Electroconvulsive Therapy ECT for Depression

Beginning in 1979 with the publication of my book Electroshock Its Brain-Disabling Effects, followed by many other book chapters and scientific reports, I have marshaled innumerable studies, bolstered by my clinical experience, to show that electroconvulsive therapy (ECT) causes permanent brain dysfunction and damage, including widespread memory 

Since the 1997 edition of this book, my task has been lightened by research from the heart of the ECT establishment confirming that ECT causes permanent brain damage and dysfunction with widespread cognitive deficits and that ECT greatly elevates the suicide risk, especially in the first week following treatment. In addition, a recent review of controlled clinical trials for ECT demonstrated once again that the so-called treatment is ineffective. And finally, for the first time in history, an ECT malpractice case has been won in court. 

Since the ECT literature almost never provides clinical cases that describe the damage caused by the treatment, I will begin with a case from my own clinical practice. 

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Ross (2006) recently reviewed the sham ECT literature The author reviewed the placebo-controlled literature on electroconvulsive therapy (ECT) for depression. No study demonstrated a significant difference between real and placebo (sham) ECT at 1 month posttreatment. This was the crowning summary of considerable prior research confirming that ECT is ineffective. 

The client is undergoing electroconvulsive therapy (ECT) for major depression and is receiving tubocurarine, a nondepolarizing neuromuscular blocker. Wbicb data would warrant immediate intervention by tbe nurse ... 

Electroconvulsive therapy (ECT) is the application of prescribed electrical impulses to the brain for the treatment of severe depression, mixed states, psychotic depression, and treatment-refractory mania in patients who are at high risk of suicide. It also may be used in pregnant women who cannot take carbamazepine, lithium, or divalproex. 

Electroconvulsive therapy (ECT) is used for severe mania or depression during pregnancy and for mixed episodes prior to treatment, anticonvulsants, lithium, and benzodiazepines should be tapered off to maximize therapy and minimize adverse effects. 

Shock Therapy. The early 20th century saw the development of the first effective biological treatments for depression, the shock therapies. The first shock treatments used injection of horse serum or insulin. A major advance in treatment occurred with the advent of electroconvulsive therapy (ECT) in 1934. Although initially used to treat schizophrenia, ECT was soon found to be highly effective for other psychiatric disorders including depression and mania. ECT remained the primary biological psychiatric treatment until the widespread release of psychiatric medications in the 1950s. 

Electroconvulsive Therapy (ECT). Introduced in the mid-1930s, ECT was initially used to treat schizophrenia (for which it is not effective) but was later found to be very effective in the treatment of major depression and mania. It gained widespread use and was the primary biological psychiatric treatment until the introduction of newer psychiatric medications in the 1950s. 

Shock Therapy. Insulin coma treatments were used in the early 1900s but offered no tangible improvement. Electroconvulsive therapy (ECT) arose in the 1930s and 1940s and was the hrst treatment to provide some relief from psychosis. However, its effects are only temporary and it proved too costly for continuous use. ECT continues to have some use for life-threatening catatonia, but it is mainly used to treat refractory depression or bipolar disorder. 

For very severe cases of depression, electroconvulsive therapy (ECT) can be tried. However, you must remember that demented patients are especially sensitive to the adverse memory effects of ECT. 

Repetitive TMS, unlike electroconvulsive therapy (ECT), uses sub-convulsive stimuli to treat depression. Compared to ECT, TMS has a potential to target specific brain regions and to stimulate brain areas thought to be primarily involved in depression while sparing areas like the hippocampus, thereby reducing the probability of cognitive side effects. However, the therapeutic efficacy of TMS as a treatment for depression is, unlike ECT, modest. Most TMS studies use high-frequency, fast stimulation (> 10 Hz) over the left dorsolateral prefrontal cortex, an area which has been... 

Electroconvulsive therapy [ECT] is mostly used for severe depression. Elowever, a balanced, extensive review of the literature by Sackeim s group (see Nobler et ah, Chapter 10, in this volume] reveals not only the remarkable potency and safety of this politically controversial mode of treatment, but also the multiplicity of its biological influence and impact on a diversified gamut of brain functions. ECT is probably also effective in acute manic states and might be viewed as a mood stabilizer. Whether or not maintenance ECT acts as a mood stabilizer is still unknown. It might be viewed as an antidepressant with a broad stabilizing effect. 

Electroconvulsive therapy (ECT) is an established and effective treatment of depression and some forms of schizophrenia. ECT is the treatment of choice in several types of depression (W. Z. Potter and Rudorfer 1993), especially severe depression (American Psychiatric Association Task Force on Electroconvulsive Therapy 1990 W. Z. Potter et al. 1991). The mechanism by which ECT exerts its antidepressant effect is still unknown. Studies of pharmacologically as well as of electrically induced convulsions suggest that the convulsion is a necessary condition for ECT s therapeutic effects (Cerletti and Bird 1938 Lerer 1987 Lerer et al. 1984). However, there is no satisfactory explanation for the clinical efficacy of convulsions. 

Tremor and akathisia are less common and can be managed with dose reduction or the addition of a P-blocker such as propranolol (10-40 mg). There are isolated case reports of SSRl-related dystonia and increasing reports of SSRl-related exacerbation of Parkinson s disease (Di Rocco et al. 1998 Linazasoro 2000). The advisability of SSRl use in depressed patients with Parkinson s disease remains to be determined. Bupropion and electroconvulsive therapy (ECT) may be reasonable alternatives for these patients. 

Failure to respond to a variety of antidepressants, singly or in combination, is the key factor indicating consideration of electroconvulsive therapy (ECT). This is the only therapeutic agent for the treatment of depression that is rapid in onset and can... 

Finally, some patients may need a completely different type of treatment, such as electroconvulsive therapy (ECT). ECT is often viewed as a treatment of last resort, but it should not be withheld from patients with this disorder who cannot be helped by drug therapy. For patients with psychotic depression, ECT may be a treatment of first choice. 

The adverse effects of lithium in elderly patients include cognitive status worsening, tremor, and hypothyroidism. The authors suggested that divalproex is also useful in elderly patients with mania and that concentrations of divalproex in the elderly are similar to those useful for the treatment of mania in younger patients. They noted that carbamazepine should be considered a second-line treatment for mania in the elderly. A partial response would warrant the addition of an atypical antipsychotic drug. For bipolar depression, they recommended lithium in combination with an antidepressant, such as an SSRI. They also noted that lamotrigine may be useful for bipolar depression. Electroconvulsive therapy (ECT) may also be useful, but there have been no comparisons of ECT and pharmacotherapy in elderly patients with bipolar depression. 

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