We have a lot of respect for James Potash, a well-known researcher from Johns Hopkins who has made his career by studying the genetic basis of mood disorders and schizophrenia and possible overlaps.
So we were a little saddened to see him write this love letter to ECT, over at ABC News. We don’t doubt that ECT has helped many, many people over the years, and, that as a treatment of last resort for people with serious, chronic depression, it is relatively effective.
We’re a little concerned about his data in this article. ECT doesn’t appear to be effective in 75% of cases where it is used, from our reading of the research — its efficacy in fact varies from about 25% to 65% (see, for example, Eschweiler, et. al., 2007; Kellner, et. al. 2006; Kho, et. al., 2005). Since the article provides no citations for the figures he throws out, we don’t know where his single data point comes from. When citing efficacy figures, given the wide variability found within the literature, it is almost always preferable to cite a realistic range, not a single number.
And the lack of mention of its biggest drawback — unknown memory loss severity and duration — isn’t mentioned until you’re more than halfway into the article. Then it’s dismissed (as it usually is by the professionals advocating for more ECT usage):
The side effect of greatest concern is memory problems. In the same way that rebooting the computer can cause the loss of whatever the computer brain was working on at the time, so ECT commonly causes loss of memories around the time of the treatment. It is important to consider the context here. I have had patients tell me that this was not bothersome because they did not particularly want to recall the horrible feelings they had that led to the necessity of ECT.
In other words, memory loss is a Good Thing, according to this article, because you don’t have to remember the bad times associated with the depression. Ah, okay. Nice reframing there. Just like that lack of sexual interest with many commonly-prescribed antidepressants is also a good thing — no need to have all that sex that just reminds you of your vitality and enjoyment of life! 🙂
On the other hand, the memory problems can extend further, leaving gaps in the period up to six months before ECT and up to two months after it. This effect is more pronounced in people undergoing a form of ECT called “bilateral” ECT, in which the electricity is run through the whole brain, than in the form called “unilateral,” in which it is run only through the right side. For this reason, unilateral is the form generally used. For those who experience this memory loss, the memories generally return gradually, over a period of about six months.
I couldn’t find any research to back up this last assertion. The fact is, there are very few longitudinal studies (e.g., long-term, following up with patients years after the treatment) on ECT. And even fewer that look at cognitive deficits and memory loss (as opposed to simple symptom relapse). Some patients, in fact, never recover all of their memories — even memories that can date back to their childhood. In what little research I could find that examined long-term outcomes of ECT, it showed that if you had a deficit after ECT, it generally remained 6 months later:
After six months patients who received bilateral ECT continued to have a deficit relative to patients who received unilateral treatment on the measure of autobiographical memory (Fuller, 2005).
Back to the article…
Many patients have described how memory difficulties are a price worth paying for relief from devastating and debilitating depression.
Which is absolutely true.
But if your ECT prescribing doctor isn’t saying something to the effect of, “We’d like to try a treatment you may have heard of called ECT. One of its common side effects is memory loss. Patients often ask us, How much memory loss will I experience? How bad will it be for me? Will it eventually return? We can’t tell you how you will react to the treatment, nor answer those questions with any kind of specificity for you. You may have memory loss just surrounding the treatments. You may also have memory loss from earlier times in your life; some people have even had memory loss extending to their childhood. We cannot tell you what you will experience, other than to say that most people who go through this procedure do not have extreme or long-term memory loss.”
One study showed that either putting patients back on antidepressant medications, or continuing to do occasional ECT treatments (called “maintenance” ECT), led to two-thirds of patients staying well over the next six months. The rate of wellness over that period in patients with no treatment was only 16 percent.
Yes, which is a very sobering statistic. There is an 84% chance, according to the article, that without continued treatment after your initial round of ECT, you will relapse back into depression. Other studies have shown better effects. For instance, Birkenhäger (2004) found that after 1 year, 73% of people who had received ECT for depression relapsed — meaning 27% did not. In any case, ECT generally means more ECT for the rest of your life.
So if you’re going into an ECT treatment for the first time, print this entry out. Bring it with you to your doctor, and make sure they say something similar to the above. Because then you will know all the risks associated with this extreme treatment modality before you undergo it.
Don’t get me wrong — I know people who have successfully undergone ECT. Most say they are thankful for the option. But it is not the cure-all this article makes it out to be. It is still an extreme procedure requiring a lot of forethought prior to accepting it, and the research is far from clear as to its long-term effectiveness and efficacy.
References
Birkenhäger, T.K. (2004). One-Year Follow-Up After Successful ECT: A Naturalistic Study in Depressed Inpatients. Journal of Clinical Psychiatry, Vol 65(1), pp. 87-91.
Eschweiler, G.W. et. al. (2007). Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): A short-term randomised controlled trial in pharmaco-resistant major depression. Journal of Affective Disorders, Vol 101(1-3), pp. 149-157.
Fuller, R. (2005). Comparison of clinical and cognitive outcomes of bilateral and right unilateral ECT in community settings. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 65(7-B), 2005. pp. 3706.
Kellner, C. H. et. al. (2006). Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression. Archives of General Psychiatry, Vol 63(12), pp. 1337-1344.
Kho, K.H. et. al. (2005). Predictors for the Efficacy of Electroconvulsive Therapy: Chart Review of a Naturalistic Study. Journal of Clinical Psychiatry, Vol 66(7), pp. 894-899.
22 comments
Thank you for writing about this! As a psychiatry resident I have seen several people with chronic resistant depression doing well on ECT. Almost all of them have significant memory problems. Yes, they would still choose to have ECT in retrospect. But too many psychiatrists/researchers brush over the memory loss as something minor, something temporary or eve, as you pointed out, something Good. It is not.
I have seen pre-printed informed consent forms for ECT which make No mention at all of the memory loss. That is unethical and probably illegal, and it definitely turns trainees like me off what might well be a valid treatment option for some.
Please do what you can to make the system honest and accountable. ECT has no benefits only pain for the victim. Maybe there can be some honesty the ECT industry but then it would never happen again and the money would stop.
I am really sorry for all those people who feel they have been badly affected by ECT treatment. What should be remembered is that ECT is not the first line of treatment for people with severe depression, but usually a last resort when all else has failed and the person is very seriously ill. My own elderly mother spent six months in a psychiatric hospital, on a very high dose of antidepressants. Nothing worked for her and it was heart-breaking to see her, she wanted to die. We did not believe that she would ever be able to leave the hospital. She needed round the clock care. In desperation we agreed to try ECT treatment and after the first five treatments the results were astounding. We have our mother back. She was discharged from hospital back to her own home two years ago and lives an independent life. She is mentally very alert and she is enjoying life. I don’t regret the decision to allow ECT treatment, in fact I wish she could have had it sooner, it would have saved her months of misery and humiliation. To those people who have suffered side effects, I am truly sorry, but you also need to remember that you must have been very seriously ill, perhaps suicidal, to be given ECT treatment in the first place and there is a possibility that you would not be alive today had you not been given ECT. I wish you all well and hope for an advancement in the treatment of depression and a better understanding of this horrible, life destroying illness. Mary x
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I have seen first hand the positive effects ECT has brought to patients that are in need of an effective treatment for Depression. I don’t believe it was Dr. Potash’s intent to brush off the adverse effects that ECT can bring. He works on a specialty unit at Hopkins and sees severely sick people from all over the world. It is about weighing risks verses the benefits, and the benefits are strong when you compare devastating symptoms of depression that people endure verses temporary memory loss.
Last year (2008) I was admitted into hosptial for a major depressive disorder = A rare form or Melancholic Depression. I was trialed on various drugs and had 18 rounds of ECT (8 bilateral and 10 unilateral).
I went and saw the head Professor at the Australian Black Dog Institute. He has recently put me on one of his trials whereby I am taking Ritalin (30mg) so far I have seen an improvement in my energy and motivation levels and not as constantly down as I was when I was not on this medication.
My question is… I have been trying to find any information on if ECT has any effects on sexuality? I have always been hetrosexual! While undergoing ECT I was told (as my memory has no recollection of anything that happend while in hosptial) I became very close to another patient of the same sex. I am really worried about this as it horrifies me to think I got that close to someone of the same sex.
Could you possibly shed any light on this? It would be greatly appreciated?
I have suffered bad memory lost but I am slowly regaining some memory.
I had ECT about 4 years ago. I have a lot of memory loss, including information about my children, which is very distressing to me. I have also not been able to return to the profession I had, in part because of memory losses, as this could have serious results to the people I would be serving (health care professional).
I was never warned of serious memory loss possibilities. It was glossed over with “some memory loss around the time of ECT”. Had I known this possibility it may have changed my decision.
My depression recurred very soon after the treatments, partly due to the distress of having gone through ECT itself. I am still in disbelief that I “agreed” to it. The choice was left to me, a severly depressed person who only hoped the result of treatment would lead to death.
I know that ECT has helped a lot of people, I just hope that they are give more information as to the side effects. That way they can give a more informed consent.
And what could you do if you really want to lose all the memories of one year before? It is REALLY important! Is this possible when you are desperate and you know that THIS is the only way to survive for your child? How can you do this if you have money and you don’t know what to do? I don’t care about the consequences!
I am a scientist bipolar, who has had about 60 of these treatments. I was deeply depressed. While it cleared up much of my depression, I lost my dream job and cannot obtain a 3rd degree due to memory loss. If I had to do it again, I would not. My doc minimized the risks so I became a willing victim. ECT should be used as a last resort.
Memory loss is something hardly mentioned, and I will like to see the “peice of paper” you have to sign for consent for ects. Much more, doctors take advantion to “hit you when your down”, meaning, you are in a state of depression or otherwise– meaning it wouuld be very hard for someone to accurately make such a big decision. Any doctor that provides ects as a “second line of defense” over it being “the last line of defense” should be open to malpractice. But, this is a slipery slope, and quite smart of those ect doctors. I’m guessing that docs can “bank on” never getting sued, because, afterall, we’ve lost our memory. Therefore, how could we ever make a coherent arguement in court?! –quite genious of them, don’t you think? Further more, ect equipment (both procucing and selling) is a fairly “cornered” market. It has come ot my attention that Dr.Charles Kellner previously (still?) had major shares in a company that makes ect equipment. So, let’s review. Ects require a short letter of consent when a patient is not in a coherent state of mind. Due to loss of memory, no patient can win a case in court, and doctors have a large incentive to administer ects because they are incredibly lucrative. So bravo, charles kellner, you’ve found a great way to make money!!
It’s so distressing to see the impact of memory loss swept under the rug as long as it’s for the ‘better good’. I’ve had ECT. I know what it feels like. We’re intelligent adults, so let’s cut the façade. ECT can and often does cause cognitive deficits. I’m not the same person I was pre-ECT.
Please don’t discount the effects of this life altering procedure.
I had 8 treatments of ECT back in December, 2004. I was a Special Education Teacher before this, but had been on medical leave for several months prior to my ECT treatments. I suffer (note the present tense of the word ‘suffer’) from Severe Chronic PTSD, and my psychiatrist had been trying a myriad of medications in varying combinations with other medications with absolutely no effect whatsoever. I told him from the start that I would never go through ECT because my father had gone through it many times in the 60’s, and it never appeared to me, as a child, that it did anything but make matters worse. My psychiatrist had been working with me for approximately 18 months by that time, and I knew he was frustrated by my lack of any noticeable progress at all. Finally, he spent a lot of time with me, trying to get me to change my mind about having ECT. I must admit that even I was desperate, hopeless, suicidal and simply didn’t have the strength to oppose this anymore. I have never been SO SORRY in my life that I agreed to this. Yes, it was used as a ‘last resort’ treatment, and I have no ill wishes concerning my psychiatrist, but the LONG TERM EFFECTS OF ECT for me have been so debilitating that I want now, more than ever, to die! I used to be extremely intelligent, could spell any word given to me, read voraciously (one or two novels per week), was very creative, loved solving logic puzzles/crosswords, could juggle 5 or 6 groups of learning disabled children at one time, had wonderful insight into these children and their specific needs, was also an excellent Examiner, and kept impeccable records. When I was asked to consent to this procedure I was told that there might be a LITTLE retrograde memory loss, but it would return in about two weeks. I signed consent and underwent the procedures. First of all, I experienced SEVERE retrograde memory loss (people coming up to me in public, obviously knowing me very well and talking to me as if we were best friends. It wasn’t that I had forgotten their names. I had forgotten THEM completely. I had no idea who they were, where I might have seen them, or in what context I had seen or known them. I later found out that several of these people were currently paraprofessionals for me and had worked with me for three or four years; some of them were people I had worked with for 16 years; some of them were actually “close friends” of mine; some of them were the parents of the students I was presently working with for the past 4 years and had developed a very close, professional relationship with, etc. None of these people, NOT ONE, has EVER been recovered in my memory. I recently attended a funeral where I saw someone I had known for over 20 years and mistook her for someone else. I was talking about our relationship, and she just kept looking at me and saying she was sure she didn’t have any idea what I was talking about. Eventually, someone next to me whispered her name to me. I was embarrassed beyond words, ashamed of myself, and felt so incredibly stupid that I still have not gotten over this horrible mistake! That was about 6 weeks ago and was the first time I had ever approached anyone in public first, since my ECT treatments in 2004. So, I lost many, many, many memories (of course none of the horrible ones) and have never, in the past six years, recovered any of them! I also now suffer from extreme short-term memory loss; forgetting only seconds after I have heard or said something that I ever said or heard that info at all; am constantly being informed that I have been told something several times but have no memory of it whatsoever; frequently forget what I am talking about right in the middle of a sentence and have to ask the person to whom I am talking to remind me what we were talking about, and even then, am usually unable to come up with what I was going to say; become disoriented fairly often, not having any idea where I am inside my own house, have gone into a specific room but am unable to recall why I went there; having no idea what street I am on or where I was trying to drive to in the first place as suddenly nothing around me looks at all familiar, even though I have driven that same route over 500 times; am unable to concentrate or focus on anything; have not been able to read even ONE book in six years; am unable to spell many simple words (which is why I keep a dictionary on my desktop at all times) and am very, very thankful for ‘spellcheck’ (especially the ones that come up with lots of different suggestions as to what you might be trying to spell) or come up with a word that I know I know but have lost; obviously, a Thesaurus has become my best friend (I keep a list of words that I often use but cannot ever remember (once I have figured out what they are), so that it is easier for me to find the word I am looking for. I am not kidding when I say that I CAN TELL that I have lost a MINIMUM of 40 IQ points; I am unable to recall even the simplest of information; figure out the simplest of puzzles; have any idea what my grown nieces and nephews are talking about during a conversation (and am able to see it in their faces just how out-of-it I am; am completely unable to participate in a conversation involving more than one person or I become totally lost; find it so very frustrating that I must read a paragraph of information over and over again until I finally, ‘sort of’ understand it; am unable to help my very learning disabled, language disordered son in college because I no longer remember the rules for punctuation, paragraphing, themes, styles, etc.; must record anything I have any intention of watching so that I can continuously play it back as many times as necessary in order to understand the juncture that just took place, and so on! As far as I’m concerned, I suffered severe brain damage during my ECT treatments and would absolutely NEVER undergo this procedure again, and have made it clear to everyone I know just how dangerous it is! ECT has ruined my life! I can barely function anymore. I am socially inept, so I keep myself isolated as much as possible so as not to continually embarrass myself! ECT took away from me so many parts of years of past memory that I feel LOST as an individual and has damaged my brain to such an extent that I am completely unable to work any job at all because I am unable to remember from one minute to the next what it is/was I was supposed to be doing! I have been to three rehabs for my severe PTSD and Major Depressive Disorder with no improvement at all. I continue to attend therapy twice a week but to no avail. I was not only not helped by ECT. I believe it “stuck” me in the same frame of mind I was in when I agreed to this horrific procedure! I am 50 years old and have been disabled since I was 44. My fixed income doesn’t come close to covering my financial responsibilities, so I have had (for the first time since I was 17 years old) go to my mom and ask for help! I want nothing more than to die! If I experienced suicidal ideation on occasion BEFORE ECT, my suicidal ideation has increased to almost a minutely basis. The only reason I am still here to write this note is because I try desperately, every day, to fight this urge so that I won’t hurt my two sons! They are the ONLY reason I am still alive, but how long I can keep up this charade, I don’t know! ECT is SO dangerous! It should be taken off the market as even a POSSIBILITY for easing depression!!!!!! The after-effects are so devastating as to be SUICIDE-INDUCED therapy!!!!
I see that your comment is from a while ago, just wondering how your going if you are still alive. Before I die I want to do something to protect others from ECT, it is evil. I do hope that you can make it for your sons, I know exactly what you mean when you say you want to die because of it. I truly would like for you to find a way to get at least some life back but from my experience I sadly do not in all honesty see that happening. Kindest wishes my fellow victim/survivor.
@rita…Okay, I acknowledge your experience with ECT as being negative, but your writing skills seem pretty intact to me. Which, in my opinion, puts you STILL ahead of 90% of the public at large. If your two sons are the only reason you are still alive, but you fight every day not to harm them or yourself, YOU NEED HELP. You’re hysterical and suicidal/homicidal. Get off the computer and check yourself in somewhere! Pronto! Otherwise, for everyone else (yes I have had ECT, in case anyone is wondering “well who is she to tell…” ) THIS issue is an EXCELLENT example of how important it is to EDUCATE YOURSELVES, and be your own ADVOCATE!!!!!! If you do not have the faculties to research a treatment or speak for yourself, sign a Mental Health Directive for someone you trust to speak for you! Educate THEM as well. It baffles me that people agree to treatments, medications, etc. and then fall apart because of the side effects when they could/should have done their homework. Blind faith, even in doctors, scientists, etc. is DANGEROUS. Throwing up your arms and saying “Okay, just do it.” is ignorant. I wholeheartedly agree that the glossing over of the memory side effects in the vague consents is morally and ethically wrong on all kinds of levels. BUT, there is no magic treatment/pill people! It doesn’t matter what we do, we are not always going to be the same forever and ever. The human body and mind are constantly changing with age, etc. If anybody knows that, we (the suffering) do! It’s a chance you take out of desperation. I am about to take that chance out of desperation again in 2.5 hours today, committing myself to inpatient because I myself want to die. BUT. I research things, keep myself aware of new developments in the field, SPEAK OUT. If you don’t, who will??? I DO NOT, blindly sumbit myself to the mercy of an M.D. I have a say. I want documentation. And like I said, if you don’t have the energy or where with all to make these decisions, appoint a mental health care advocate for yourself. Just as you would an advance directive for health care…here’s a link.
http://www.dshs.wa.gov/mentalhealth/advdirectives.shtml
AND, someone couldn’t pursue a THIRD (!!!!!) degree because of ECT??? DAmn! I couldn’t pursue 1 single degree that I have wanted nothing more than anything I have ever wanted in my whole life. I’m sorry, but BOO freakin HOO. My point is COUNT YOUR BLESSINGS, WHAT EVER THEY MAY BE. There is MORE to life than being some super genius. Find NEW things that bring you peace and happiness. I am getting help because I KNOW my life is not over. It may not be what it was, but I will make do the best I can with what I’ve got. I’m not giving in. I’m not throwing in the towel. I won’t stop. I’m not going to submit that “I’m a victim” thinking, and drown in what could have/might have been had X not happened. I’m looking forward and making the best of it. All of you should too.
Thank you. Wonderful response.
I had ECT just over 12 mths ago now, it has utterly destroyed my life on every level. I will suicide because of it, I am trying to plan it out right now, hell can be no worse than what life is like after ECT. The thing that is really upsetting I guess is that people are deceived into ECT, when you are involuntary at a psych. unit and never known what ect is how could you do any research and in my case I would have agreed to euthanasia anyway, wish that is what I had had done, now I got to work out how I going to finish the job, yes it makes you that dumb that you can no longer even work that out, I mean how to kill yourself. In any case if you don’t go along with it they can do it to you anyway, they just give you extra because your “not compliant”. I never attempted suicide until after I had ECT (yes thought about it, yes taken a pathetic OD of relatively harmless prescription medication (or so I am told, as I can not remember hardly any of the last five or more years and my memories back my whole lot are either gone or only seem like something I saw on tv) but never actually attempted it for real I was just to chicken) and have since tried to hang myself twice, gas myself with my car and over dose using 120 tablets of paracetamol (35-40 should have done it, but I got found and revived). In effect ECT for me was Euthanasia the slow and painful way. My experience of it is that you are much, much better off to suicide than even consider ect. At least if suicide goes right the pain stops, that’s all I want. It really is that bad. You may think your depressed prior, but I can assure you that you can not even imagine how much worse it will be post ECT. Once you have had ect you will find out what it is like to to be genuinely in pain, you will have every problem you have prior to it plus all the ECT induced brain deficits so you will never, never be able to even have a chance to resolve your nightmare, you will be in agony till the day you die. The only bonus I see is that it is so bad there will be no more fear of making your situation any worse, it just can not get worse than having to live in an ECT fried brain – Hell.
I had ECT treatments 1 year after my son died of suicide. I should never of been given these treatments. It was GRIEF that caused my major.depressive .disorder and PTSD. My memory is horrible, and the psychiatrists all claim its due to depression. I will never.do them again. I remember going to a hospital by ambulance and waking up one day in a different hospital
Who signed for me to have.these.txs I do not know. I know I wasn’t in any way, shape or form capable of agreeing to them. 9 years later I still don’t remember. I have trouble remembering recent events and names. I feel so stupid when someone tells me things I should know. I repeat myself constantly. I worked as a medical assistant and tried to retirn to work, but had to give myself notes and couldn’t remember intricate parts of my job. I can’t be a medical lrofessional and forget things.
I’m a journalism professor and journalist.
I have lost my ability to write well.
I have lost my ability to spell well.
I have an incredibly difficult time remembering people’s names.
I get lost when I’m within four blocks of my home when all I have to do is look up and see a high rise landmark.
I have lost my ability to teach well.
My thought process is significantly clouded.
I forget movies and books just hours or days after finishing one.
I am angry, sad and will likely be unemployed before too long.
To go from expert status to bumbling status has only added to my serious depression.
My god, how could I have made such a bad decision?
If I was a physician, I would no longer be able to practice medicine.
A heartbreaking mistake on my part. I was given ECT 11 times by a flippant, arrogant, cock-sure doctor who runs head shock mill and enriches himself by doing so told me memory was a minor medical issue.
I’d rather have both my legs cut.
My ability to think at a medium-high level has been reduced to a poor level.
Nobody should undergo this procedure. No one.
I have not had ECT,. I was fortunate enough to get through a psychotic depressive episode with antidepressants. My mother on the other hand was not so fortunate and needed Ect with her psychotic melancholia. It was nothing short of a miracle. I think it works best for severe biological depression rather than the reactive types. Also memory loss occurs in such illnesses regardless of Ect. The depression itself causes a dumbing down of sorts for some time. I think with time yhe cognitive effects should improve.
I have had 8 ECT treatments so far, I am scheduled to have 12. Memory loss was discussed at length by the 4 Dr’s I consulted with. My wife was at all 4 of the required consultations as well. My consent form has all the known side effects listed in detail. The memory issues have been minor, muscle aches have been more bothersome. The treatments have made a big improvement, I was running out of options and I’m glad it was available.