Doctor "Shock" Talks about Electroconvulsive Therapy

Merely Me Health Guide


    Electroconvulsive therapy or ECT has been around for some time.  It was introduced to psychiatry in the 1930's and gained much popularity in the 40's and 50's.  What is ECT?  The simplest definition is that this treatment uses electricity to induce seizures for the purpose of a therapeutic effect.  Electroconvulsive therapy has been used in the treatment of the mania most often present in bipolar disorder and has also been used for treating schizophrenia.  But predominantly it has been used as a method to help those who suffer from major depressive disorder when other treatments including antidepressants do not work. 

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    There are many who may have a negative view of this type of therapy gleaned from abuses highlighted in films such as One Flew over the Cuckoo's Nest where electric shock therapy was given to patients without their consent.  This scenario was once not so far from the truth, as in the case of my mother, who suffers from schizophrenia.  She described being involuntarily shocked and without any anesthesia back in the fifties.  She also reported to me that she lost some of her memory due to this treatment.  So has ECT changed over the decades?


    As a partially objective observer (I have not had this treatment myself) I would say the answer is a cautious yes.  Many people all over the world, an estimated one million people worldwide, voluntarily receive this type of treatment each year.  Some of these people include the rich and famous such as Carrie Fisher. In this article, Fisher discusses how she underwent electro shock therapy as treatment for her bipolar disorder and how she loved it at first, except for the part about losing some of her memory.  Clearly this type of therapy is not without risks.


    Despite the fact that some psychiatrists and patients believe that ECT is a safe and effective method of treatment for mental illness including major depression, it is still considered to be a controversial way to help those who suffer from depression or other mental disorders. 


    In order to gain some greater insight about this particular method of treatment, I have enlisted the aid of a fellow blogger who is known to his blog audience as "Doctor Shock."  I do hope that the following interview will shed some new light into what is known as electroconvulsive or electric shock therapy.  Doctor Shock will also discuss his general thoughts about depression as well as why he enjoys being a psychiatrist.


    I now present to you Doctor Shock.


    Name: Walter van den Broek

    Type of Therapist: Psychiatrist

    Type of Therapy: Supportive Psychotherapy

    Blog Name:  Dr. Shock, MD, PhD

    Blog Name and link: Dr Shock MD, PhD   


    Can you tell us more about how you chose the name Dr. Shock for your blog persona?


    Doctor Shock is a nickname given to my by our residents. One of the pleasures of working in a University Hospital is educating students and residents. Their use of this nickname is an insider's term of affection mostly used when being together at parties, dinners and discussing psychiatric problems such as indications for electroconvulsive therapy.


    My mother had electroshock therapy over 40 years ago and she did lose some of her memory.  How has ECT changed over the years?  What are the biggest risks?


    ECT has changed a lot since then. Most of all the use of general anesthesia has improved the procedure and lessened side effects. Also the research resulting in better ECT machines contributed to making ECT one of the safest treatments for severely depressed patients.


    The purpose of ECT is to elicit a general seizure. During the seizure blood pressure and heart frequency can increase for a short period (30-60 seconds). Patients with a recent myocard infarction (heart attack) or cerebrovascular accident (stroke) are at risk, recent being 4-6 weeks in the case of myocardial infarction and 3 months for CVA.

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    What sorts of patients are good candidates for Electroshock Therapy and which patients are not good candidates?


     Patients with a severe depressive disorder especially with psychotic features are good candidates for ECT. Also those with antidepressant treatment failure for their depression can benefit from ECT as well as patients that had good outcome on ECT before during a previous depressive episode. Other less frequent indications are Schizophrenia with positive symptoms (hallucinations and delusions) not responding to several antipsychotics or mania not responding to mood stabilizers. ECT is not useful for personality disorders, drug dependency.


    What can one expect from ECT? 


     It is one of the safest and most efficacious treatments in psychiatry when needed. ECT is given in a cure mostly thrice or twice a week on average a total of 12 treatments with a wide range. Some patients only need a few others between 10 and 20 treatments. This means general anesthesia for treatment during 10 to 15 minutes for a treatment. After ECT treatment with antidepressants is needed to prevent relapse.


    It also has side effects. Some patients can suffer from retrogradeamnesia. Retrograde amnesia is the loss of recent memories. Some of the patients are sometimes unable to recall events prior to a treatment. It doesn't affect long-term memory. Some patients develop anterograde amnesia during a cure. They are unable to form new memories. This disappears after three to four weeks after ECT has finished. ECT doesn't have an influence on other cognitive functions; it doesn't change your personality.


    Does insurance pay for this type of treatment?


     In The Netherlands that is not a problem. We have a different insurance system than the US or UK.


    What sorts of conventional treatments would you recommend for treating depression?


     Depends on the type of depression and co morbidity. Most important is a good working alliance with the patient. Exercise, light therapy, psychotherapy and antidepressants or combinations of these treatments can be of help.


    In your opinion, what is the best anti-depressant for the treatment of depression?


    Imipramine, but since we work in a tertiary psychiatric center most of our patients did not respond to more usual treatments.


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    Do you believe that depression is something which can be cured?


     Not always but most of the time.


    You seem to have a fondness for chocolate from what I have read from your blog.  What is your favorite kind of chocolate and do you think chocolate can induce happiness?


    Dark chocolate is my favorite and alas chocolate is not an antidepressant but maybe it can be of help for prevention of cardiovascular diseases. Wrote an awful lot on that topic on my blog.


    What is the best thing about your job?


    Speaking with patients as being a psychiatrist. I can survive many boring endless meetings and bureaucratic procedures with the knowledge that I will be working with patients.


    What is your best advice for someone who suffers from depression?


    Get help. Don't be discouraged when a treatment does not work immediately, go back to your physician and discuss the options.


    Last thoughts?


    A lot of new forms of treatment for depression are being developed, different forms of neurostimulation. Neuroscience is improving our knowledge about mood and mood disorders. This makes me hopeful for the future treatment of depression.



Published On: December 15, 2008