Electroconvulsive Therapy – 2007 Updates

Memory loss attributed to electroconvulsive therapy (ECT) may to a large extent be associated with how the treatment is administered, according to a study of patients referred to one of seven hospitals in the New York metropolitan area for ECT.

"The team found that electrical waveform and electrode placement had marked cognitive effects. Sine wave stimulation resulted in pronounced slowing of reaction time, immediately and 6 months following ECT. Bilateral ECT resulted in more severe and persisting retrograde amnesia than right unilateral ECT."

The above paragraph is not easy to understand. The message is that if you are contemplating ECT for your depression, it is critical that the ECT clinician be highly skilled, experienced and up-to-date on the latest ECT techniques.

Dr. Harold Sackeim of New York State Psychiatric Institute commented that ECT is currently”the most effective short-term antidepressant and its adverse cognitive effects can be substantially reduced, if not eliminated, by adoption of advances in technique."

The results were reported in the February 2007 issue of Neuropsychiatry.

ECT Effectiveness

In February of 2007, Harvard Medical School published a special report investigating the effectiveness of ECT and explaining its dangers. Here is a quick summary:

• ECT does not cause any damage visible on brain scans
• The most common complaint is short-term memory loss
• Memory retrograde (events that occurred before treatment) declined with each treatment
• Memory anterograde (ability to absorb new knowledge) declined with each treatment
• Memory usually returns to normal within a few weeks, but not for all patients and all respects
• Researchers have agreed that most patients suffer some permanent memory loss

In controlled studies, ECT had a response rate of about 70%, even though it usually isn't attempted until other treatments fail.

"Like other treatments for depression, ECT is no cure. About half of the patients relapse within a year and require maintenance ECT treatments. The high relapse rates are not surprising given that most people who undergo ECT have particularly severe symptoms"

What are the Dangers?

Here is a quick summary:

• ECT does not cause any damage visible on brain scans
• The most common complaint is short-term memory loss
• Memory retrograde (events that occurred before treatment) declined with each treatment
• Memory anterograde (ability to absorb new knowledge) declined with each treatment
• Memory usually returns to normal within a few weeks, but not for all patients and all respects
• Researchers have agreed that most patients suffer some permanent memory loss

According to the Harvard Medical School report, the placement of the electrodes and the type of electric current make a big difference in improving patient outcomes and memory loss. Originally, electrodes were placed at the templates on opposite sides of the head( bilateral placement). Two new innovations:

• Placement of both electrodes on the same side (unilateral placement), usually the right
• A new ECT machine that produces brief intermittent pulses instead of continual electrical stimulation. This allows for an electrical dose that can be adjusted so that it just is strong enough to cause a seizure.

Researchers determined that these newer procedures greatly reduced the memory loss. There is still more extensive research required about these new ECT procedures.

If you are considering ECT, I think that three things are critical:

1. Your psychiatrist should clearly identify you as a good candidate for ECT
2. The clinician that administers the ECT must be highly skilled with extensive experience in ECT
3. The anesthesiologist should be up-to-date on the latest strategies when administering the muscle relaxant and the anesthesiology

It should be noted that there is no relationship between the potential effectiveness of vagus nerve stimulation and lack of effectiveness with ECT. I had a series of fifteen unsuccessful ECT treatments in 1998. Thankfully, in April of 2001, I was implanted with the vagus nerve stimulator. The therapy completely changed my life, I still have the implant, I don't feel the stimulation, the remarkable response has been sustained (i.e. "Prozac poop out") and there was no absolutely no cognitive impairment.