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    ECT (Electroconvulsive Therapy) is a procedure in which a brief application of electricity is used to produce a generalized seizure. It is not known how or why ECT works or what the electrically stimulated seizure does to the brain. In the U.S. during the 1940's and 50's, the treatment was administered mostly to people with severe mental illnesses.

During the last few decades, researchers have been attempting to identify the effectiveness of ECT, to learn how and why it works, to understand its risks and adverse side effects, and to determine the best treatment technique. Today, ECT is administered to an estimated 100,000 people a year, primarily in general hospital psychiatric units and in psychiatric hospitals. It is generally used in treating patients with severe depression who cannot wait for antidepressant medication to take effect. It is also used for acute mania, and certain schizophrenic syndromes.

ECT treatment is generally administered in the morning, before breakfast and can be on an in-patient or out- patient basis. Prior to the actual treatment, the patient is given general anesthesia and a muscle relaxant. Electrodes are then attached to the patient's scalp and an electric current is applied which causes a very brief convulsion. A few minutes later, the patient awakens confused and without memory of events surrounding the treatment. The entire experience takes less than one hour. The ECT treatment is usually repeated three times a week and the number of treatments varies. Usually the patient maintains a regimen of medication, after the treatments, to reduce the chance of relapse.

After 60 years of use, ECT is still the most controversial psychiatric treatment. Much of the controversy surrounding ECT revolves around its effectiveness vs. the side effects, the objectivity of ECT experts, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization. Because of the concern about permanent memory loss and confusion related to ECT treatment, some researchers recommend that the treatment only be used as a last resort. It is also unclear whether or not ECT is effective. In some cases, the numbers are extremely favorable; citing 80 percent improvement in severely depressed patients, after ECT. However, other studies indicate that the relapse rate is high, even for patients who take medication after ECT. Some researchers insist that no study proves that ECT is effective for more than four weeks.

If ECT is recommended, the patient will be given a complete medical examination including a history, physical, neurological examination, and EKG and laboratory tests. Medications will be noted and monitored closely, as well as cardiac conditions and hypertension. The patient and family will be educated and informed about the procedure and asked to sign a written consent.

My name is James and I have received two series of ECT treatments spaced 3 years apart. The first series consisted of 12 treatments and the second series consisted of two treatments. Prior to my first ECT series I was experiencing very severe depression and had made two suicide attempts. The first ECT treatment made me feel better immediately, it was a miracle, when they initially pushed me into the treatment room I didn't care if they were going to give me an ECT treatment or push me in front of a truck. The procedure was not painful, except for an IV needle in my arm, a mild headache and a little confusion afterward. I had a total of 12 treatments over a period of 15 days, 3 were as an in-patient and the remaining 9 as an outpatient. I do not feel that I have any short or long term memory loss from this series of treatments, however my wife disagrees with me. Now for the bad news, the ECT treatment neither stopped nor reduced my dependence on antidepressant drugs. So the major benefit was the ECT immediately brought me out of the depression, something that would have taken weeks, months or never with the drugs alone.

I continued to use of Psychotropic drugs and my mood was stabilized for the next 19 months, then I slowly started having problems with depression again. My Psychiatrist suggested I have a single maintenance ECT, to reinforce the earlier treatments, a policy that is standard for this area of the country. I elected not to do it and over the next 17 months my condition continued to deteriorate through a series of rapid cycling events until I was feeling extremely suicidal and instead of actually making suicide attempts like the two previous times, I voluntary went to the emergency room and was admitted. My psychiatrist tried for a week to stabilize my mood through the use of drugs, but was unsuccessful so I elected ECT again, I was given 2 treatments and felt wonderful, so I was discharged, sent home with no apparent memory problems. I stayed home for a week, on my first day back to work, I got lost, I couldn't remember the building I worked in, I couldn't remember how to log on to the computer network that I designed. Strange, but I could do the difficult tasks of my work, design networks, solve equations, write programs, etc. Then I got lost again going home. I had trouble every day through Wednesday, when I had a manic attack and didn't go to work any more that week. My wife thinks the memory loss is from the ECT and doesn't want me to ever have another treatment. My Psychiatrist says it could be from either the ECT or the anxiety of returning to work or a combination of both. I am still an ECT advocate, I don't believe it is a total cure for depression, but perhaps we don't have a total cure for everybody yet. I know from my own experience when you are in so much pain that you want to die in order to stop the pain and a moderately simple procedure is available that can eliminate that pain even if only temporarily then I want to use it.