I will be teaching on depression (types, causes, treatments) and despair in class today. In light of that I want to highlight two medical treatments that try to shock the brain into a better mood state. Will follow with more posts on depression through the week.
ECT.Electroconvulsive therapy has been around since 1938. Psychiatrists found that inducing the brain into a seizure led to patients feeling better (they also tried hypothermia and water blasts to no avail). The practice is no longer barbaric. Patients are given a drug that suppresses the violent muscle contractions and limits the seizure’s physical impact. Today’s ECT is given only to the most treatment resistant clientele (when all else has failed and the client is suicidal or unable to function) and supposedly has few negative side effects. ECT is given about a dozen times over the course of several weeks. Does it work? Mostly yes, and better than most antidepressants. Positive response rates of over 70% suggest it is very effective. Relapse rates may be somewhere between 30 and 50 percent suggestive and while that sounds bad, it is much lower than the 70 percent relapse rate for no treatment. So, it works, maybe not as long as it should. But are there side effects. Yes, certain memory deficits are often present–holes in affect-laden autobiographical data. This is definitely not true for all but I have witnessed clients with small deficits (e.g., can’t remember sister’s wedding). Such holes can be very painful for many who feel robbed of pieces of their history. Memory problems seem greater in female and older clients and for those who have bilateral seizures (opposed to unilateral). For those whose lives depend on a better treatment, ECT provides a way of escape. If you are interested in research on ECT, check out this article:
McElhiney et al. (1995). Autobiographical memory and mood: Effects of ECT. Neuropsychology, 9, 501-517.
VNS. Vagus Nerve Stimulation. This is a procedure where a device is implanted that sends electrical impulses to the vagus nerve in the neck. Its a form of long-term electrical stimulation. It was approved by the FDA for treatment resistant depression in 2005. The research is still out on this form of treatment. Clearly, some do get better. It may be a less effective form of depression treatment without the memory problems of ECT.
Musings on Faith and Psychology 
Hi Phil, interesting blog!
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for myself, personally i find the stigma of surgical procedures in treating depression to be the biggest pitfall.. I’ve got to admit i’ve never had ect or vns for my manic depression – but it does terrify me that, if at some point in the distant future if i don’t have remission it could become an option.
How i feel at the moment is that i wouldn’t undergo a surgical procedure. Mostly because i’m not sure i could handle the concept of my self-integrity being challenged so much i.e: ‘i’m so insane i need to have an operation to make me well’.
it’s a cowardly way of looking at it i guess. I’d be interested to hear if counselling would be a major part of the lead-up and post-op? One thing i have noticed in the Uk that just being admitted into hospital can be strangely bereft of after-care. These are challenging concepts and experiences for an individual, especially ppl suffering from mood disorders.
I knew someone who had epilepsy who had a VNS implant. The major side effect was that every 5 minutes his voice would go hoarse for a minute as the electrical stimulation occurred. I’m curious how that might affect someone with depression. They might avoid talking for fear of having to explain why their voice goes hoarse. But I don’t know if that is a side effect for all people.
Ian, thanks for sharing your honest struggles. It would make sense to address stigma prior to doing either ECT or VNS (thanks Curtis for sharing that problem–I was unaware). However, I imagine most work would actually be done postop. ECT is rarely done unless one is facing life threatening consequences from the depression. In that case, I imagine it is hard to do much pre-op counseling since the person isn’t likely to be in good shape at the time.
Cowardly? I don’t think taking such procedures seriously would be cowardly. Stigma is huge here, huh. If you had a brain tumor pressing on an area that created confusion, you wouldn’t likely think less of yourself if you had surgery. But, because there is no obvious, structural problem, then we think less of ourselves.
Phil, Thanks for a neat summary of the two ‘shock treatments’. My late aunt suffered those memory gaps after ECT – and I went on to major in psychology. I feel we somehow need to access thinking and replace thought patterns and habits rather like computer programming. The practice of mantra-like thought can be very helpful, as in prayer. Geoff.
Hi Phil, I live in Perth, Western Australia. I found your site by typing into the search engine “walking with God through mental illness”. This particular post I really attatched to. I received 20 ECT’s last year over a 6 week period. Did it do anything? Absolutely not. Did it affect my memory? More so than I was ever told. Would I have it done knowing this now? Probably because I needed and still need help, I kew of a lady who it had been very successful. Nothing worked, I had been through so much for 11 years and nothing worked. ECT was as I was told the last hope. Well it didnt work and I guess my last hope was gone. Not long after I had an EEG done which showed I had Temporal Lobe Epilepsy. I moved suburbs which moved my psychiatrist and I ended up with one who seemed to know what he was doing. The neurologist didnt help me at all but the psychiatrist did. He also cut out all the labels/diagnosis I had received over the last 11 years and believe me it was a huge list, he cut it down to two…TLE being the obvious because of two EEG’s (I had another done at the neuro’s request which ended up with exactly the same result) and Bi Polar 2 which my GP had been questioning for two years. I was put onto medications that started to work a little, no huge changes or benefits but enough to keep going on them. I was “cold turkeyed” off those meds 6 weeks ago because I found out I was pregnant and this was a big no with these meds I was on. I was put in touch with the Head of the Psychiatric unit at KEMH, a hospital for women because he was well practised in this field. He told me if need be I can return to the medicaiton after I hit the 12 week mark in my pregnancy but if I could cope off the medication that would be alot better. Well I am now one day off being 13 weeks pregnant and I am seeing him this week. I am not coping, not doing well and yet I do not want to go back on the medication. I may have already seriously harmed my child and that was unknowingly, going back onto the medication then I would knowingly be causing such a huge risk to my child. Life is really really hard. My husband is worn out completely. My two children (5.5yrs and 21 months) are greatly affected and our lives are so out of whack it isnt funny. My husband was our full time carer for the last year and a half but last week he started studying. it is a full time three year advanced diploma. My oldest son has started full time school this year. I am a mess, I am not coping but I have no other choice. I can not ask my husband to come home even though inside I desperately want to but to do this would ruin him. I have been a Christian for around three-four years now but I am not strong in my faith. I have had many upsets in these last few years to really rock my faith. We do not have the money to get appropriate help for me day to day. We do not have the money for me to help through a Christian ministry. Have I lost hope? Honestly, yeah pretty much. Why am I writing this to you? I dont know, I really do not know. I just felt I needed to. Am I scared? More than anyone could know. Am I broken? Yes. Where do I go from here? I can not answer that one. People are always telling me I am intelligent and very “smart”, that I will have a great ministry one day, that God has great plans for me, that I will get through this… Nearly 28 years of age and still no direction ahead. Many many people have told me to “just do it”, “suck it up and get things done”. Have I tried this? Yes and it hasnt worked. Is there an end to this? I hope so, i really do hope so.
Thankyou for your time and thankyou for your site. If you deem this inappropriate to have here, I understand and am ok with you not putting it up. I do not want to harm anyone in anyway, I really dont want to do that.
Sharlene,
Thanks for sharing some of your experiences. I wish I had a magic wand… There are some new ideas about vagus nerve stimulation but these are pretty experimental. Your search engine entry, “Walking with God through mental illness” is key. What does it mean to walk with him when nothing seems to work and everything seems to be bleak. How do you benefit even when the mood doesn’t change? As Ed Welch says in his Depression book, you are a hero to keep fighting each day.