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Shock Treatment

A Therapy For Depression Once Seen As Outdated Now In Vogue

Once seen as the essence of barbarity, shock therapy is being used more and more in the United States. More than 100,000 Americans receive the treatment every year.

Doctors call it electroconvulsive therapy, or ECT. And those who endorse it say it's the most effective anti-depressant treatment available.

But not everyone agrees. Opponents of shock say it should be banned.

Correspondent Bob Simon traces one patient's shock treatment inside the New York State Psychiatric Institute in Manhattan and speaks to others on both sides of the debate.

On her way to the ECT room, Susan was accompanied by a nurse's aide, and by her physician, Dr. Harold Sackeim, one of the country's leading practitioners of shock therapy. (The patient asked that her last name not be used.) She has had a long history of severe depression, not the blues that afflict everyone from time to time, but the kind that attacks like a virus, finds a home in the brain and cripples the will to live.

Susan has been dealing with depression all her life, she says. "I had some form of fear all my life even as a child." Her mother attempted suicide several times, when Susan was a teen, she says.

At some point, Susan moved into her mother's world, with suicide often looming as the only escape. She tried every form of psychotherapy and many medications. Nothing worked. Shock was the last option.

She admits she was frightened. "It's a scary proposition."

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When One Flew Over the Cuckoo's Nest came out in 1975, it portrayed shock therapy as a punishment nothing less than savage. Jack Nicholson's character was held down and forcibly shocked, without an anesthetic. That doesn't happen anymore. Today patients are always put to sleep. Still the movie is not entirely a Hollywood fantasy.

In the 1950s, before the proliferation of anti-depressant drugs, patients were often shocked without their consent. They were shocked for ulcers, psoriasis and even for homosexuality. And still today, people are forcibly shocked for depression, by court order.

Shock therapy is no onetime procedureIt involves a series of shocks, from six to 16. Susan has undergone at least 14 shock treatments in the space of two months. Electroshock is as much art as science because how it works is still a mystery.

All that's known is that a short jolt of electricity triggers a seizure that lasts less than a minute. This seizure - not the electricity - apparently changes the brain's chemistry in a way that lifts depression.

For Susan, however, it's not a matter of how it works but that it works. Gel was applied to the electrode paddles so the electricity can flow easily. The stimulus was delivered and Susan had a seizure. Susan's seizure lasted 29 seconds. It was simple and safe, which is not always the case.

Dianna Loper knows from experience what can go wrong with ECT. "Enough electricity went through my brain to light up a 60-watt light bulb," she says. Loper says she was forcibly shocked after seeing a psychiatrist for postpartum depression 30 years ago. She is an activist in the fight to get ECT banned, but it's still terribly painful for her to talk about her experience.

She remembers a psychiatrist telling her the procedure isn't going to hurt, only help, she says.

The treatment did, however, erase large chunks of her life, she says. She does not remember getting married or giving birth and she feels shock therapy lowered her IQ, Loper says. "I'm brain damaged."

But shock practitioners, like Dr. Sackeim, say there's no proof that ECT causes brain damage. Memory loss is another matter; but it's almost always short term and temporary, he says. People tend to forget what happened right before and after the treatment, he notes. "The vast majority say that's a small price to pay for the relief."

In rare cases, "the retrograde amnesia may be more dense, and it may extend back, much further back in time," he says. "And those patients have a much more devastating, retrograde loss."

Still Loper's experience is not unique. There are ECT patients who have been treated more recently than she has who say they, too, have large gaps in their memory.

Yet there are so many variables that there's no way to predict memory loss. And studies show that depression itself kills brain cells and lowers IQ. So it's hard to determine if electroshock or mental illness is responsible.

But psychiatrist Peter Breggin has no doubts. A leader of the campaign against ECT, he says the therapy causes severe brain dysfunction and should be outlawed. "There are certain things which should not be considered a treatment merely because doctors give it," he says.

He argues against the use of anti-depressant medication and believes that depression should be treated by talk therapy.

Most psychiatrists today dismiss Breggin's approach as old-fashioned, though.

The question asked by psychiatrists is not whether to use ECT, but when: Do you employ it only as a last resort, aftemedication has failed? Or do you try to cut short a patient's suffering and use it sooner?

There's no absolute answer of course; it depends on the psychiatrist and the patient. But electro-shock therapy is being used earlier and more often.

"The medical community recognizes universally that ECT is the most effective anti-depressant we have," Sackeim says. No medication has ever shown superiority to ECT in any trial, he asserts.

When it comes to comparing medication to ECT, Dr. Martha Manning is an expert; she has tried them all. A psychologist, Manning has been chronically depressed much of her life. Drugs helped her for a while. But then they stopped working and she started thinking of suicide. She even contemplated getting a gun at a pawn shop. She checked into a hospital instead.

Doctors recommended that Manning try electroshock. She told them, "Forget about it."

She almost died, she says. "I was one day away from killing myself. And I realized that I had two choices: I could die or I could do the very last thing that there was possible, at this point, in the treatment of depression, that might save me."

Manning underwent ECT and was fine for a while. But two years later, she suffered a relapse, a cruel reminder that there are no cures for depression.

Once again, Manning received shock therapy, as an outpatient.

"ECT did what nothing else could do," she says. "And if I had gone on much longer in the state I was, or worse, I would be dead."

Last summer, the word was that William Styron, the author of Sophie's Choice and other prize-winning novels, had fallen into such a deep depression that he was virtually comatose. Styron had written a piercing memoir 1O years earlier called Darkness Visible. It described an earlier struggle he had with the illness.

This time, he was advised to try shock therapy. But what would it do to his creative powers? Would it destroy his memory and his life? Styron tried ECT.

I'm feeling fine; I'm feeling better than I have in years," he reports.

"I'm writing," he says. "I don't sense any memory loss whatsoever....I would say my memory is somewhat better than it might have been a year ago."

There isn't that big a difference between the zapping of Jack Nicholson's fictional character nearly 30 years ago and Susan's recent ECT. The therapy is more controlled now, more humane and less painful. Seizures are shorter.

But the idea is the same: reset the brain's chemistry through a seizure and then stand back and watch the patient smile. Manning got better. So did Styron. Loper did not, however.

After 74 days in the hospital and 15 shock treatments, Susan reports some short-term memory loss and cannot remember her address or her phone number. But when she headed home with her fiancee recently, she said she was feeling better. She was slated to receive more shock treatmen - what doctors call "maintenance ECT" - every other week for about six months.

But for now, the black clouds that have darkened Susan's life for decades have lifted. And that's all she ever wanted.

"It would be a really nice thing to know...that there is a chance for a person like me to be able to enjoy the simple things in life. Because when I was feeling depressed, I couldn't," she says. "That would be a gift," Susan says.

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