Shock Treatment Benefits Outweigh Risks

Controversy continues to surround a treatment for major depression known as electroconvulsive therapy (search).

Last year, the U.K.'s top health policy organization recommended sharp restrictions on its use in people with severe depression, citing concerns about a lack of clinical data regarding long-term effects on memory and quality of life.  Now, new research has addressed these concerns, finding that for most patients with major depression, the therapy’s benefits far outweigh its risks.

The Hollywood image of shock treatment notwithstanding, electroconvulsive therapy remains an accepted form of treatment for severe depression. Its supporters say it is the only treatment that works for many severely depressed patients, but detractors counter that a large percentage of electroconvulsive therapy patients experience troubling memory loss.

In a survey of British electroconvulsive therapy patients, published last year, one in three reported persistent memory problems following the treatment. Many patients also reported feeling conflicted about the experience.

Memory ‘Not a Big Issue’

The newly reported study by researchers at North Carolina’s Wake Forest University included 77 patients with major depression who had electroconvulsive therapy. The patients underwent a battery of psychiatric tests measuring quality of life and ability to function immediately before and after electroconvulsive therapy treatment, and again two and four weeks later. Close family members were also interviewed to provide independent assessments of patient progress.

Researchers found that 66 percent of the patients with major depression experienced significant improvements in mood, thinking, quality of life, and ability to function during the four-week study period.  Memory loss did occur in many patients, but lead researcher Vaughn McCall, MD, tells WebMD that it was not a major concern for most of them.

The findings are published in the November issue of the British Journal of Psychiatry.

“There are a very small number of patients who experience substantial and disturbing memory loss with this treatment, but for the vast majority of our patients it was not a big issue,” he says.  “The improvement in mood seemed to drive the patients’ perceptions of their own quality of life, and the memory effect didn’t seem to enter into it.”

‘Electroconvulsive Therapy Saves Lives’

The typical candidate for electroconvulsive therapy is a person with severe, life-threatening depression who has not responded to antidepressant medications or psychotherapy or one who is catatonic (search) or suicidal.

A muscle relaxant and anesthesia are given before treatment. Electroconvulsive therapy causes a brief (about 30 seconds) seizure within the brain. The person receiving this therapy is not awake during the treatment.

“This is a treatment that works amazingly well in some patients for whom we have very little else to offer,” psychiatrist E. Fuller Torrey, MD, tells WebMD. “Many of them will tell you that it saved their life.”

Torrey says memory impairment is not a big issue for most of his patients, but he concedes that some patients may find any loss of memory troubling.

“Someone who relies on their memory to do their job would probably find it more of a problem, just as a draftsman or artist might find the minor tremors that are brought on by the drug lithium to be extremely annoying,” he says. “But when you are talking about a patient who is so profoundly depressed that he can’t get out of bed, (memory loss) may be an acceptable tradeoff to feel better.”

By  Salynn Boyles, reviewed by  Brunilda Nazario, MD

SOURCES: McCall, V. British Journal of Psychiatry, November 2004; vol 185. W. Vaughn McCall, MD, MS, department of psychiatry and behavioral medicine, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. E. Fuller Torrey, MD, research psychiatrist, Stanley Medical Research Institute, Bethesda, Md.