Some Reflections on Electroconvulsive Therapy, Past and Present

The online magazine Psychiatric Times features an exchange between two respected psychiatrists on the history and status of electroconvulsive therapy (ECT).  In a piece entitled “Electroconvulsive Rx: A Memoir and Essay (Part 1),” Dr. Alan Stone (Touroff-Glueck Professor of Law and Psychiatry in the Faculty of Law and the Faculty of Medicine at Harvard University) discusses his experience after reporting for  military service at Fitzsimmons Army Hospital outside Denver, Colorado in 1959:

The Colonel in charge of the psychiatric unit prescribed a course of 20 to 25 unmodified ECT’s for virtually every soldier requiring admission to the inpatient unit. When I questioned this rigid regimen and expressed my unwillingness to participate, the Colonel informed me that I was not being asked I was being ordered and would either take my turn administering the full course of unmodified ECT or be court martialed.  As I look back on my military service, I have always regretted that I did not risk being court martialed. In any event, under the Colonel’s threat, I learned what a course of 20 -25 unmodified bilateral ECT could do to a sample of approximately 100 young physically healthy men of various diagnoses.

Stone goes on to reflect on what he considers to be the unethical and careless manner in which ECT was employed at the time.

In his response, “ECT Today: The Good It Can Do,” Dr. Charles Kellner (Professor of Psychiatry and Chief of the Division of Geriatric Psychiatry at the Mount Sinai School of Medicine in New York City) insists that any abuses of ECT committed some fifty years ago should not be taken to impugn ECT today, which, in his view, is “practiced to high standards of medical care and with fully informed consent.”  Kellner sums up the benefits of ECT this way:

ECT is the only “somatic” treatment from the early 20th century that has survived. It has done so because of its unparalleled efficacy and safety. ECT is the most effective antidepressant treatment we have; response rates are typically in the 60% to 90% range.   Because ECT is rarely given as a first line treatment, most ECT patients have already proven refractory to multiple trials of antidepressant and other psychotropic medications. Severely suicidal or catatonic patients often improve dramatically within 1 to 3 weeks of starting an ECT course. Interestingly, the most severely ill patients respond best to ECT; high severity of depressive symptoms, presence of melancholic and catatonic features, and psychosis all predict better outcomes with ECT.  Where else in medicine is severity of illness a predictor of good outcome?

You can follow this exchange and all subsequent reader comments at Psychiatric Times. Keep in mind, you must register in order to read articles at the site, but registration is free.

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    • Susan
    • September 18th, 2010

    A doctor had wrongly diagnosed me as Bipolar I when I was BPD. He built up my medication regimen to about 20+ pills a day, most to counteract the side effects of others. Finally upon reaching near kidney failure, another doctor took over, finding I was seriously over medicated to a toxic level.

    I underwent ECT. After months slowly reducing the treatments I was on half the meds as earlier and doing much better. Within a year I was medication free and in recovery from BPD.

    Although I did suffer from some memory loss that seems to be permanent, it is a small price to pay for the returned function and health. Treatment is no worse, if not easier, than going through a root canal. No big deal – and a gift for those who suffer and nothing to fear.

    • Grace
    • November 3rd, 2012

    I am doing a project in my nursing class at Clemson University on Electroconvulsive therapy, and I was wondering if I could use your photo of an ECT procedure.

    • gae16802
    • November 4th, 2012

    We have no proprietary rights when it comes to this photograph. Fair academic use, I would think, would allow you to use this in a paper for class. You should, however, make a point of using the citation for it noted in the caption. – GE

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