12/13/98

Electroconvulsive treatments on the rise across nation

By Genna McLaughlin

TRIBUNE-REVIEW

She sleeps peacefully, even after the shock they just gave her, the electricity they pumped into her brain through the electrodes pasted to her gray-haired temple.

She didn't feel the charge, the anesthesiologist in blue scrubs assures, or the seizure that came after, though it was powerful enough, doctors hope, to stir up the chemicals in her 75-year-old brain.

She didn't convulse or wince in pain during the grand mal seizure, registered only by the change in vital signs on the monitor and the continuous twitch of her big toe.

The electroconvulsive therapy Alverda Stanley received minutes ago looked far more routine than anything out of "One Flew Over the Cuckoo's Nest," the 1975 Jack Nicholson movie that showed torturous shock treatment methods.

While Stanley lies in the recovery room at Brownsville General Hospital, waiting for the anesthesia and muscle relaxants to wear off, her daughter waits in a room on the psychiatric unit, explaining why a treatment as stigmatized as electroconvulsive therapy is her only option.

"It's the only thing that brings her out of the depression," says Kathy Benford , who has been bringing her mother from her home in Fairchance to psychiatrist Ravindra Mehta at Brownsville General Hospital for four years.

After the third treatment, Stanley, who has a 46-year history of depression, will begin coming out of her catatonic state. By the sixth or eighth ECT over the next few weeks, she'll be eating, talking and singing again, as she has after other treatments.

She won't remember anything about the ECT and probably won't recall details of the hospital stay, Mehta said. When she begins to slide again - refusing to eat, staying in bed all day, talking about voices in her head - her daughter will bring her back for the only treatment that proved effective after antidepressant drugs and hospitalization failed.

GROWING USE OF ECT

"It's miraculous when used correctly," Robert Lowenstein, a psychiatrist at Monsour Medical Center in Jeannette, said of ECT.

Although some people outside the medical field are shocked to learn that it's still around, doctors all over the country are performing ECT on depressed patients at a rate higher than ever. Although there are no official numbers, psychiatrists estimate it's administered to 200,000 patients a year in the United States. The majority are aged 65 and older, according to a study performed by the California Department of Mental Health.

Supporters say the treatment, an outpatient or inpatient procedure performed at hospitals throughout western Pennsylvania, is more effective and safer than antidepressant medications that come with side effects, some psychiatrists say, that can be more harmful than an electric charge to the skull.

But the treatment is not without detractors - psychiatrists and former ECT patients who say it causes brain damage, memory loss and even death.

The debate rages over the Internet and in medical publications. While advocates promote electroconvulsive therapy with success stories like Stanley's, an equal number of opponents denounce it, arguing it's just as barbaric and inhumane as it was 50 years ago.

A NEW IMAGE

When electroshock therapy began in the 1940s, it was performed without anesthesia or muscle-paralyzing drugs that prevent convulsions and fractures. Some patients seized so violently they broke limbs and cracked vertebrae, giving ECT a grisly image that has lasted decades. It didn't help that it was used more as a punishment in psychiatric institutions than as a treatment for depression.

But with anesthesia and monitoring and a new name to match its new image, advocates say, electroconvulsive therapy now is less harrowing than a trip to the dentist for most patients. Even opponents, who call ECT by its old name, can't deny modern medicine has made the procedure more routine.

The Washington Hospital in Washington County performs at least one ECT every Monday, Wednesday and Friday. Some days doctors do as many as nine. Patients go to the recovery room, like any other surgical patients, after a 15-minute procedure attended by a psychiatrist and an anesthesiologist. The shock itself lasts for a few seconds. Some patients are released from the hospital within hours.

"If they have a headache, we just give them Tylenol," said Beth Avolia, a registered nurse at the hospital.

Most mainstream medical organizations support the use of ECT and advertise its effectiveness, including the National Institute of Health and the American Psychiatric Association. Medicare and managed care organizations consider it an acceptable and reimbursable procedure.

With a 90 percent success rate, Lowenstein said, he considers it the best form of treatment he gives at Monsour.

But many people can't erase the image of violent convulsions and pain in "One Flew Over the Cuckoo's Nest" - and consider the treatment inhumane, said Stanley Raymond, nurse manager at Brownsville's psychiatric unit.

Some family members or patients still reject ECT after talking to doctors and watching an educational video, but not many.

"By the time the patient is an inpatient (at Brownsville), they've been through many failed treatments and they've reached the critical point," said Raymond. "They have the right to say no, but it really limits their treatment options."

With its success rate, quick results and medical reimbursements, doctors believe ECT could become the treatment of choice for depression .

"Sure, there are still a lot of people out there that still believe it's painful or cruel or scary. They need to be educated," said Lowenstein. In the medical profession, "it's perfectly acceptable. There is no real debate as far as its effectiveness."

Enter Peter Breggin, psychiatrist, author and leader of the fight to ban ECT for 30 years.

"They lie," he said from his home in Bethesda, Md., during a quick break between therapy sessions one evening. "It's the damage that does the trick. When you give somebody a severe electrical jolt you so disorient the brain, the person can no longer feel depressed because depression is a higher emotional state.

"The person becomes artificially euphoric, high. And they write in the chart `mood elevation.' It's nothing more than a closed head injury."

Breggin has been arguing his point since 1963 when he gave ECT at Harvard-Radcliffe Mental Hospital. He remembers patients begging not to go to treatments, even though anesthesia and muscle relaxants were used. "They realized they were deteriorating and they got terrified," he said.

CHALLENGING THE TREATMENTS

Psychiatrists don't know exactly how ECT works to diminish depression but they suspect the seizure that occurs releases chemicals in the brain that work with depression: seratonin and epinephrine, said Dr. Mehta. A pamphlet given to patients at Brownsville General Hospital says ECT causes no brain damage and no permanent memory loss. Mehta said temporary memory loss is likely but it usually returns within weeks of the treatment.

Breggin said studies on animals prove there is brain damage and 50 percent of ECT patients will say memory has not been restored a year after treatment.

Doug Cameron, a 51-year-old high school teacher in Austin, Texas, said his memory loss was permanent. An ECT at 21 wiped away his high school and college educations. He founded the World Association of Electroshock Survivors to ban the procedure and has collected hundreds of similar complaints.

Breggin said doctors don't tell patients that the electrical current used in today's treatments are stronger than those used years ago so they can overcome the anti-seizure affect of the anesthesia.

"It's simple, requires no intelligence, no ability to empathize, it's quick, swift and it makes psychiatrists feel like they're real doctors," Breggin said. "Whether you get electroshock depends much more on your psychiatrist's mental condition than yours."

Breggin founded the Center for the Study of Psychiatry and Psychology during the 1970s in an effort to stop lobotomies, ECTs and other forms of psychosurgery. Lobotomies have since been stopped but ECTs are experiencing a revival, according to Breggin.

Area hospitals are mixed on the procedure. Some hospitals, such as Washington, Monsour and Brownsville, regularly perform ECT; others, such as Indiana and Somerset, do not. Some hospitals declined comment.

Those who have lived to see ECT success want to tell the world.

Karen Blotzer of North Huntingdon Township had serious doubts when psychiatrists at Monsour Medical Center proposed ECT for her 86-year-old mother who had stopped walking, eating and responding. She immediately recalled ECT "horror stories" a high school friend had told her 30 years ago.

After two treatments, Nellie Peterson greeted her daughter with a smile from her hospital room where she sat eating a sandwich.

"I cried," Blotzer said. "I couldn't believe it. My whole attitude toward it has changed."