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The pros and cons of ECT: electroconvulsive therapy

Electroconvulsive therapy (ECT), typically the treatment of last resort, can ease depression when nothing else has worked. But, some people who have experienced it have suffered significant memory loss and cognitive difficulties. If you’re considering the treatment for yourself or a loved one, here’s what you should know.

ECT is considered a highly effective treatment for depression, when medication and psychotherapy aren’t working to relieve severe symptoms such as psychosis or thoughts of suicide. It may also be considered for those who cannot take antidepressant medications.

Its effectiveness in treating severe mental illnesses is recognized by the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health, the Food and Drug Administration and the US Surgeon General’s office.

ECT, says the American Psychiatric Association, produces a substantial improvement in at least 80 percent of patients. It also helps patients who suffer with most forms of mania, some forms of schizophrenia, bipolar disorder, Parkinson’s disease and other disorders.

How does ECT work?
A course of treatment with ECT usually consists of six to twelve treatments given three times a week. The patient is given general anesthesia and a muscle relaxant, then the patient’s brain is stimulated by electrodes placed at precise locations on their head with a brief, controlled series of electrical pulses.

This causes a seizure within the brain, which lasts about a minute. The muscle relaxants and anesthesia prevent the patient’s body from convulsing and the patient feels no pain. The patient awakens after five to ten minutes.

The brain functions through complex electrochemical processes, which may be impaired by certain types of mental illnesses. Scientists believe ECT acts by temporarily altering some of these processes.

Are there after-effects?
Many doctors assert that the treatment can cause short-term memory loss, with less loss occurring with unilateral ECT (where only one side of the head is stimulated electrically) and more with bilateral ECT.
But many people who have received the treatment say their memory loss was long-term, possibly permanent, that many memories were wiped out and that job skills had to be relearned.

In June, 2005, a South Carolina woman became the first survivor of electroconvulsive therapy to win a lawsuit with a large money judgment in compensation for extensive permanent amnesia and cognitive disability caused by the procedure.

Some medical practitioners argue that when someone has received ECT and subsequently experiences memory loss, it is difficult to determine whether the memory loss has been caused by the ECT, or is a side effect of their disorder or medications they may be taking following the ECT. It’s true that depression and bipolar disorder can cause memory loss and cognitive difficulties, and so can many of the medications prescribed for these disorders.

Mental Health America, the country’s oldest and largest nonprofit mental health organization, recommends that ECT be presented as an alternative with extreme caution, only after all other treatment approaches, such as medication and psychotherapy, have either failed or have been seriously and thoroughly evaluated and rejected.

Some people who have experienced ECT say it saved their lives; others say they were irreparably harmed by the procedure.

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