives and an awful prognosis without something to try for treatment.

Clinical reality #2: I've never had a single patient receive ECT and regret it.  My hospital is so daunted by the kind of press you see on ect.org, they don't want to offer this treatment.  So my patients go to another town an hour away, which in itself is a pretty serious hassle given the treatment they're going there for, and folks like the ect.org person are responsible for that long trip (oops, I'm beginning to rant myself, aren't I?).  So, as ECT is hard to arrange, in 6 years of daily full-time practice I've had about 15 patients receive it.  I've seen at least half of those people improve so dramatically, neither they nor their families nor I had any doubt that was the right thing to do -- again, especially when you look at where they were prior to treatment and what they might experience without such treatment.  No one in the other half, the group that didn't get better, came back and said "why did you send me for that?"

Clinical reality #3: people who might get ECT have bad illness.  If you have bad illness, you may want to blame somebody or something for that.  Some doc' with poor "bedside manner" who recommends ECT is a pretty good target for that anger.  Take a look at ect.org and see if that model applies there.

Wow, you must have hit a nerve, eh?  I'll admit it: the nerve is when people rant against something they understand only from their point of view.  There are few things in life as simple as "ECT is bad".  Don't listen too closely to anybody in psychiatry who makes it sound like something is black & white, and simple.  Most diagnoses and treatments in this business are not.

Dr. Phelps


Published October, 2000

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