When is electroconvulsive therapy an appropriate treatment for depression? Irving M. Reti, M.B.B.S., director of the Electroconvulsive Therapy Service at The Johns Hopkins Hospital, offers advice.
Electroconvulsive therapy (ECT) is hands-down the most controversial treatment in modern psychiatry. No other treatment has generated such a fierce and polarized public debate. Critics of ECT say it’s a crude tool of psychiatric coercion; advocates say it is the most effective, lifesaving psychiatric treatment that exists today.
The truth is that modern-day ECT is a far cry from the old methods that earned ECT its sinister reputation. For many of you reading this, the thought of ECT conjures up images of the 1975 movie "One Flew Over the Cuckoo’s Nest," with Jack Nicholson thrashing about, forced against his will to endure painful, violent seizures. This is not an accurate portrayal of how ECT is used today. The treatment has evolved into a relatively painless procedure with proven effectiveness in the fight against depression. It has survived its critics because it is safe and because it works.
ECT involves passing a carefully controlled electrical current through a person’s brain to trigger a seizure -- a rapid discharge of nerve impulses throughout the brain. The electricity is passed between two electrodes that are placed on the patient’s scalp.
Is ECT right for you or your loved one with depression? Here are five questions to ask yourself:
- Is fast symptom relief crucial? If a person is acutely suicidal, is so depressed that he/she refuses to eat or drink, or experiences delusions or hallucinations that put him at risk for hurting himself or others, there is not time to wait for antidepressants to take effect. In these emergency situations, ECT can offer faster benefits than antidepressant medications.
- Have several antidepressants been ineffective? When a person has failed two or three adequate trials of antidepressant medications (and possibly psychotherapy as well), ECT is a feasible option. “Adequate” means an antidepressant medication is taken at high enough doses for a long enough period of time to give it a real chance to be effective.
- Is taking antidepressants out of the question? Some people experience intolerable side effects from antidepressants, even at the lowest possible therapeutic doses. For these people, antidepressant medications are not an option. Antidepressants may potentially be dangerous to women who are pregnant and want to avoid exposing their unborn child to psychiatric medications. ECT is a viable option for pregnant women.
- Have you had ECT in the past and responded well to it? If ECT successfully treated your depression in the past, it makes sense to stick with a treatment that you know has worked for you previously.
- Have you failed to respond to other treatments in the past? If you’ve suffered from depression in the past and could not find an effective treatment, it may be time to consider ECT for your current depression.
