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|Posted by (Service User Network) Sun Cornwall & Plymouth on 27 November, 2011 at 17:25|
... Should we STILL be using electric shock therapy for depression?
By Pat Hagan
Last updated at 1:53 AM on 1st February 2011
When Gabrielle Blackman-Sheppard told family and friends she was to have electro-convulsive therapy (ECT) for her severe depression, they were horrified.
‘The image they all had was of someone being forcibly strapped into an electric chair,’ recalls Gabrielle, who has suffered from bipolar disorder, previously known as manic depression, for nearly 30 years.
‘Many people still see it as a form of torture. But I was desperate. I was more terrified of not having it because, at the time, I was spending every second of my life fighting the urge to kill myself.’
Shocking: Jack Nicholson's character, McMurphy, being given ECT in the 1975 film One Flew Over the Cuckoo's Nest
Doctors had tried numerous drug combinations to try to get her condition under control, but with no success.
As she became increasingly suicidal, they suggested ECT as a last resort.
‘After the first ECT treatment in 2008, I immediately felt better,’ says the 60-year-old from Wolverhampton. ‘It was like my brain had been put back on its rails.
‘I had greater clarity of thought, my speech, which had become slurred, was a lot clearer, and I was able to read again. Before, I was so ill I couldn’t concentrate on the words on the page.’
Over the next year she was to undergo 23 treatments in all, with similar benefits.
It might surprise many people to learn that ECT is still being used to treat depression.
NICE, the Government’s health watchdog, has judged it suitable for use in severe depression, and every year around 12,000 Britons undergo the treatment.
Among those ECT has helped is former Coronation Street actress Beverley Callard, who played barmaid Liz McDonald.
Last year, she spoke of how ECT helped put her on the road to recovery after a severe bout of depression.
ECT first emerged in the 1930s after doctors noticed patients with epilepsy often felt happier after a fit.
It was thought that the electrical ‘storm’ in the brain that caused seizures also boosted mood.
During treatment, the patient is put under anaesthetic and given a muscle relaxant to reduce the risk of serious injury when they go into spasm.
Electrodes are placed either side of the forehead and a current is passed between them.
This triggers a seizure lasting between 20 and 50 seconds and a single course of treatment can involve up to 12 sessions, spread out over several weeks.
Cure for depression? ECT first emerged as a solution to epilepsy in the 1930s. Doctors found seizures also boosted the mood of depressed patients
Eighty years on, there is still no conclusive rationale for why zapping the brain with bursts of electricity should work.
Some studies suggest it may stimulate the release of ‘feel-good’ chemicals in the brain, or promote the growth of new blood vessels.
It could also be that it has a placebo effect — the benefits being due to the extra attention patients get when they receive treatment.
Typically, ECT sessions can involve two or three nurses, a psychiatrist and an anaesthetist.
Whatever the explanation, there remains ‘a lot of stigma and myth attached to the treatment’, says Dr Susan Benbow, from the Royal College of Psychiatrists.
And now, following a major review of the evidence that suggested it has little or no benefit for most people, there are calls for the treatment to be banned.
Furthermore, the review found that ECT damages the brain’s ability to function properly, including wiping large chunks of patients’ memories.
The review, by psychologists Professor Richard Bentall, from Bangor University in Wales, and Professor John Read, of Auckland University in New Zealand, pooled the results of dozens of earlier studies into ECT for depression and schizophrenia.
They claim that while some patients, like Gabrielle, may feel an immediate benefit, this is short-lived.
There is no evidence, the psychologists argue, that ECT reduces overall suicide rates in the deeply depressed.
Now the British Psychological Society wants an end to the use of what it describes as an ‘inhumane and degrading’ treatment.
Professor Peter Kinderman, a leading light in the organisation, says: ‘There is a myth that ECT is reserved purely for psychiatric emergencies.’ In fact, he says, ‘it is quite a common practice’.
Consultant clinical psychologist Lucy Johnstone adds: ‘There is no known mechanism by which ECT acts on depression, and little evidence that it is effective beyond the first four weeks.
‘And my own research shows that a third of patients find it distressing and upsetting.
Many feel like they have been abused.’ The support group ECT Anonymous says patients often report major changes in personality aft er treatment.
Among those ECT has helped is former Coronation Street actress Beverley Callard, who played barmaid Liz McDonald
‘One person had lost the ability to tell the time, and another, a teacher, could no longer do joined-up handwriting,’ says spokesman Una Parker, who suffered memory loss herself after having ECT in the early 1970s.
The latest controversy highlights deep divisions within mental health about what causes conditions like depression and how they should be treated.
Psychiatry subscribes to the view that depression is largely due to a biological mechanism, such as a chemical imbalance in the brain.
Treatments such as drugs or ECT are designed to restore the balance.
Psychologists, on the other hand, mostly hold the view that depression is due to nurture rather than nature.
In other words, in most people the illness stems from some form of early psychological trauma and, with proper counselling and nursing care, patients can recover without medical intervention.
But as Dr Benbow points out, the treatment has been assessed by NICE to be effective.
‘Depression can be a life-threatening condition, and there is good long-term evidence to support the use of ECT.
‘Patients are warned there may be long-term effects on memory, but usually they are so ill that it’s a trade-off between the risks and the benefits.’
Gabrielle Blackman-Sheppard, who has written a book documenting her battle with mental illness, admits the therapy has robbed her of memories.
‘There is a five or six-year gap in my memory. Occasionally I’ll meet people who know me — but I have no idea who they are.’
But she remains convinced that ECT saved her life. After treatment, she began to respond to antidepressant drugs that had previously had no effect on her.
‘ECT was the turning point.’
Bi-Polar Girl — An Irreverent Look at Bipolar Disorder by Gabrielle Blackman-Sheppard (Crown House, £12.99)