ELECTROSHOCK
What the professional literature says:
Who receives ECT?
* Electroshock treatment (EST) or electroconvulsive treatment (ECT) is widely used. It's estimated that from fifty to 100,000 Americans receive the treatment each year,(1) primarily in urban and university centers.(2)
* ECT is largely used on women who are diagnosed with depression, of which the typical patient is elderly.(3) Increasingly, ECT is being used for a variety of diagnoses including schizophrenia, mania, Parkinsonism disease, and alcoholism.
*An unknown number of children and adolescents are given ECT, with estimates of several hundred per year in the United States.(4)
* The American Psychiatric Association backs the use of ECT by force on adults and children. Cases in Federal court have variously denied and upheld that use.
How did ECT start?
* ECT was experimented on dogs by the psychiatrist Cerlitti in Fascist Italy. After half of the dogs died when the current was passed from head to tail, his student Bini found that the dogs survived when the current was applied through the temples of the head.(5)
* Noting that pigs in a slaughterhouse were stunned by electrical current prior to being killed, Cerlitti and Bini first used electroshock on an homeless engineer in 1937. After he protested, "Not another, it's deadly!" they continued to administer a second treatment.
* The Nazis pioneered the theory of shock treatment, heavily using such "active therapy" in the T4 Project, which later exterminated over 40,000 mental patients.(6)
Why is it unethical to administer ECT as currently practiced?
*ECT remains an experimental procedure, listed by the FDA as a Class III device, with little or no proven safety and efficacy.
* "New and improved" ECT has actually increased electrical power with more potential to create severe cognitive problems and brain damage.
* A full and accurate informed consent is not given. Memory loss and risk of death are understated, and information on the lack of long term efficacy are omitted.
*No mention is made of persons who experienced severe dysfunction due to ECT, including loss of ability to perform at their previous job level, as evidenced by thousands of letters of complaint to the FDA.
*Typically, information given a patient on ECT are provided by physicians who have vested interests in the procedure, or are produced by the Vendor such as Somatics.(7)
*A procedure that risks profound negative impact on autobiographical memory, what defines us as individual humans, is too harmful and egregious to be used in any widespread manner. The use of such a "controversial procedure" runs counter to the physician ethic "to do no harm."
How much electricity is used in Electroshock treatment?
* ECT is the passage of high amounts of electrical current or amperage through the human head. Approximately one amp is delivered, using between 160 to 500 volts---a massive electrical dose to the brain's fourteen volt system.(8) Such voltage is in the zone of pain / noxious-level stimulation,(9) far beyond the body's normal physiological range, where as little as 1/10 amps can be fatal.(10)
* Considerably more electrical power is used compared to classic electroshock. The current or amperage has doubled, voltage can be doubled to insure constant current is applied to resistant heads, and the duration of current has leapt from ½ seconds to 3 to 6 seconds.(11) Despite the fact that one factor (the size of electrical pulse) has decreased, the total charge of modern ECT is greatly increased.(12)
*Nearly 2.5 to 5 times the electricity needed to induce a convulsion is used.(13) Thus, seizure alone does not "work,"(14) but sufficient intensity of "bodily discharge" is required.(15) The need for high dosages of raw electricity suggests that ECT works by electrical injury.
What are the immediate physiological effects of ECT?
* A Grand Mal Seizure where the brain's neurons are forced to fire at their maximal (16) rate, four to 6 times normal. In a neural short circuit, such paroxysmal firing of cells causes the brain's EEG recording to look like a black smear.
* ECT results in a drastic fall and increase of blood pressure, causing acute circulatory stress on the heart. Evidence is strong that ECT causes heart tissues to be starved of nutrients (myocardial ischaemia) resulting in improper heart function.(17)
* The immune system is activated, indicating that the body is attempting to repair damage. After ECT Nerve Growth Factor is released to repair injured cells,(18) as well as specialized cells (phagocytes) to digest damaged tissue.(19)
*The body's built-in "pain killer,"endorphins, are released to reduce the severity of seizures and their recurrence.(20)
* The body's stress response system is aroused. The body's glandular / endocrine system responds to electric shock by flooding the body with many of its major hormones including adrenalin, growth hormone, thyroxine, prolactin, and oxytocin.(21)
What are the psychic effects of ECT?
*Acute disorientation is common after ECT, and delirium which occurs in 10% of patients.(22) Delirium is comparable to an acute psychotic state with hallucinations.(23) This set of symptoms induced by ECT has been termed an Organic Brain Syndrome.(24)
* ECT induces "chronic stress."(25) as a series of shock treatments are typically given, The biological signs and symptoms after ECT can be compared to Post Traumatic Stress Syndrome.(26)
Does ECT cause brain damage?
* Patients typically report symptoms of euphoria, denial, memory loss---a syndrome consistent with brain damage.
* ECT's "efficacy" is correlated with the development of slow Delta waves in the brain, that is typically an indicator of brain damage,(27) as in acute head injury.
* In animal studies, ECT impairs synaptic connections in the brain's hippocampus, which is believed to be central to long term memory.(28)
* Recent animal studies have shown that even a few brief seizures induced by electric shock cause damage to neurons in the brain.(29)
*Electrical injury opens large holes in the body's cell membranes, known as electroporation---where the cell's sensitive ion volt channels are
damaged.(30)
* Persons who suffer from conditions that have clear physiological pathology such as lesion induced seizures,(31) electric injury, (32) or head trauma (33) have memory loss and patterns of intellectual / cognitive deficits similar to ECT.
Does ECT cause memory loss and other long term effects?
* Memory loss is a problem with all patients who receive ECT, especially around the time of treatment.
* The literature admits permanent memory loss for up to several weeks or months around the time of treatment.(34) "significant" memory problems in more than half of the patients,(35) and "persistent memory loss" for autobiographical memories at 6 month follow up(36) to periods of up to ten years.
* Physicians have failed to devise a specific memory test for ECT, leaving the full impact of memory loss unknown.(37)
Does ECT work?
* The literature admits no long-term efficacy of ECT: 50-70% of depressed patients relapse within 2-4 months.(38) Other studies report that efficacy goes no further than four weeks.(39) Even Abrams, a foremost proponent of ECT, admits that after 1-3 months there is no evidence for any difference between ECT and Sham treatment.(40) After the initial set of treatments fail, doctors increasingly recommend maintenance ECT and outpatient ECT
* A 1986 review found that there was little or no difference between sham ECT and ECT with both bringing "substantial improvement." (41) A more recent 1992 review of 13 studies confirmed no effective difference between sham ECT and real ECT.(42)
How is ECT claimed to work?
*In recent times, doctors state that the mechanism of action is unknown.(43)
*The first users of ECT believed that convulsive therapy worked because a person couldn't have both seizures and schizophrenic, research subsequently refuted.(44)
* A recent theory proposes that ECT works by enhancing dopamine function, the brain's major excitatory neurohormone. The psychomotor activity and dopamine level of rats was observed to increase after repeated ECT.(45)
*Another theory hypothesizes that the "mild insult" of ECT activates the brain's neuroprotective response, the brain's built-in response to repair any damage.(46)
How might ECT really "work," if only for a limited time?
* Early researchers variously believed that ECT worked by "abolishing pathological experiences,""total dissolution of brain function," i.e. damaging the brain and/or erasing memories of painful experiences.(47)
*Some doctors, using a psychodynamic model, hypothesized that the "near death" of ECT induced a "rebirth" experience.(48) Repeated use of general anesthesia within a few week period would serve to heighten the effect of dying.
* Some doctors suggest that ECT, like head injury, artificially induces euphoria.(49) Noted by early researchers as "post convulsive euphoria," this giddiness or high due to brain damage is interpreted by psychiatrists as improvement.
* The limited "efficacy" of ECT may be due to the highly ritualized use of electricity generating a "profound placebo effect"(50) the fear of renewal of treatment,(51) and/or special attention from staff now believed to be responsible for any efficacy of insulin coma.(52)
Does ECT cause death due to medical complications?
* The official psychiatric literature admits only 1 death in 10,000 persons after ECT,(53) without any supporting documentation.
* Anesthesia alone, used with each ECT treatment, causes three deaths per 10,000 persons.(54)
* A national newspaper, citing 5 studies and statistics from new reporting requirements in Texas, reported a death rate of one in 200 among the elderly.(55)
*A 1993 study reported a death rate of over 25% among elderly patients within one year of the ECT treatments, compared to less than 4% with non-ECT treatments.(56)
* ECT does not prevent suicide. One study found a suicide rate almost double for people undergoing ECT--a 14% death rate compared to about 7.5 % for non-ECT.(57)
What role does money play in all this?
*ECT treatments generate a considerable amount of income, requiring up to thirty days of stay in a hospital, use of a doctor and anesthesiologist for each treatment. A typical course of 8-12 treatments can bring in over 30,000 dollars.
*Many researchers of ECT also use ECT to make their livelihood, and others have interests in ECT manufacturing companies. Psychiatry's definitive textbook on ECT is written by Richard Abrams, the President of Somatics, a manufacturer of ECT machines.(58)
What to do?
*Currently the FDA is in the process of upgrading the treatment as safe, without conducting any systematic animal or human studies. Write your Congressperson demanding an investigation into the public safety of Electroshock treatment.
* Write to the FDA expressing your concerns about ECT, calling for a moratorium on its use until safety and efficacy is established by impartial tests.
Prepared by Michael A. Susko, M.S. Baltimore, Maryland. November 25, 1997
REFERENCES
1. Kaplan, H.I., Sadock, B.J., and Grebb, J.A. (1994). Electroconvulsive Therapy: In Kaplan and Sadock's Synopsis of Psychiatry, 7th edition (p.1005-1011). Baltimore: Williams and Wilkens.
2. Hermann, R.C. et al. (1995). Variation in ECT use in the United States. American Journal of Psychiatry, 152 (6), 869-875.
3. Pritchett, J. T., Kellner, C. H. and Coffey, C. E. (1994). Electroconvulsive Therapy in Geriatric Neuropsychiatry. In Coffey, C. E., Cummings, J.L., (eds) Textbook of Geriatric Neuropsychiatry.
4. Rey, J. M. & Walter, G. (1997). Half a century of ECT use in young people. American Journal of Psychiatry; 154:5; 595-602.
5. Shorter, E. (1997). A history of Psychiatry: From the era of the asylum to the age of Prozac. New York: John Wiley & Sons, Inc.
6. Aly, Gotz. (1994). Pure and tainted progress. In Cleansing the Fatherland: Nazi medicine and racial hygiene. (Eds). Gotz. A., Chroust, P. & Pross, C. Baltimore MD: The Johns Hopkins Press.
7. Swartz, C. And Abrams, R. (1992). What you need to know about Electroconvulsive Therapy: A patient information pamphlet distributed as a public service by Somatics, Inc. Lake Bluff, IL: Somatics Inc.
8. Oppenheimer, P. (1996). Evil and the demonic: A new theory of monstrous behavior. New York: New York University Press.
9. Robinson, A. J. Snyder-Mackler, L. S. (1995). Clinical Electrophysiology: Electrotherapy and Electrophysiologic Testing, 2nd Edition. Baltimore: Williams & Wilkens. (See page 291).
10. Young, H., and Freedman, R. (1996). University Physics, 9th Edition. (p. 822). Reading, Massachusetts: Addison-Wesley Publishing Company, Inc.
11. Swartz, C.M. and Abrams R. (1996). ECT Instruction Manual, Sixth Edition.. Somatics Inc.
12. Cameron, D.G. (1994). ECT: Sham statistics, the myth of convulsive therapy, and the case for consumer misinformation. The Journal of Mind and Behavior, 15 (1,2) Winter, Spring 1994.
13. Abrams, R. (1997). "Electroconvulsive Therapy." In Current Psychiatric Therapy II (ed.) Dunner D. L. (p. 608-612) Philadelphia: W.B. Saunders Co.
14. Sackeim et al. (1993). Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New England Journal of Medicine, 328 (12).
15. Folkerts, H. (1996). The ictal electroencephalogram as a marker for the efficacy of ECT. European Archives of Psychiatry and Clinical Neuroscience. 246, 155-164.
16. Abrams, R. (1997). See Footnote 8.
17. Bready L. and Tyler D. (1997). Electroconvulsive therapy. In Albin, M.S. (ed). Textbook of Neuroanesthesia with Neurosurgical and Neuroscience Perspectives. NY: McGraw-Hill Co.
18. Duman, R. , Vaidya, V., Nibuya, M., Morinobu, Fitzgerald, R. (1995). Stress, antidepressant treatments, and neurotrophic factors. The Neuroscientist: 1 (6), 351-360.
19. Baciu, I. et al, (1995). The effects of electroconvulsive shock on phagocytic activity and on phagocytic response. Romanian Journal of Physiology 32 (1-4), 77-81.
20. Holaday, J. et al. (1986). Endogenous opioids and their receptors: Evidence for involvement in the postictal effects of electroconvulsive shock. In Malitz, S. And Sackeim, H. (Eds). Electroconvulsive therapy: Annals of the New York Academy of Sciences, 462, 124-139.
21. Rudorfer, MV., Henry, M. E., Sackeim, H.A. (1997) Electroconvulsive Therapy. In Tasman, A., Kay, J., and Lieberman, J.A. (Eds) Psychiatry, Vol. 2. Philadelphia: W. B. Saunders Co.
22. Swartz and Abrams (1996) See Footnote 5.
23. Adams, R. D., Victor, M, and Ropper, A. H. (1997). "Delirium and other acute confusion states." In Principles of Neurology, Sixth Edition. New York: McGraw-Hill.
24. Weiner, R. (1984). Does electroconvulsive therapy cause brain damage? The behavioral and brain sciences, (The author's response). 7, 1-53.
25. Bready and Tyler (1997). See Footnote 13.